远程交互式认知行为治疗慢性失眠症的疗效观察

Effect of remote-interactive cognitive behavioral therapy in patients with chronic insomnia

目的评价远程交互式认知行为治疗对慢性失眠症的短期疗效。方法将62例慢性失眠症患者按随机数字表分为远程交互式认知行为治疗联合药物治疗组（联合组）、远程交互式认知行为治疗组（CBTI组）和药物治疗组（药物组），治疗6—8周。利用睡眠日志及量表评价治疗效果及各组间疗效差异。结果治疗结束后，药物组睡眠潜伏期（39．9±23．7）min、入睡后觉醒时间（79．1±39．4）min高于联合组[（25．5±11．2）min、（54．4±38．5）min]及CBTI组[（27．8±11．6）min、（51．8±29．0）min]，均差异有统计学意义（P=0．018，P=0．046）；药物组睡眠效率[（76．5±11．9）％]低于联合组[（83．8±8．7）％]及CBTI组[（82．8±7．0）％，P=0．042]，差异具有统计学意义。三组总睡眠时间芹异无统计学意义（P〉0．05）。药物组睡眠个人信念与态度简化量表评分[（97．6±16．4）分]高于联合组[（67．5±20．1）分]及CBTI组[（75．0±26．9）分]，差异有统计学意义（P〈0．01）；其余量表评分各组之间均差异无统计学意义（P〉O．05）。联合组服药频率[（3．35±3．05）晚／周]低于药物组[（5．56±2．33）晚／周]，差异有统计学意义（P=0．016）。联合组6例（29％）患者撤药，药物组1例（5％）患者撒药，OR=7．286。结论远程交互式认知行为治疗能显著提高睡眠效率、增加总睡眠时间、缩短觉醒时间，早期联合药物治疗能迅速缓解失眠症状，撤药后疗效持续稳定，远程交互的方式可有效降低治疗的脱失率。

Objective To assess the effect of remote-interactive cognitive behavioral therapy in pa- tients with ehronic insomnia. Methods A total of 62 patients with chronic insomnia were randmnly divided into combined treatment group,cognitive behavioral therapy for insonmia （CBTI） group and drug treatment group.The study lasted for 6-8 weeks.The curative effects were assessed using sleep diary and scales. Results The sleep onset latency （SOL） （ （39.9±23.7） rain） and wake time after sleep onset（WASO） （ （ 79.1 ± 39.4） rain） in the drug treatment group were higher than that in the eomhined treatment group （（ 25,5± 11.2 ） min and （ 54.4±38.5 ） rain, respectively ） and CBTI group （ （ 27.8± 11.6） min and （ 51.8±29.0 ） min, re- spectively ） at the end of treatment, the difference was statistical significance（ P= 0.018 and P= 0.046 respec- tively） .The sleep effieieney（SE） in drug treatment （ （76.5± 11.9）% ） was lower than that in the other two groups（ （83.8±8.7） % and （82.8±7.0） % respectively） , （P= 0.042）. And no similar difference were seen in TST after treatment（P〉0.05）.The Brief Version of Dysflmctional Beliefs and Attitudes about Sleep（ DBAS- 16） score in the drug treatment group （97.6± 16.4） was higher than the other two groups （（67.5±20.1） and （75.0±26.9） respectively） after Inatment（P=0.000）.No significant difference was seen in scores of the oth- er scales among the three groups（P〉O.O5）.After treatment, a greater proportion of patients in the combined treatment group had withdrawn from hypnotics use completely （ 29% （6/20） vs 5% （1/18） ; odds ratio （ OR ） was 7.286） ;and the combined treatment group produced significant reduction in frequency of hypnotics use （ （ 3.35±3.05 ） nights/week） when compared with drug treatment group （ （ 5.56± 2.33 ） nights/week, P=0.016）. Conclusions Remote-interactive cognitive behavioral therapy was effective and acceptable for treating patients with chronic insomnia,combining drug treatment in the early period could quickly relieve the symptoms of insomnia,and can avoid the adverse effect from the hypnotics.And the treatment method can reduce the dropout rate.