Effect of Digital Cognitive Behavioral Therapy for Insomnia on Health, Psychological Well-being, and Sleep-Related Quality of Life: A Randomized Clinical Trial
Effect of Digital Cognitive Behavioral Therapy for Insomnia on Health, Psychological Well-being, and Sleep-Related Quality of Life: A Randomized Clinical Trial
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DOI：
10.1001/jamapsychiatry.2018.2745
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发表时间：
2019-01-01
期刊：
影响因子：
25.8
通讯作者：
Luik, Annemarie I.
中科院分区：
文献类型：
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作者：
Espie, Colin A.;Emsley, Richard;Luik, Annemarie I.
重要性 数字认知行为疗法 (dCBT) 是一种可扩展且有效的失眠治疗干预措施。然而，大多数失眠患者会因为白天睡眠不佳而寻求帮助，这会对生活质量产生不利影响。 目的 调查 dCBT 治疗失眠对功能健康、心理健康和睡眠相关生活质量的影响，并确定失眠症状的减轻是否是一个中介因素。 设计、设置和参与者 这项在线、2 臂、平行组随机试验比较 dCBT 治疗失眠与睡眠卫生教育 (SHE) 对 1711 名自述有失眠症状的参与者进行了评估。参与者于2015年12月1日至2016年12月1日期间招募，并使用网络和/或移动渠道提供dCBT并照常进行治疗； SHE 包括一个网站和一本可下载的小册子以及像往常一样的治疗。在线评估在第 0（基线）、第 4（治疗中期）、第 8（治疗后）和第 24（随访）周进行。项目在纳入后 12 周内完成。 主要结果和测量 主要结果是自我报告的功能健康测量得分（患者报告结果测量信息系统：全球健康量表；范围 10-50；得分越高表明健康状况越好）；心理健康（沃里克-爱丁堡心理健康量表；范围，14-70；分数越高表示幸福感越好）；和睡眠相关的生活质量（格拉斯哥睡眠影响指数；范围，1-100；分数越高表明损害越大）。次要结果包括情绪、疲劳、困倦、认知障碍、工作效率和关系满意度。使用睡眠状况指标评估失眠（范围：0-32；分数越高表示睡眠越好）。 结果 在意向治疗分析中纳入的 1711 名参与者中，1329 名 (77.7%) 为女性，平均 (SD) 年龄为 48.0 (13.8) 岁，1558 名 (91.1%) 为白人。与 SHE 相比，使用 dCBT 与功能健康（第 4 周的调整差异 [95% CI]，0.90 [0.40-1.40]；第 8 周，1.76 [1.24-2.28]；第 24 周，1.76 [1.22-2.30]）和心理健康（第 4 周的调整差异 [95% CI]， 1.04 [0.28-1.80]；第 8 周，2.68 [1.89-3.47]；第 24 周，2.95 [2.13-3.76]），并且与睡眠相关的生活质量大幅改善（第 4 周，-8.76 [-11.83 至 -5.69]；第 8 周，-17.60 [-20.81 至-14.39]；第 24 周，-18.72 [-22.04 至 -15.41]）（所有 P < .01）。失眠的大幅改善介导了这些结果（范围介导，45.5%-84.0%）。结论和相关性使用 dCBT 可有效改善报告失眠症状的人的功能健康、心理健康和睡眠相关的生活质量。失眠症状的减少可以促进这些改善。这些结果证实，dCBT 可改善白天和夜间的失眠，强化了 CBT 作为失眠治疗选择的现有建议。
IMPORTANCE Digital cognitive behavioral therapy (dCBT) is a scalable and effective intervention for treating insomnia. Most people with insomnia, however, seek help because of the daytime consequences of poor sleep, which adversely affects quality of life.OBJECTIVES To investigate the effect of dCBT for insomnia on functional health, psychological well-being, and sleep-related quality of life and to determine whether a reduction in insomnia symptoms was a mediating factor.DESIGN, SETTING, AND PARTICIPANTS This online, 2-arm, parallel-group randomized trial comparing dCBT for insomnia with sleep hygiene education (SHE) evaluated 1711 participants with self-reported symptoms of insomnia. Participants were recruited between December 1, 2015, and December 1, 2016, and dCBT was delivered using web and/or mobile channels plus treatment as usual; SHE comprised a website and a downloadable booklet plus treatment as usual. Online assessments took place at 0 (baseline), 4 (midtreatment), 8 (posttreatment), and 24 (follow-up) weeks. Programs were completed within 12 weeks after inclusion.MAIN OUTCOMES AND MEASURES Primary outcomes were scores on self-reported measures of functional health (Patient-Reported Outcomes Measurement Information System: Global Health Scale; range, 10-50; higher scores indicate better health); psychological well-being (Warwick-Edinburgh Mental Well-being Scale; range, 14-70; higher scores indicate greater well-being); and sleep-related quality of life (Glasgow Sleep Impact Index; range, 1-100; higher scores indicate greater impairment). Secondary outcomes comprised mood, fatigue, sleepiness, cognitive failures, work productivity, and relationship satisfaction. Insomnia was assessed with the Sleep Condition Indicator (range: 0-32; higher scores indicate better sleep).RESULTS Of the 1711 participants included in the intention-to-treat analysis, 1329 (77.7%) were female, mean (SD) age was 48.0 (13.8) years, and 1558 (91.1%) were white. Use of dCBT was associated with a small improvement in functional health compared with SHE (adjusted difference [95% CI] at week 4, 0.90 [0.40-1.40]; week 8, 1.76 [1.24-2.28]; week 24, 1.76 [1.22-2.30]) and psychological well-being (adjusted difference [95% CI] at week 4, 1.04 [0.28-1.80]; week 8, 2.68 [1.89-3.47]; week 24, 2.95 [2.13-3.76]), and with a large improvement in sleep-related quality of life (at week 4, -8.76 [-11.83 to -5.69]; week 8, -17.60 [-20.81 to -14.39]; week 24, -18.72 [-22.04 to -15.41]) (all P < .01). A large improvement in insomnia mediated these outcomes (range mediated, 45.5%-84.0%).CONCLUSIONS AND RELEVANCE Use of dCBT is effective in improving functional health, psychological well-being, and sleep-related quality of life in people reporting insomnia symptoms. A reduction in insomnia symptoms mediates these improvements. These results confirm that dCBT improves both daytime and nighttime aspects of insomnia, strengthening existing recommendations of CBT as the treatment of choice for insomnia.