A Prevention Program for Insomnia in At-risk Adolescents: A Randomized Controlled Study
A Prevention Program for Insomnia in At-risk Adolescents: A Randomized Controlled Study
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DOI：
10.1542/peds.2020-006833
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发表时间：
2021-03-01
期刊：
影响因子：
8
通讯作者：
Wing, Yun Kwok
中科院分区：
文献类型：
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作者：
Chan, Ngan Yin;Li, Shirley Xin;Wing, Yun Kwok
目的：预防高危青少年将来出现失眠。方法：一项随机对照试验，将 4 周失眠预防计划与非积极对照组进行比较。受试者在基线、干预后以及干预后 6 个月和 12 个月时进行评估。评估人员对随机分组不知情。根据意向治疗原则进行分析。 结果：共有 242 名有失眠家族史和阈下失眠症状的青少年被随机分配到干预组（n = 121；平均年龄 = 14.7 +/- 1.8；女性：51.2%）或对照组（n = 121；平均年龄 = 15.0 +/- 1.7；女性： 62.0%）。在 12 个月的随访中，与对照组相比，干预组的失眠症（急性和慢性）发生率较低（5.8% vs 20.7%；P = .002；需要治疗的人数 = 6.7；风险比 = 0.29；95% 置信区间：0.12-0.66；P = .003）。在干预后和整个 12 个月的随访期间，干预组的失眠症状有所减轻 (P = .03)，并降低了与压力相关的失眠的易感性 (P = .03)。干预后观察到白天嗜睡减少 (P = .04)、睡眠卫生习惯改善 (P = .02) 和总睡眠时间增加 (P = .05)。与对照组相比，干预组在 12 个月的随访中报告的抑郁症状也较少 (P = .02)。结论：简短的认知行为计划可有效预防失眠发作并改善脆弱因素和功能结果。
OBJECTIVES: To prevent the future development of insomnia in at-risk adolescents.METHODS: A randomized controlled trial comparing 4 weekly insomnia prevention program with a nonactive control group. Subjects were assessed at baseline, postintervention, and 6 and 12 months after intervention. Assessors were blinded to the randomization. Analyses were conducted on the basis of the intention-to-treat principles.RESULTS: A total of 242 adolescents with family history of insomnia and subthreshold insomnia symptoms were randomly assigned to an intervention group (n = 121; mean age = 14.7 +/- 1.8; female: 51.2%) or control group (n = 121; mean age = 15.0 +/- 1.7; female: 62.0%). There was a lower incidence rate of insomnia disorder (both acute and chronic) in the intervention group compared with the control group (5.8% vs 20.7%; P = .002; number needed to treat = 6.7; hazard ratio = 0.29; 95% confidence interval: 0.12-0.66; P = .003) over the 12-month follow-up. The intervention group had decreased insomnia symptoms (P = .03) and reduced vulnerability to stress-related insomnia (P = .03) at postintervention and throughout the 12-month follow-up. Decreased daytime sleepiness (P = .04), better sleep hygiene practices (P = .02), and increased total sleep time (P = .05) were observed at postintervention. The intervention group also reported fewer depressive symptoms at 12-month follow-up (P = .02) compared with the control group.CONCLUSIONS: A brief cognitive behavioral program is effective in preventing the onset of insomnia and improving the vulnerability factors and functioning outcomes.