Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial.
Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial.
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认知行为疗法单独并与药物相结合，用于持续性失眠：一项随机对照试验。
DOI：
10.1001/jama.2009.682
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发表时间：
2009-05-20
影响因子：
120.7
通讯作者：
Baillargeon, Lucie
中科院分区：
文献类型：
--
作者：
Morin, Charles M.;Vallieres, Annie;Guay, Bernard;Ivers, Hans;Savard, Josee;Merette, Chantal;Bastien, Celyne;Baillargeon, Lucie
认知行为疗法（CBT）和催眠药物对失眠症的短期治疗是有效的，但很少有患者通过任何单一治疗达到完全缓解。目前尚不清楚联合治疗或维持治疗是否会改善结局。评估药物治疗相对于单独CBT治疗失眠症的急性治疗的附加价值以及维持治疗对长期结局的影响。一项前瞻性、随机、临床试验，包括2002年1月至2005年4月在大学医院睡眠中心治疗的160名持续性失眠成年人的两阶段治疗。参与者接受CBT单独或CBT加唑吡坦的初始6周治疗，随后延长6个月治疗。接受CBT治疗的患者最初接受每月维持CBT或不接受额外治疗，接受联合治疗的患者最初继续接受CBT加间歇性药物治疗或不用药的CBT（逐渐减量）。睡眠开始潜伏期、睡眠开始后的清醒时间、总睡眠时间和来自每日日记的睡眠效率（主要）以及来自失眠严重程度指数的应答率和缓解率（次要）。CBT单独使用或与药物联合使用，在初始治疗期间，睡眠潜伏期、睡眠开始后的清醒时间和睡眠效率均得到显著改善（P < 0.001）;联合使用方法可获得更大的睡眠时间增加（P = 0.04）。CBT和联合治疗产生了相似的治疗应答率（60% [45/75] vs. 61% [45/74]，P = 0.84）和缓解（39% [29/75] vs. 44% [33/74]，P = 0.52）接受急性治疗，但在延长治疗和随访期间，联合治疗相对于单独CBT产生了更高的缓解率（56% [43/74，32/59]对比43% [34/75，28/68]，P = 0.05）。最好的长期结果是最初接受联合治疗的患者，其次是单独接受CBT治疗的患者，6个月随访时的缓解率高于在扩展治疗期间继续用药的患者（67% [20/30] vs. 41% [12/29]，P = 0.04）在持续性失眠患者中，在CBT基础上增加药物治疗在急性治疗期间产生额外的益处，但在维持性CBT期间停药时，长期结果是最佳的。
Cognitive-behavior therapy (CBT) and hypnotic medications are efficacious for short-term treatment of insomnia, but few patients achieve complete remission with any single treatment. It is unclear whether combined or maintenance therapies would enhance outcome. To evaluate the added value of medication over CBT alone for acute treatment of insomnia and the effects of maintenance therapies on long-term outcome. Prospective, randomized, clinical trial involving two-stage therapy with 160 adults with persistent insomnia treated at a university hospital sleep center between January 2002 and April 2005. Participants received CBT alone or CBT plus zolpidem for an initial six-week therapy, followed by extended 6-month therapy. Patients treated with CBT initially attended monthly maintenance CBT or no additional treatment and those treated with combined therapy initially continued with CBT plus intermittent medication or CBT without medication (tapering). Sleep onset latency, time awake after sleep onset, total sleep time, and sleep efficiency derived from daily diaries (primary) and response and remission rates derived from the Insomnia Severity Index (secondary). CBT used singly or in combination with medication produced significant improvements of sleep latency, time awake after sleep onset, and sleep efficiency during initial therapy (Ps < 0.001); a larger increase of sleep time was obtained with the combined approach (P = 0.04). Both CBT and combined therapies produced similar rates of treatment responders (60% [45/75] vs. 61% [45/74], P = 0.84) and remissions (39% [29/75] vs. 44% [33/74], P = 0.52) with acute treatment, but combined therapy produced a higher remission rate relative to CBT alone over the extended therapy and follow up period (56% [43/74, 32/59] vs. 43% [34/75, 28/68], P = 0.05). The best long-term outcome was obtained with patients treated with combined therapy initially, followed by CBT alone, as evidenced by higher remission rates at the 6-month follow-up relative to patients who remained on medication during extended therapy (67% [20/30] vs. 41% [12/29], P = 0.04) In patients with persistent insomnia, the addition of medication to CBT produces added benefits during acute therapy, but long-term outcome is optimized when medication is discontinued during maintenance CBT.
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影响因子：
4.8
作者：
Bastien, Celyne H.;Vallieres, Annie;Morin, Charles M.
通讯作者：
Morin, Charles M.
影响因子：
5.6
作者：
Hauri, PJ
通讯作者：
Hauri, PJ
影响因子：
120.7
作者：
FORD, DE;KAMEROW, DB
通讯作者：
KAMEROW, DB
影响因子：
5.6
作者：
Manber, Rachel;Edinger, Jack D.;Kalista, Tasha
通讯作者：
Kalista, Tasha
影响因子：
--
作者：
Morin, Charles M.;Belanger, Lynda;Gregoire, Jean-Pierre
通讯作者：
Gregoire, Jean-Pierre