酒石酸唑吡坦片治疗急性脑卒中后失眠的临床疗效

目的分析酒石酸唑吡坦片在急性脑卒中后失眠治疗中的应用价值。方法选取我院2014-07—2016-08收治的急性脑卒中后失眠的90例患者,随机分为2组,对照组44例给予常规治疗,观察组46例给予酒石酸唑吡坦片治疗,比较2组患者治疗效果及不良反应。结果对照组治疗总有效率70.45%,观察组93.48%,差异有统计学意义(P0.05);治疗后,观察组阿森斯失眠量表评分、MESSS评分均显著低于对照组,Barthel指数显著高于对照组(P0.05)。对照组无不良反应,观察组不良反应发生率为4.35%,2组比较差异无统计学意义(P0.05)。结论将酒石酸唑吡坦片用于急性脑卒中后失眠的临床治疗,可有效改善患者失眠症状,提高患者的日常生活能力,且不会增加不良反应的发生风险,值得临床推广。     

认知-行为疗法及结合药物治疗原发性失眠的对照研究

目的了解认知-行为疗法在原发性失眠患者中的治疗作用。方法 99例原发性失眠患者随机分成3组:认知行为治疗组、药物治疗组和联合治疗组。分别使用匹兹堡睡眠质量指数(PSQI)评价认知-行为疗法、药物疗法(唑吡坦10mg)及认知-行为疗法结合药物递减疗法(联合治疗)治疗原发性失眠症患者99例的疗效。结果联合治疗组及药物治疗组在治疗第1周较认知-行为治疗组PSQI值明显下降(P0.01);联合治疗组与药物治疗组PSQI相比差异无统计学意义(P0.05);治疗第6周3组PSQI差异无统计学意义(P0.05);治疗3个月时联合治疗组与认知-行为治疗组较药物治疗组PSQI明显下降(P0.01),联合治疗组与认知-行为治疗组PSQI差异无统计学意义(P0.05)。联合治疗组不同时间点PSQI比较差异有统计学意义(P0.01);药物治疗组治疗第1周及治疗第6周与治疗前PSQI比较明显下降(P0.01),治疗第6周与治疗3个月时PSQI比较差异无统计学意义(P0.05);单纯认知行为治疗组在治疗前与治疗第1周PSQI比较差异无统计学意义(P0.05),与治疗第6周及3个月PSQI明显下降(P0.01)。结论认知-行为疗法结合非苯二氮卓艹类安眠药物治疗失眠,起效快,与认知-行为疗法治疗同样具有显著稳定持久的远期效果。     

唑吡坦按需治疗失眠症的临床研究

目的　探讨唑吡坦非每夜给药 (按需治疗 )对慢性失眠症的疗效及不良反应。方法　比较唑吡坦非每夜给药 (按需治疗 )和唑吡坦每夜给药 (持续治疗 )的疗效和不良反应。对慢性失眠者 40例进行对照研究。结果　持续治疗和按需治疗疗效相近 ,治疗过程中无反跳现象及撤药反应。结论　唑吡坦按需治疗方法有效可行 ,对不需每夜服药 ,又害怕对药物产生依赖的患者提供了一个较好的长期治疗方案。     

唑吡坦治疗失眠症双盲研究

目的：比较国产唑吡坦片和进口唑吡坦片治疗失眠症的疗效和不良反应。方法：对32例失眠症患者随机分为两组,分别服用国产或进口唑吡坦。采用睡眠障碍量表（SDRS）、汉密尔顿焦虑量表（HAMA）、临床总体印象量表（CGI）和副反应量表（TESS）评定疗效和不良反应。结果：SDRS评定国产唑吡坦组减分率为49．7％,与进口唑吡坦组49．8％相近,主要不良反应为头痛、口干、便秘和出汗等,病人均能耐受。结论：国产唑吡坦治疗失眠症的疗效和进口唑吡坦相当。     

酒石酸唑吡坦依赖2例报告

随着现代生活节奏加快和环境应激增多,焦虑和睡眠障碍已成为全社会关心的话题,同时,应用抗焦虑催眠药所存在的依赖现象,也越来越受到人们的关注。酒石酸唑吡坦(zolpidem,商品名:思诺思)是一种新型催眠剂。其作用特点是:起效快,对睡眠无影响,药物残留效应不明显。曾有思诺思致短暂精神障碍的报告[1],但对其依赖性的研究尚未见报道,作者在临床工作中曾遇2例,现报告如下。1资料例1:女,38岁,经理,硕士学历,患者因感情生活不顺心自高处坠落导致:①胸4、5椎体骨折,合并脊髓横断性损伤,②延颈髓分离综合征,③左侧第7~10后肋骨骨折并左肺挫裂伤,④左…     

唑吡坦所致幻视1例

1病例患者女,42岁。无故心情沮丧、悲观想死、失眠3周到我院就诊。3周前无明显原因渐出现心情差,觉得自己处处比不上别人,感到生活无意义,总想哭泣,甚至有想死的念头,睡眠差,早醒。精神检查:意识清晰,定向力完整,接触被动。语量少,语音低,语速慢。言谈切题,未引出精神病性症状     

唑吡坦治疗老年原发性失眠的开放性前瞻性多中心自身对照研究

目的 评价唑吡坦5 mg每日1次治疗老年原发性失眠的疗效和安全性.方法 采用开放性、前瞻性、固定剂量、多中心、自身对照的研究方法.115例符合美国精神障碍诊断和统计手册第4版原发性失眠诊断标准的老年门诊患者每日1次服用固定剂量唑吡坦5 mg,疗程3周.以治疗第1周末匹兹堡睡眠质量指数评分(PSQI)相对于基线的差值作为研究的主要疗效评价指标,次要疗效指标包括:治疗第3周末PSQI评分相对于基线的差值,治疗第1周末和第3周末主观睡眠有效参数评分(睡眠潜伏期、总的睡眠时间、睡眠质量)相对于基线的差值,治疗第3周末17项汉密尔顿抑郁量表(HAMD-17)评分和汉密尔顿焦虑量表(HAMA)评分相对于基线的差值.结果 治疗第1周末,PSQI量表总分较基线下降2.8分,差异有统计学意义(P＜0.01);治疗第3周末,PSQI评分较基线下降3.2分,差异有统计学意义(P＜0.01);治疗第1周末和第3周末主观睡眠有效参数均有明显改善:睡眠潜伏期缩短(P＜0.01),睡眠时间延长(P＜0.01),日间功能提高(P＜0.01);治疗第3周末,患者的HAMD-17和HAMA评分较基线均有降低(P＜0.01);不良事件的发生率为19.1%,主要为头晕、头痛、困倦、恶心、乏力等,程度为轻、中度.结论 每日1次服用固定剂量唑吡坦5 mg治疗老年原发性失眠安全有效.     

唑吡坦治疗老年原发性失眠的开放性前瞻性多中心自身对照研究

Objective To evaluate the clinical efficacy and safety of zolpidem in treatment of primary insomnia in elderly patients.Methods An open, perspective, fixed-dose, multicentre and selfcontrolled clinical trial was conducted.Total of 115 elderly patients who met with the Diagnostic and Statistical Manual of Mental Disorders, 4th edition criteria for primary insomnia were administered 3 week nightly treatment with zolpidem 5 mg.The primary efficacy measurement was the change of Pittsburg Sleep Quality Index(PSQI) score after 1 week treatment in comparison with the baseline.The secondary efficacy measurement included the changes from baseline in total score of the PSQI, Hamilton Depression Scale (HAMD-17) and Hamilton Anxiety Scale (HAMA) and self-reported sleeping parameters ( latency of falling asleep, total sleeping time and sleeping quality) after 3 week treatment.Results The mean reduction score 17 items of PSQI were 2.8 after 1 week treatment and 3.2 at the end of 3 week ( P ＜ 0.01 ).The selfreported sleeping parameters were much improved from the baseline (P ＜0.01 ).The total scores of HAMD and HAMA were reduced significantly ( P ＜ 0.01 ) after 3 week treatment.The overall incidence of adverse events was 19.1%, with the frequent adverse events of dizziness, headache, sleepiness, nausea and fatigue, and the severity was mild or moderate.Conclusion It is effective and safe of zolpidem 5 mg nightly in treatment of elderly insomnia patients.     

唑吡坦治疗老年原发性失眠的开放性前瞻性多中心自身对照研究

Objective To evaluate the clinical efficacy and safety of zolpidem in treatment of primary insomnia in elderly patients.Methods An open, perspective, fixed-dose, multicentre and selfcontrolled clinical trial was conducted.Total of 115 elderly patients who met with the Diagnostic and Statistical Manual of Mental Disorders, 4th edition criteria for primary insomnia were administered 3 week nightly treatment with zolpidem 5 mg.The primary efficacy measurement was the change of Pittsburg Sleep Quality Index(PSQI) score after 1 week treatment in comparison with the baseline.The secondary efficacy measurement included the changes from baseline in total score of the PSQI, Hamilton Depression Scale (HAMD-17) and Hamilton Anxiety Scale (HAMA) and self-reported sleeping parameters ( latency of falling asleep, total sleeping time and sleeping quality) after 3 week treatment.Results The mean reduction score 17 items of PSQI were 2.8 after 1 week treatment and 3.2 at the end of 3 week ( P ＜ 0.01 ).The selfreported sleeping parameters were much improved from the baseline (P ＜0.01 ).The total scores of HAMD and HAMA were reduced significantly ( P ＜ 0.01 ) after 3 week treatment.The overall incidence of adverse events was 19.1%, with the frequent adverse events of dizziness, headache, sleepiness, nausea and fatigue, and the severity was mild or moderate.Conclusion It is effective and safe of zolpidem 5 mg nightly in treatment of elderly insomnia patients.     

唑吡坦引起假性幻觉1例

1病例 患者女,17岁,诊断为抑郁症,病情稳定已4年。以舍曲林（商品名：左洛复）25mg／晚维持治疗。近3d忘服舍曲林,第4天19：00服下与舍曲林相似的唑吡坦（商品名：思诺思）10mg以补漏服。服后边吃饭边看报,约20min感到思睡,趴在桌子上,隐隐入睡,听到隔壁房间的电视声音变大,好像在播新闻,想回卧室休息,感到头重脚轻,行走困难,需扶墙而行,挨到床边睡下后,     

认知行为疗法治疗慢性失眠障碍的研究现状

本文目的是分析失眠的认知行为治疗(CBTI)对慢性失眠障碍的效果,以期为推动CBTI的临床运用提供理论依据,为我国慢性失眠障碍患者选用非药物治疗提供参考.慢性失眠障碍是常见的疾病,CBTI已成为慢性失眠障碍的首选治疗方法.本文主要从CBTI对慢性失眠障碍的生理机制及神经影像学方面研究现状、疗效、不良反应、面临的问题及处...     

失眠的认知行为治疗对失眠障碍患者睡眠质量和认知功能的影响

背景 失眠障碍已成为当前社会的一种常见疾病,失眠的认知行为治疗（CBTI）是失眠障碍的非药物治疗方法之一,其对失眠障碍患者睡眠质量和认知功能影响的研究有限。目的 探索CBTI对失眠障碍患者睡眠质量和认知功能的影响,为失眠障碍的非药物治疗提供参考。方法 选取2021年1月-2022年10月在四川省精神卫生中心就诊、符合《精神障碍诊断与统计手册（第5版）》（DSM-5）诊断标准的47例失眠障碍患者为研究对象。患者接受为期6周的CBTI治疗。治疗前,采用汉密尔顿抑郁量表24项（HAMD-24）和汉密尔顿焦虑量表（HAMA）评定患者的抑郁和焦虑症状,在治疗前及治疗6周后采用匹兹堡睡眠质量指数量表（PSQI）和蒙特利尔认知评估量表（MoCA）评定患者的睡眠情况和认知功能。采用Spearman相关分析考查治疗后失眠障碍患者PSQI总评分减分值与MoCA总评分增分值的相关性。结果 治疗6周后,失眠障碍患者PSQI的主观睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、日间功能障碍因子评分及PSQI总评分均低于治疗前,差异均有统计学意义（t=5.569~15.290,P均<0.01）,MoCA的视空间与执行功能、命名、注意力、语言能力、抽象思维、记忆力因子评分及总评分均高于治疗前,差异均有统计学意义（t=-11.273~-4.277,P均<0.01）。Spearman相关分析显示,经6周CBTI治疗后,失眠障碍患者PSQI总评分减分值与MoCA总评分增分值呈正相关（r=0.323,P=0.027）。结论 CBTI可能有助于改善失眠障碍患者的睡眠质量和认知功能。CBTI干预后,失眠障碍患者睡眠质量的提高可能与认知功能的改善存在一定的关联。     

慢性失眠症认知行为治疗研究进展

慢性失眠症的治疗方式主要包括药物治疗和认知行为治疗.药物治疗慢性失眠症起效时间短、见效快,但易增加成瘾性,产生不良反应.认知行为疗法（CBT）是应用最广泛的非药物治疗方法,现已用于慢性失眠症的治疗并取得显著的疗效.CBT在治疗慢性失眠症的同时避免了药物治疗的不良反应,并且长期治疗效果优于药物治疗.     

Cognitive mechanisms of sleep outcomes in a randomized clinical trial of internet-based cognitive behavioral therapy for insomnia

ObjectiveThe aim of this study was to investigate in a randomized clinical trial the role of sleep-related cognitive variables in the long-term efficacy of an online, fully automated cognitive behavioral therapy intervention for insomnia (CBT-I) (Sleep Healthy Using the Internet [SHUTi]).MethodThree hundred and three participants (M_age = 43.3 years; SD = 11.6) were randomly assigned to SHUTi or an online patient education condition and assessed at baseline, postintervention (nine weeks after baseline), and six and 12 months after the intervention period. Cognitive variables were self-reported internal and chance sleep locus of control, dysfunctional beliefs and attitudes about sleep (DBAS), sleep specific self-efficacy, and insomnia knowledge. Primary outcomes were self-reported online ratings of insomnia severity (Insomnia Severity Index), and sleep onset latency and wake after sleep onset from online sleep diaries, collected 12 months after the intervention period.ResultsThose who received SHUTi had, at postassessment, higher levels of insomnia knowledge (95% confidence interval [CI] = 0.10–0.16) and internal sleep locus of control (95% CI = 0.04–0.55) as well as lower DBAS (95% CI = 1.52–2.39) and sleep locus of control attributed to chance (95% CI = 0.15–0.71). Insomnia knowledge, chance sleep locus of control, and DBAS mediated the relationship between condition and at least one 12-month postassessment sleep outcome. Within the SHUTi condition, changes in each cognitive variable (with the exception of internal sleep locus of control) predicted improvement in at least one sleep outcome one year later.ConclusionOnline CBT-I may reduce the enormous public health burden of insomnia by changing underlying cognitive variables that lead to long-term changes in sleep outcomes.     

失眠的认知行为治疗在抑郁障碍共病失眠障碍患者中的应用进展

抑郁障碍共病失眠障碍的现象在临床中非常普遍.失眠的认知行为治疗(Cognitive Behavioral Therapy for Insomnia,CBT-I)作为一个基于证据的非药物治疗方法已经在治疗失眠障碍中广为接受.CBT-I也开始应用于抑郁障碍共病失眠障碍,并且获得一些证据的支持,但是尚需要增强CBT-I治疗抑郁障碍共病失眠障碍患者的依从性,从而提高疗效.     

The efficacy of integrated cognitive behavioral therapy (CBT) and acupressure versus CBT for insomnia: a three-arm pilot randomized controlled trial

ObjectivesThis pilot study aimed to examine the efficacy of integrated cognitive behavioral therapy (CBT) and acupressure in treating insomnia and its daytime impairments in a Chinese adult population.Methods40 eligible participants with insomnia were randomly assigned to either the integrated CBT and acupressure (CBTAcup) group (n = 14), the CBT group (n = 13), or the waitlist control (WL) group (n = 13). Participants in the CBTAcup group attended a 2-hour integrated CBT and self-administered acupressure group treatment once per week for six consecutive weeks, while participants in the CBT group attended six weekly 2-hour CBT for insomnia. Sleep, mood, daytime impairments, quality of life, and treatment credibility and adherence were assessed at baseline, immediate post-treatment (Week 7), and 4-week post-treatment (Week 11).ResultsLinear mixed-effects models showed that both the CBTAcup and CBT groups had significantly lower insomnia severity (d = −1.74 and d = −2.61), dysfunctional beliefs related to sleep (d = −2.17 and −2.76), and mental fatigue (d = −1.43 and −1.60) compared with the WL group at Week 7. The CBTAcup group provided additional benefits in reducing total fatigue (d = −1.43) and physical fatigue (d = −1.45). Treatment credibility was found to be improved in the CBTAcup group from baseline to Week 7.ConclusionsIntegrated CBT and acupressure demonstrated comparable efficacy to pure CBT in treating insomnia symptoms, with additional advantages to improve fatigue symptoms and acceptability in the Chinese population. Further methodologically rigorous studies on a larger scale and longer follow-up are warranted to confirm these findings.     

Web- vs telehealth-based delivery of cognitive behavioral therapy for insomnia: a randomized controlled trial

ObjectivesThe purpose of our study was to evaluate and compare two methods of service delivery (web-based and telehealth-based) for chronic insomnia with regard to patient preference, clinical effectiveness, and patient satisfaction.MethodsOur study was a randomized controlled trial with manualized telehealth- and web-based delivery conditions (nonblinded). The sample comprised 73 adults with chronic insomnia. Participants received web-based delivery from their homes or telehealth-based delivery from a nearby clinic. Both interventions consisted of identical psychoeducation, sleep hygiene and stimulus control instruction, sleep restriction treatment, relaxation training, cognitive therapy, mindfulness meditation, and medication-tapering assistance.ResultsUsing a linear mixed model analysis, results showed that both delivery methods produced equivalent changes in insomnia severity, with large effect sizes. Attendance patterns favored telehealth, whereas homework adherence and preference data favored web-based delivery.ConclusionsWeb- and telehealth-based delivery are both helpful in treating chronic insomnia in rural-dwelling adults.     

失眠伴抑郁与单纯失眠患者失眠认知行为治疗的疗效分析

目的分析失眠认知行为疗法(cognitive behavioral therapy on insomnia,CBT-i)对失眠伴抑郁患者以及单纯失眠患者的疗效。方法71例符合失眠症诊断的患者,根据贝克抑郁量表(Beck Depression Inventory,BDI)得分分为单纯失眠组(<14分,33例)和失眠伴抑郁组(≥14分,38例)。2组患者每天填写睡眠日记,并给予8周标准的CBT-i治疗,在治疗前(基线)、治疗第4周、治疗第8周、治疗结束后4周(第3个月)、治疗结束后16周(第6个月)采用匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI)、失眠严重程度指数(Insomnia Severity Index,ISI)、BDI、贝克焦虑量表(Beck Anxiety Inventory,BAI)、SF-36健康调查简表对2组患者睡眠质量、抑郁焦虑程度、个人健康状况等进行评估,采用独立样本t检验进行组间比较,采用重复测量方差分析进行各时间点组内比较。结果与基线时比较,单纯失眠组和失眠伴抑郁组第8周、第3个月和6个月随访时入睡潜伏期、睡眠效率、PSQI、ISI、BDI、BAI、SF-36组内比较差异均有统计学意义。失眠伴抑郁组较单纯失眠组在基线、第8周、第3个月和6个月随访时BAI(t=-6.340、-3.301、-3.511、-2.982)、SF-36(t=4.162、3.195、2.022、3.629)评分差异有统计学意义(P<0.01或0.05),2组ISI评分在第6个月随访时差异有统计学意义[(7.3±4.6)分与(4.7±3.4)分,t=-2.044,P=0.048]。2组入睡潜伏期和睡眠效率以及PSQI的评分在第8周、第3个月和6个月随访时与基线的变化量差异均无统计学意义;而2组BAI、BDI评分在第8周与第3个月和6个月随访时与基线的变化量差异有统计学意义。结论CBT-i对失眠伴抑郁患者和单纯失眠患者均有效,且可以缓解失眠伴抑郁患者的抑郁症状以及改善患者生活质量。     

Cognitive behavioral treatment for insomnia is equally effective in insomnia patients with objective short and normal sleep duration

BackgroundIt has been suggested that insomnia patients with short sleep duration and insomnia patients with normal sleep duration may respond differently to cognitive behavioral treatment for insomnia (CBT-I). To evaluate this hypothesis, we retrospectively examined a large sample of patients with chronic insomnia regarding their outcome post-treatment and six months after participating in a two-week standardized inpatient CBT-I program.ObjectivesSeventy-two women and 20 men with chronic insomnia received standardized inpatient CBT-I and were examined with three nights of polysomnography (two baseline nights and one post-treatment night directly following the two-week treatment). Follow-up measurements of subjective insomnia symptoms were conducted after six months. The CBT-I outcome was compared between insomnia patients with polysomnographically determined short (< 6 h) and normal (≥ 6 h) sleep duration.ResultsConcerning subjective outcomes, CBT-I was equally effective in insomnia patients with objective short and normal sleep duration. Secondary analyses of polysomnographic data collected at post-treatment revealed that insomnia patients with short sleep duration showed a better treatment response in comparison to those with normal sleep duration.ConclusionsThese results suggest that the distinction in insomnia between objective short and normal sleep duration may be of limited value for treatment decisions regarding CBT-I. However, as the overall picture of the literature on this issue is not conclusive, we conclude that further prospective research is necessary to investigate the clinical validity of phenotyping insomnia patients by objective sleep data.