失眠的短程行为治疗改善失眠共病慢性原发性头痛

Clinical study of brief behavioral therapy for insomnia(BBT-I)improving symptoms of patients suffering insomnia and primary chronic headache

目的探索失眠的短程行为治疗(Brief behavioral therapy for insomnia,BBT-I)对失眠伴慢性原发性头痛患者头痛症状的影响。方法2020年3月~9月于陆军特色医学中心睡眠心理科门诊纳入临床诊断为失眠伴慢性原发性头痛患者共50例。按照年龄、性别匹配分为两组:BBT-I组与对照组。对照组予以睡眠卫生宣教,BBT-I组在此基础上实施为期4 w的BBT-I,主要通过刺激控制治疗与行为限制治疗改善睡眠行为,入组患者每日填写睡眠日记,采用失眠严重程度量表(Insomnia severity scale,ISI)评估患者失眠严重程度,通过贝克焦虑抑郁量表评估焦虑抑郁,随访1 m后通过失眠情况及头痛严重程度、发作频率以及通过头痛影响测验(Headache impact test version 6,HIT-6)评估BBT-I的对日常生活质量影响。结果组间对比,头痛发作频率BBT-I组(13.72±3.40)较对照组(16.08±4.42)下降(P<0.05);组内比较,BBT-I组(19.64±5.68)与对照组(20.28±5.59)干预后1月,睡眠严重程度均较干预前改善,其中BBT-I组干预后(12.48±6.50)失眠严重程度改善存在统计学意义(P<0.01),其头痛发作频率(13.72±3.40)均较治疗前下降(P<0.01)。BBT-I组睡眠觉醒指数与头痛频率改善情况呈负相关,相关系数rs=-0.559,P=0.004。结论BBT-I对失眠伴慢性原发性头痛患者失眠程度具有明显的改善作用,同时减轻其慢性原发性头痛疾病的疼痛程度及发作频率。觉醒指数可能成为评估应用BBT-I治疗失眠伴原发性头痛患者头痛症状临床指标。

Objective To explore the effect of brief behavioral therapy for insomnia(BBT-I)for insomnia patients with primary chronic headache.Methods From March to September 2020,50 patients with insomnia and primary chronic headache were collected and divided into two groups called BBT-I group and control group,which was matched with age and gender.The control group was given sleep hygiene education,the BBT-I group was given BBT-I for 4 weeks.All the patients have been collected patients’daily sleep diaries,the severity of insomnia scale(ISI),and the Beck anxiety and depression scale.After 1 month of follow-up,patients were assessed for their insomnia and headache severity,headache attack frequency,and daily quality of life by headache impact test version 6(HIT-6).Results The ISI in the BBT-I group(19.64±5.68)were decreased after BBT-I intervention(12.48±6.50),and the results were statistically significant(P<0.01).Compared with the control group(20.28±5.59),in the BBT-I group(13.72±3.40)the attack frequency of headache was reduced(P<0.05).In the BBT-I group,the sleep arousal index was negatively correlated with the defference of headache frequency before and after BBT-I,with the correlation coefficient rs=-0.559,P=0.004.Conclusion BBT-I can improve the degree of insomnia severity in patients with insomnia and primary headache insomnia,and reduce the chronic pain attack frequency.sleep awakening index might become a new assessment application on whether BBT-i can improve the symptoms of patients with primary headache and insomnia.