认知行为治疗对强直性脊柱炎患者睡眠障碍的影响

目的探讨认知行为治疗（CBT）对改善强直性脊柱炎（AS）患者睡眠障碍的疗效。方法将81例As合并失眠患者按随机数字表法分为认知行为治疗组（41例）和对照组（40例）。2组患者均接受正规的抗风湿治疗（根据病情选用非甾类抗炎药、柳氮磺胺吡啶片口服，部分磺胺药过敏者改用来氟米特或（和）白芍总苷，病情严重者加用生物制剂如TNF-α拮抗剂，益赛普等）。认知行为治疗组在此基础上，接受睡眠限制疗法、认知疗法、刺激控制疗法及睡眠健康教育等治疗。2组均4周为1个疗程。对2组治疗前后匹兹堡睡眠质量指数量表（PSQI）总分及单项指标（睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、催眠药物、日间功能）分进行比较。结果治疗前2组PSQI总分及各因子分比较差异均无统计学意义（均P〉0．05）；治疗后认知行为治疗组PSQI总分及各项因子分均低于对照组（P〈0．05或P〈0．01）。结论CBT能有效地改善AS患者的睡眠质量。

Effects of Cognitive-behavior Therapy on Insomnia in Patients with Ankylosing Spondylitis

Objective To explore the effects of cognitive-behavior therapy（CBT） on insomnia in patient with ankylosing spondylitis （AS）. Methods A total of 81 AS patients with insomnia were rando- mly divided into CBT group（41 patients） and control group（40 patients）. All patients were treated with non-steroidal anti-inflammatory drugs or sulfasalazine tablets according to the patient＇s condition. Patients with sulfa drug allergies were given leflunomide or （and） total glucosides of paeony. Patients with serious illness were additionally given biological agents such as TNF-α antagonists and etanercept. On this basis, the CBT group received sleep restriction therapy, cognitive therapy, stimulus control therapy and sleep health education. Patient were treated for 4 weeks as a course, and were assessed by the Pittsburgh Sleep Quality Index （PSQI） and its individual components （sleep quality,sleep latency, sleep duration,habitual sleep efficiency,sleep disturbances,hypnotic drugs and daytime function） before and after treatment. Results There were no significant differences in the global PSQI score and PSQI component scores between the two groups before treatment（all P〉0.05）. After treatment,the global PSQI score and PSQI component scores in CBT group were significantly lower than those in control group（P〈0.05 or P〈0.01 ）. Conclusion CBT can effectively improve sleep quality in AS patients with insomnia .