Cognitive Behavioral Therapy for Insomnia in Older Veterans Using Nonclinician Sleep Coaches: Randomized Controlled Trial.
Cognitive Behavioral Therapy for Insomnia in Older Veterans Using Nonclinician Sleep Coaches: Randomized Controlled Trial.
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DOI：
10.1111/jgs.14304
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发表时间：
2016-09
影响因子：
6.3
通讯作者：
Mitchell MN
中科院分区：
文献类型：
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作者：
Alessi C;Martin JL;Fiorentino L;Fung CH;Dzierzewski JM;Rodriguez Tapia JC;Song Y;Josephson K;Jouldjian S;Mitchell MN
测试一种新的失眠症认知行为疗法（CBT-I）程序，该程序设计用于非临床医生。随机对照试验。退伍军人事务部医疗保健系统。60岁及以上的社区居住退伍军人，符合失眠持续时间3个月或更长的诊断标准（N = 159）。非临床医生的“睡眠教练”提供了一个五个会话的基于手册的CBT-I程序，包括刺激控制，睡眠限制，睡眠卫生和认知治疗（单独或小组），每周电话行为睡眠药物监督。对照组接受五次一般睡眠教育。在基线、治疗后评估、6个月和12个月随访时测量主要结局，包括自我报告（7天睡眠日记）的睡眠起始潜伏期（SOL-D）、睡眠起始后觉醒（WASO-D）、总觉醒时间（TWT-D）和睡眠效率（SE-D）;匹兹堡睡眠质量指数（PSQI）;和客观睡眠效率（7天腕动计，SE-A）。其他指标包括失眠严重程度指数（ISI）、抑郁症状（患者健康问卷-9（PHQ-9））和生活质量（医学结局研究12项简短调查第2版（SF-12 v2）。在SOL-D的基线和治疗后评估、基线和6个月评估以及基线和12个月评估之间，干预受试者的改善程度大于对照组（分别为-23.4、-15.8和-17.3分钟），TWT-D（分别为-68.4、-37.0和-30.9分钟），SE-D（分别为10.5%、6.7%和5.4%），PSQI（总分分别为-3.4、-2.4和-2.1）和ISI（总分分别为-4.5、-3.9和-2.8）（均P <0.05）。SE-A、PHQ-9或SF-12 v2无显著差异。由非临床睡眠教练提供的基于手册的CBT-I改善了患有慢性失眠症的老年人的睡眠
To test a new cognitive behavioral therapy for insomnia (CBT-I) program designed for use by nonclinicians. Randomized controlled trial. Department of Veterans Affairs healthcare system. Community-dwelling veterans aged 60 and older who met diagnostic criteria for insomnia of 3 months duration or longer (N = 159). Nonclinician “sleep coaches” delivered a five-session manual-based CBT-I program including stimulus control, sleep restriction, sleep hygiene, and cognitive therapy (individually or in small groups), with weekly telephone behavioral sleep medicine supervision. Controls received five sessions of general sleep education. Primary outcomes, including self-reported (7-day sleep diary) sleep onset latency (SOL-D), wake after sleep onset (WASO-D), total wake time (TWT-D), and sleep efficiency (SE-D); Pittsburgh Sleep Quality Index (PSQI); and objective sleep efficiency (7-day wrist actigraphy, SE-A) were measured at baseline, at the posttreatment assessment, and at 6- and 12-month follow-up. Additional measures included the Insomnia Severity Index (ISI), depressive symptoms (Patient Health Questionnaire-9 (PHQ-9)), and quality of life (Medical Outcomes Study 12-item Short-form Survey version 2 (SF-12v2)). Intervention subjects had greater improvement than controls between the baseline and posttreatment assessments, the baseline and 6-month assessments, and the baseline and 12-month assessments in SOL-D (−23.4, −15.8, and −17.3 minutes, respectively), TWT-D (−68.4, −37.0, and −30.9 minutes, respectively), SE-D (10.5%, 6.7%, and 5.4%, respectively), PSQI (−3.4, −2.4, and −2.1 in total score, respectively), and ISI (−4.5, −3.9, and −2.8 in total score, respectively) (all P < .05). There were no significant differences in SE-A, PHQ-9, or SF-12v2. Manual-based CBT-I delivered by nonclinician sleep coaches improves sleep in older adults with chronic insomnia.