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。

Effect of cognitive behavioral therapy for chronic insomnia comorbid with depression and chronic insomnia alone

Objective To study the effect of cognitive behavioral therapy on insomnia(CBT-i)for patients with insomnia and patients with comorbid depressive disorder.Methods According to the score of Beck Depression Inventory(BDI),71 patients who met the diagnosis of insomnia were divided into the insomnia group(<14 points,33 cases)and the insomnia with depression group(≥14 points,38 cases).Patients in both groups filled in sleep diaries every day and were given standard CBT-i treatment for 8 weeks.Pittsburgh Sleep Quality Index(PSQI),Insomnia Severity Index(ISI),BDI,Beck Anxiety Inventory(BAI),and the SF-36 Health Survey were evaluated before treatment(baseline),at 4 weeks,8 weeks,4 weeks after treatment(3 months),and 16 weeks after treatment(6 months).Independent sample t test was utilized to compare difference between two groups,while repeated measures ANOVA was adopted to analyze data at different timepoints.Results Compared with baseline assessment,both insomnia group and insomnia with depression group showed significant differences in Sleep Onset Latency(SOL),Sleep Efficiency(SE),PSQI,ISI,BDI,BAI,and SF-36.There were no significant difference between the two groups,at baseline,8 weeks,3 months and 6 months in SOL,and SE,however,significant difference was found in the scores of BAI(t=-6.340,-3.301,-3.511,-2.982),and SF-36(t=4.162,3.195,2.022,3.629;P<0.01 or 0.05).In the meantime,there was a significant difference on PSQI and ISI at 8 weeks and 3 months,while there was no significant difference of them at month 6(7.3±4.6 vs.4.7±3.4,t=-2.044,P=0.048).There were no statistically significant differences in sleep latency,sleep efficiency and PSQI scores between the insomnia group and the insomnia with depression group at 8 weeks,3 months and 6 months.However,compared with baseline measurement,the two groups showed statistically significant differences on BAI and BDI scores at week 8,month 3 and month 6(all P<0.01).Conclusions CBT-i is effective for patients with insomnia as well as those with comorbid depression,it could be helpful to alleviate the depressive symptoms and improve patient′s quality of life.