认知行为疗法联合非苯二氮?类药物降阶梯疗法对轻中度失眠症的治疗效果

The therapeutic efficacy of cognitive behavioral therapy combined with non-BZDs de-escalation therapy on mild to moderate insomnia

目的观察认知行为疗法(cognitive behavioral therapy,CBT)联合非苯二氮䓬类药物(non-benzodiazepines,non-BZDs)降阶梯疗法对轻中度失眠症的治疗效果。方法采用前瞻性随机对照研究方法,将汕头市中心医院2021年8月至2022年2月睡眠亚专科门诊接诊的轻中度失眠症患者90例随机分为对照组与研究组,每组各45例。对照组采用non-BZDs降阶梯疗法,研究组采用CBT联合non-BZDs降阶梯疗法,疗程22周,对比两组患者治疗前后匹兹堡睡眠质量指数量表(The Pittsburgh sleep quality index scale,PSQI)评分及客观睡眠质量,比较两组患者在22周的non-BZDs服用情况。结果对照组共36例,研究组共39例纳入最终分析。研究组患者治疗22周PSQI量表的睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠紊乱、催眠药物、日间功能维度得分及总分低于对照组同期,差异有统计学意义(P<0.05)。研究组患者治疗22周的睡眠时间长于对照组,夜间觉醒次数低于对照组,差异有统计学意义(P<0.05)。治疗22周时,研究组患者non-BZDs足量服用比例低于对照组(23.08%vs.58.33%),停药比例高于对照组(28.21%vs.8.33%),差异有统计学意义(P<0.05)。结论与仅应用non-BZDs疗法相比,轻中度失眠症患者应用CBT联合non-BZDs降阶梯疗法,失眠改善效果更好,non-BZDs戒断效果更好,值得在临床推广应用。

Objective:To explore the therapeutic effect of cognitive behavioral therapy(CBT)combined with non-benzodiazepines(non-BZDs)drug de-escalation therapy on mild to moderate insomnia.Methods:The research type was a prospective randomized controlled study.Ninety patients with mild to moderate insomnia admitted to the sleep subspecialty outpatient clinic in our hospital from August 2021 to February 2022 were randomly divided into the control group and the research group,with 45 cases in each group.The control group were treated with non-BZDs de-escalation therapy,while the research group were treated with CBT combined with non-BZDs de-escalation therapy for 22 weeks.The Pittsburgh sleep quality index scale(PSQI)score and objective sleep quality were compared.The non-BZDs drug taken in the two groups at the 22th week were compared.Results:A total of 36 cases in the control group and 39 cases in the research group were included in the final analysis.The sleep quality,sleep onset time,sleep time,sleep efficiency,sleep disturbance,hypnotic drugs,daytime function dimension scores and total scores of the PSQI scale of the patients in the study group after 22 weeks of treatment were lower than those in the control group during the same period,and the difference was statistically significant(P<0.05).The sleep time of the patients in the study group after 22 weeks of treatment was higher than that in the control group;the number of nighttime awakenings was lower than that in the control group,and the difference were statistically significant(P<0.05).At the 22th week of treatment,the proportion of patients in the study group who took adequate amounts of non-BZDs drugs(23.08%vs.58.33%)was lower than that in the control group,and the proportion of patients who discontinued medication(28.21%vs.8.33%)was higher than that in the control group,and the difference was statistically significant(P<0.05).Conclusion:Compared with non-BZDs drug therapy alone,CBT combined with non-BZDs drug de-escalation therapy used in patients with mild to moderate insomnia is better in the insomnia improvement effect and non-BZDs drug withdrawal,which is worth applying.