失眠短程行为治疗对主观性失眠患者的失眠症状疗效分析

Efficacy of Brief Behavioral Therapy for Insomnia(BBT-I)in patients suffering Paradoxical insomnia

目的探索失眠短程行为治疗(BBT-I)对主观性失眠治疗效果及治疗影响因素。方法门诊收集60例符合ICSD-3原发性失眠诊断标准的患者,标准多导睡眠监测(PSG)及匹兹堡睡眠质量指数量表(PSQI)收集睡眠数据并进行分组,分为:主观性失眠组(SI组)及非主观性失眠组(NSI组),采集入组患者PSQI、睡前唤醒量表(PSAS)、睡眠信念态度量表(DBAS)、睡眠卫生习惯量表(SHPS)评估患者睡眠的认知、信念及行为相关影响因素,均予以4 w失眠短程行为治疗,对患者在入组前1 w、治疗后1 w通过PSQI及睡眠日记进行评估。结果在多导睡眠监测客观睡眠数据中,对比发现SI组较NSI组存在觉醒指数增高(5.10±2.85,3.27±1.52;P<0.05),两组DBAS量表对比发现,SI组较NSI组在DBAS第3因子对睡眠的期望及第4因子药物信念分值更低,即存在更多不合理信念(4.29±1.92,5.27±1.73;P<0.01),(8.04±1.68,9.35±1.87;P<0.01);组内对比发现SI组中入睡潜伏期(SL)、睡眠效率(SE)、日间功能及PSQI评分在治疗前后对比均存在改善,差异均具有统计学差异(P<0.05),两组间对比发现SI组较NSI组,在干预前后SE差值中差异具有统计学意义(P<0.05)。相关性分析中发现,主观性失眠组中,干预前后日间功能差值与DBAS第1因子(对睡眠不现实期望)评分负相关(r=-0.270,P=0.037);干预前后日间功能差值与PSAS总分负相关(r=-0.268,P=0.039);睡眠潜伏期治疗前后差值与PSAS生理性激发呈负相关(r=-0.288,P=0.042)。结论主观性失眠患者较非主观性患者存在更为突出的夜间高觉醒及更多不合理信念态度。BBT-I对主观性失眠患者的入睡潜伏期、睡眠效率、日间功能及睡眠感受存在改善。

Objective To explore the effect of BBT-I on subjective insomnia and its influencing factors.Methods 60 primary insomnia patients were collected in outpatient department,and divided into two groups:Subjective insomnia group(SI group)and non-subjective insomnia group(NSI group)by sleep data collected by standard polysomnography monitoring and Pittsburgh Sleep Quality Index(PSQI),sleep diaries during the intervention were collected,and the Pre Sleep Arousal Scale(PSAS),Brief Version of Dysfunctional Beliefs and Attitudes About Sleep(DBAS)and the Sleep Hygiene Practice Scale(SHPS)were collected to evaluate the influencing factors related to sleep attitudes,beliefs and behaviors of patients.All patients received BBT-I for 4 weeks,and collected the sleep diaries and PSQI 1 week before and 1 week after treatment.Results Compared with NSI group,SI group had higher arousal index(P<0.05);compared with NSI group,SI group had lower scores in factor 3 indicated as drug belief and factor 4 representing anticipation of sleep in DBAS,that is,there were more irrational beliefs in SI(P<0.05).Intra-group comparison showed that there were statistically significant differences insleep latency、sleep efficiency,daytime function and PSQI score in SI group before and after treatment(P<0.05),and there were statistically significant differences in SE difference before and after intervention between SI group and NSI group(P<0.05).In the subjective insomnia group,daytime functional difference before and after intervention was negatively correlated with the first factor in DBAS(r=-0.270,P=0.037).daytime functional difference before and after intervention was negatively correlated with PSAS(r=-0.268,P=0.039);The difference of sleep latency before and after intervention was negatively correlated with physiological stimulation of PSAS(r=-0.288,P=0.042).Conclusion Compared with non-subjective patients,subjective insomnia patients have higher arousals and more irrational beliefs and attitudes.BBT-I may improve sleep latency/、sleep efficiency,daytime function and sleep sensation in subjective insomnia patients.