阿戈美拉汀联合认知行为治疗对青少年睡眠-觉醒时相延迟障碍的疗效

Efficacy of agomelatine with cognitive behavior therapy for delayed sleep-wake phase disorder in adolescents

目的评估阿戈美拉汀联合认知行为治疗(cognitive behavior therapy,CBT)对青少年睡眠-觉醒时相延迟障碍(delayed sleep-wake phase disorder,DSWPD)的疗效。方法收集2019年1月~2021年5月本院68例初诊为DSWPD的青少年患者,最终60例符合条件者纳入研究,在研究的第一阶段(1~4周)所有参与者采用阿戈美拉汀治疗(agomelatine therapy,AT),在研究的第二阶段(5~8周),根据是否接受CBT分为AT组、AT+CBT组。在AT治疗开始前、治疗开始后4周、8周、12周进行相关量表评估,包括睡眠日志、匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI)量表、Epworth嗜睡量表(Epworth Sleepiness Scale,ESS)、失眠严重程度指数(Insomnia Severity Index,ISI)量表、世界卫生组织幸福感问卷(World Health Organization wellbeing questionnaire,WHO-5)。结果AT治疗后评估结果显示,在睡眠开始(P<0.001)、睡眠结束(P<0.001)、睡眠时间(P<0.001)、睡眠质量(P<0.001)、失眠严重程度(P<0.001)和日间嗜睡(P<0.001)方面,较基线时明显改善;幸福感(P=0.645)方面治疗前后无明显差异。CBT治疗后评估结果显示,在睡眠时间(P=0.002)、睡眠质量(P=0.005)、失眠严重程度(P<0.001)、日间嗜睡(P=0.001)及幸福感(P=0.007)方面,AT+CBT组相较于AT组有明显改善;然而在睡眠开始(P=0.099)和睡眠结束(P=0.959)方面AT+CBT组与AT组无明显差异。结论AT治疗联合CBT治疗,在睡眠时间、睡眠质量、失眠严重程度、日间嗜睡及幸福感方面显示出巩固和维持的疗效优势。

Objective To evaluate the efficacy of agomelatine combined with cognitive behavior therapy(CBT)in adolescents with delayed sleep-wake phase disorder(DSWPD).Methods From January 2019 to May 2021,68 adolescent patients who were initially diagnosed as DSWPD were collected from the outpatient department of our hospital.Finally,60 eligible patients were included.In the first phase(1~4 weeks),all participants were treated with agomelatine therapy(AT).In the second phase(5~8 weeks),the patients was divided into AT group and AT+CBT group according to whether they received CBT treatment or not.Relevant scales were used including sleep log,Pittsburgh Sleep Quality Index(PSQI),Epworth Sleep Scale(ESS),Insomnia Severity Index(ISI),World Health Organization wellbeing questionnaire(WHO-5).Results The results of the assessment after AT showed that there were significant improvements from baseline in sleep onset(P<0.001),sleep offset(P<0.001),sleep duration(P<0.001),sleep quality(P<0.001),insomnia severity(P<0.001)and daytime sleepiness(P<0.001),but with no significant differences in well-being pre-or posttreatment(P=0.645).Assessment results after CBT showed that there was no significant difference between the AT+CBT group and the AT group in sleep onset(P=0.099)and sleep offset(P=0.959),while compared with the AT group,the AT+CBT group showed significant improvements in sleep duration(P=0.002),sleep quality(P=0.005),insomnia severity(P<0.001),daytime sleepiness(P=0.001)and well-being(P=0.007).Conclusion AT combined with CBT demonstrate advantages of consolidation and maintenance in terms of sleep duration,sleep quality,insomnia severity,daytime sleepiness and well-being.