团体认知行为疗法治疗失眠障碍疗效的Meta分析

Meta analysis of clinical efficacy of group cognitive behavioral therapy in the treatment of insomnia

目的 系统评价团体认知行为疗法(GCBT)治疗失眠患者的临床疗效及其后期效应.方法 检索EMbase、Cochrane Library、Medline、中国知网和万方数据库,查找符合纳入标准的随机对照研究,GCBT组患者接受团体认知行为治疗,内容主要包括睡眠卫生宣教、认知治疗、放松训练、睡眠限制和刺激控制;对照组患者接受安慰剂治疗、健康生活教育、常规护理、等待治疗等.提取睡眠日记中入睡潜伏期、入睡后觉醒时间、总睡眠时间和睡眠效率,以及睡眠严重程度指数和匹兹堡睡眠质量指数问卷,并采用RevMan5.3和STATA15.1软件进行Meta分析.结果 最终纳入11篇文献,共计814例患者,其中GCBT组441例,对照组373例.Meta分析结果显示:GCBT组入睡潜伏期(WMD=-15.06,95%CI:-19.06^-11.05,P<0.05)、入睡后觉醒时间(WMD=-34.95,95%CI:-49.96^-19.93,P<0.05)、失眠严重程度指数(WMD=-6.13,95%CI:-8.04^-4.22,P<0.05)、匹兹堡睡眠质量指数评分(WMD=-2.49,95%CI:-4.11^-0.87,P<0.05)均低于对照组,睡眠效率高于对照组(WMD=10.46,95%CI:6.89~14.03,P<0.05),两组总睡眠时间差异无统计学意义(P>0.05).早期随访时,GCBT组入睡后觉醒时间(WMD=-32.51,95%CI:-58.61^-6.41,P<0.01)、失眠严重程度指数(WMD=-6.01,95%CI:-8.40^-3.62,P<0.05)、匹兹堡睡眠质量指数评分(WMD=-4.33,95%CI:-7.06^-1.59,P<0.05)均低于对照组(均P<0.05),总睡眠时间(WMD=0.32,95%CI:0.10~0.54,P<0.05)、睡眠效率(WMD=10.51,95%CI:5.99~15.02,P<0.05)均高于对照组(均P<0.05),两组入睡潜伏期差异无统计学意义(均P>0.05).长期随访时,GCBT组睡眠效率高于对照组(WMD=5.30,95%CI:1.61~8.98,P<0.05),匹兹堡睡眠质量指数评分低于对照组(WMD=-2.80,95%CI:-3.82^-1.78,P<0.05),两组的入睡潜伏期、入睡后觉醒时间及总睡眠时间差异均无统计学意义(均P>0.05).结论 GCBT对失眠障碍患者的临床疗效可靠,且在后期随访中仍持续有效,但其疗效会随着时间推移而下降.

Objective To systematically evaluate the clinical efficacy and late effect of group cognitive behavioral therapy(GCBT)in the treatment of insomnia.Methods EMbase,Cochrane Library,Medline,CNKI and Wanfang database were searched for randomized controlled trials that met the inclusion criteria.The GCBT group received group cognitive behavior therapy,including sleep health education,cognitive therapy,relaxation training,sleep restriction and stimulation control.The control group received placebo treatment,health education,routine care,waiting for treatment.The questionnaire of sleep latency,wake-up time after sleep,total sleep time and sleep efficiency,sleep severity index and Pittsburgh sleep quality index were extracted from sleep diary,and meta-analysis was conducted by RevMan 5.3 and STATA 15.1 software.Results Finally,11 articles were included,a total of 814 patients,including 441 cases in GCBT group and 373 cases in control group.The results of meta-analysis showed that:sleep latency(WMD=-15.06,95%CI:-19.06--11.05,P<0.05),awakening time after sleep(WMD=-34.95,95%CI:-49.96--19.93,P<0.05),insomnia severity index(WMD=-6.13,95%CI:-8.04--4.22,P<0.05),Pittsburgh sleep quality index(WMD=-2.49,95%CI:-4.11--0.87,P<0.05)of the GCBT group were all lower than those of the control group,while the sleep efficiency of the GCBT group was higher than that of the control group(WMD=10.46,95%CI:6.89-14.03,P<0.05).There was no significant difference in the total sleep time between the two groups(P>0.05).At early follow-up,the awakening time(WMD=-32.51,95%CI:-58.61--6.41,P<0.01),insomnia severity index(WMD=-6.01,95%CI:-8.40--3.62,P<0.05),Pittsburgh sleep quality index(WMD=-4.33,95%CI:-7.06--1.59,P<0.05)were lower in GCBT group than those in control group,and total sleep time(WMD=0.32,95%CI:0.10-0.54,P<0.05),sleep efficiency(WMD=10.51,95%CI:5.99-15.02,P<0.05)were higher than those in the control group,and there was no significant difference in the sleep latency between the two groups(all P>0.05).At long-term follow-up,the sleep efficiency of GCBT group was higher than that of control group(WMD=5.30,95%CI:1.61-8.98,P<0.05),and Pittsburgh sleep quality index score was lower than that of control group(WMD=-2.80,95%CI:-3.82--1.78,P<0.05).There was no significant difference between the two groups in sleep latency,wake-up time and total sleep time(all P>0.05).Conclusions The clinical efficacy of GCBT in patients with insomnia is reliable,and it will continue to be effective in the late follow-up,but its efficacy will decline with time prolongation.