The effectiveness of the behavioural components of cognitive behavioural therapy for insomnia in older adults: A systematic review.
The effectiveness of the behavioural components of cognitive behavioural therapy for insomnia in older adults: A systematic review.
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认知行为疗法的行为成分对老年人失眠的有效性：系统评价。
DOI：
10.1111/jsr.13843
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发表时间：
2023
影响因子：
4.4
通讯作者：
McLaren DM
中科院分区：
文献类型：
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作者：
McLaren DM
失眠在老年人（>60 岁）中比一般人群更普遍。失眠的认知行为疗法是金标准治疗方法；然而，对于某些人来说，这可能会导致认知负担过重。本系统综述旨在批判性地审查探索明确行为干预对老年人失眠的有效性的文献，次要目的是调查其对情绪和日间功能的影响。检索了四个电子数据库（MEDLINE – Ovid、Embase – Ovid、CINAHL 和 PsycINFO）。所有实验性、准实验性和预实验性研究都被纳入其中，前提是它们： (a) 以英文发表； (b) 招募患有失眠症的老年人； (c) 使用睡眠限制和/或刺激控制； (d) 报告干预前后的结果。数据库检索返回 1689 篇文章；纳入了 15 项研究，总结了 498 名老年人的结果，其中三项侧重于刺激控制，四项侧重于睡眠限制，八项研究采用了由两种干预措施组成的多成分治疗。所有干预措施都在睡眠的一个或多个主观测量方面带来了显着改善，尽管总体而言，多成分疗法显示出更大的效果（中位 Hedge'sg= 0.55）。体动记录或多导睡眠图结果表明影响较小或没有影响。多成分干预措施中抑郁症指标有所改善，但没有任何干预措施显示焦虑症指标有任何统计上显着的改善。这证实了现有的共识，即多成分方法能带来最大的益处，并通过简短、明确的行为干预来证明这一点，从而丰富了文献。这篇综述指导了未来对不适合采用认知行为疗法治疗失眠的人群的失眠治疗研究。
Insomnia is more prevalent in older adults (> 60 years) than in the general population. Cognitive behavioural therapy for insomnia is the gold‐standard treatment; however, it may prove too cognitively taxing for some. This systematic review aimed to critically examine the literature exploring the effectiveness of explicitly behavioural interventions for insomnia in older adults, with secondary aims of investigating their effect on mood and daytime functioning. Four electronic databases (MEDLINE – Ovid, Embase – Ovid, CINAHL, and PsycINFO) were searched. All experimental, quasi‐experimental and pre‐experimental studies were included, provided they: (a) were published in English; (b) recruited older adults with insomnia; (c) used sleep restriction and/or stimulus control; (d) reported outcomes pre‐and‐post intervention. Database searches returned 1689 articles; 15 studies, summarising the results of 498 older adults, were included – three focused on stimulus control, four on sleep restriction, and eight adopted multicomponent treatments comprised of both interventions. All interventions brought about significant improvements in one or more subjectively measured facets of sleep although, overall, multicomponent therapies demonstrated larger effects (median Hedge'sg= 0.55). Actigraphic or polysomnographic outcomes demonstrated smaller or no effects. Improvements in measures of depression were seen in multicomponent interventions, but no intervention demonstrated any statistically significant improvement in measures of anxiety. This corroborates with the existing consensus that multicomponent approaches confer the most benefit, and adds to the literature by demonstrating this to be the case in brief, explicitly behavioural interventions. This review guides future study of treatments for insomnia in populations where cognitive behavioural therapy for insomnia is not appropriate.