不同临床亚型失眠患者的心理影响因素特点

目的：探讨不同临床亚型失眠患者的心理影响因素特点，为精准简化失眠认知行为疗法提供依据。 方法：方便取样于2014年11月至2017年6月在湖南两所综合医院临床心理科或睡眠科门诊就诊的212名失眠患者，并 将其分为入睡困难型、睡眠维持困难型、早醒型、混合型4种临床亚型。采用压力下失眠反应量表、简易应对方式问 卷、简化版睡眠相关不良信念和态度量表、睡眠相关行为问卷、睡前觉醒量表、流调中心抑郁量表、贝克焦虑量表 对患者失眠心理影响因素进行调查并比较。结果：入睡困难型和混合型失眠患者睡眠安全行为使用频率高于睡眠维 持困难型，混合型失眠患者睡眠安全行为使用频率高于早醒型(均P<0.05)。入睡困难型和混合型失眠患者睡前认知觉 醒水平高于睡眠维持困难型和早醒型(均P<0.05)。混合型失眠患者知觉失眠造成的影响和对失眠的担忧多于睡眠维持 困难型，对睡眠期待高于入睡困难型(均P<0.05)。结论：不同临床亚型失眠患者的心理影响因素特点不同，失眠认知 行为疗法(cognitive behavioral therapy for insomnia，CBT-I)精准简化应同时考虑临床亚型和心理影响因素的特点。

Psychological characteristics in different clinical subgroups of insomniacs

Objective: To investigate psychological characteristics in diff erent clinical subgroups of insomniacs, and to provide the basis for the accurate simplifi cation of cognitive behavioral therapy for insomnia. Methods: A total of 212 insomniacs from November 2014 to June 2017 in Clinical Psychology Department or Sleep Department of 2 general hospitals in Hunan Province were included in convenient and classifi ed into sleep onset insomnia (SOI), diffi culty maintaining insomnia (DMI), early morning awakening insomnia (EMAI), and combined insomnia (CI) subgroups. Ford Insomnia Response to Stress Test (FIRST), Simplified Coping Style Questionnaire (SCSQ), Dysfunctional Beliefs and Attitudes about Sleep Scale 16 version (DBAS-16), Sleep-Related Behavior Questionnaire (SRBQ), Pre-sleep Arousal Scale (PSAS), Center for Epidemiological Studies Depression Scale (CES-D), Beck Anxiety Inventory (BAI) were used to investigate the psychological characteristics. Results: SOI and CI insomniacs had a higher frequency in use of sleep-related behavior than those with DMI; CI had a higher frequency in use of sleep-related behavior than those with EMAI (all P<0.05). Both SOI and CI insomniacs had a higher level of pre-sleep cognitive arousal than DMI and EMAI (all P<0.05). CI insomniacs noticed more consequences of insomnia and had more worries on insomnia than DMI, and CI insomniacs had more expectations of sleep than SOI (all P<0.05). Conclusion: Insomniacs with different clinical subgroups have different features of psychological characteristics. Both the insomnia subgroups and the psychological characteristics should be taken into account when we simplify cognitive behavioral therapy for insomnia (CBT-I) precisely.