Cognitive Behavioral Therapy vs. Tai Chi for Late Life Insomnia and Inflammatory Risk: A Randomized Controlled Comparative Efficacy Trial
Cognitive Behavioral Therapy vs. Tai Chi for Late Life Insomnia and Inflammatory Risk: A Randomized Controlled Comparative Efficacy Trial
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DOI：
10.5665/sleep.4008
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发表时间：
2014-09-01
期刊：
影响因子：
5.6
通讯作者：
Nicassio, Perry
中科院分区：
文献类型：
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作者：
Irwin, Michael R.;Olmstead, Richard;Nicassio, Perry
研究目的：探讨认知行为疗法（CBT）、太极拳（TCC）和睡眠研讨会教育控制（SS）对老年失眠症患者失眠诊断的主要结局、睡眠质量、疲劳、抑郁症状和炎症等次要结局的比较疗效。设计：随机对照、比较疗效试验。背景：洛杉矶社区。患者：123名患有慢性和原发性失眠症的老年人。干预措施：随机分配到CBT、TCC或SS组，每周2小时，持续4个月，随访时间为7个月和16个月。测量：失眠诊断、患者报告的结果、多导睡眠图（PSG）和高敏c反应蛋白（CRP）水平。结果：经临床证实，CBT对临床失眠的缓解效果优于TCC和SS (P < 0.01)，在睡眠质量、睡眠参数、疲劳、抑郁症状等方面的改善效果也优于TCC和SS （P均< 0.01）。与SS相比，CBT与16个月时高CRP水平（> 3.0 mg/L）的风险降低相关（优势比[OR]， 0.26 [95% CI, 0.07-0.97] P < 0.05）。16个月时，失眠缓解与CRP水平降低相关（P < 0.05）。与SS相比，TCC与睡眠质量、疲劳和抑郁症状的改善相关（均P < 0.05），但与失眠缓解无关。PSG指标没有改变。结论：认知行为疗法对老年失眠症的治疗效果较好。失眠的治疗和缓解降低了炎症风险的标志，这对流行病学调查中观察到的与睡眠障碍有关的心血管发病率和糖尿病有影响。
Study Objectives: To investigate the comparative efficacy of cognitive behavioral therapy (CBT), Tai Chi Chih (TCC), and sleep seminar education control (SS) on the primary outcome of insomnia diagnosis, and secondary outcomes of sleep quality, fatigue, depressive symptoms, and inflammation in older adults with insomnia.Design: Randomized controlled, comparative efficacy trial.Setting: Los Angeles community.Patients: 123 older adults with chronic and primary insomnia.Interventions: Random assignment to CBT, TCC, or SS for 2-hour group sessions weekly over 4 months with follow-up at 7 and 16 months.Measurements: Insomnia diagnosis, patient-reported outcomes, polysomnography (PSG), and high-sensitivity C-reactive protein (CRP) levels.Results: CBT performed better than TCC and SS in remission of clinical insomnia as ascertained by a clinician (P < 0.01), and also showed greater and more sustained improvement in sleep quality, sleep parameters, fatigue, and depressive symptoms than TCC and SS (all P values < 0.01). As compared to SS, CBT was associated with a reduced risk of high CRP levels (> 3.0 mg/L) at 16 months (odds ratio [OR], 0.26 [ 95% CI, 0.07-0.97] P < 0.05). Remission of insomnia was associated with lower levels of CRP (P < 0.05) at 16 months. TCC was associated with improvements in sleep quality, fatigue, and depressive symptoms as compared to SS (all P's < 0.05), but not insomnia remission. PSG measures did not change.Conclusions: Treatment of late-life insomnia is better achieved and sustained by cognitive behavioral therapies. Insomnia treatment and remission reduces a marker of inflammatory risk, which has implications for cardiovascular morbidity and diabetes observed with sleep disturbance in epidemiologic surveys.