Brief Behavioral Therapy for Refractory Insomnia in Residual Depression: An Assessor-Blind, Randomized Controlled Trial
Brief Behavioral Therapy for Refractory Insomnia in Residual Depression: An Assessor-Blind, Randomized Controlled Trial
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DOI：
10.4088/jcp.10m06130gry
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发表时间：
2011-12-01
影响因子：
5.3
通讯作者：
Perlis, Michael L.
中科院分区：
文献类型：
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作者：
Watanabe, Norio;Furukawa, Toshi A.;Perlis, Michael L.
目的：尽管对抑郁症进行了药物治疗，但失眠常常持续存在，并且是其完全缓解的障碍。本研究旨在探讨短期行为疗法治疗失眠相对于常规治疗 (TAU) 对残余抑郁和难治性失眠的附加价值。方法：37 名门诊患者（平均年龄 50.5 岁）被随机分配接受单独 TAU 或 TAU 加短期行为疗法治疗失眠，每周 4 次，每次 1 小时。失眠严重程度指数（ISI）评分（主要结果）、睡眠参数和GRID-汉密尔顿抑郁评定量表（GRID-HAMD）评分由盲评者进行评估，并在4周和8周的随访中收集失眠和抑郁的缓解率。患者的招募时间为2008年2月18日至2009年4月9日。结果：短期行为疗法联合TAU治疗8周时的ISI评分显着低于单独TAU（P < .0005）。组合的睡眠效率也显着优于单独使用 TAU (P=.015)。在总 GRID-HAMD 评分 (P=.013) 和去除 3 个睡眠项目后的 GRID-HAMD 评分 (P=.008) 上观察到有利于联合组的显着差异。与单独使用 TAU 相比，联合治疗的缓解率更高，无论是在失眠方面（50% vs 0%），需要治疗的人数 (NNT) 为 2（95% CI，1-4），还是在抑郁方面（50% vs 6%），NNT 为 2（95% CI，1-5）。结论：在残留抑郁症和治疗难治性失眠的患者中，增加针对失眠的简短行为疗法与通常的临床护理相比，产生了统计学上显着的和临床上实质性的附加益处。试验注册：clinicaltrials.gov 标识符：NCT00610259 J Clin Psychiatry 2011;72(12):1651-1658 (C) 版权所有 2011 Physicians Postgraduate Press, Inc.
Objective: Insomnia often persists despite pharmacotherapy in depression and represents an obstacle to its full remission. This study aimed to investigate the added value of brief behavioral therapy for insomnia over treatment as usual (TAU) for residual depression and refractory insomnia.Method: Thirty-seven outpatients (mean age of 50.5 years) were randomly assigned to TAU alone or TAU plus brief behavioral therapy for insomnia, consisting of 4 weekly 1-hour individual sessions. The Insomnia Severity Index (ISI) scores (primary outcome), sleep parameters, and GRID-Hamilton Depression Rating Scale (GRID-HAMD) scores were assessed by blind raters and remission rates for both insomnia and depression were collected at 4- and 8-week follow-ups. The patients were recruited from February 18, 2008, to April 9, 2009.Results: Brief behavioral therapy for insomnia plus TAU resulted in significantly lower ISI scores than TAU alone at 8 weeks (P < .0005). The sleep efficiency for the combination was also significantly better than that for TAU alone (P=.015). Significant differences were observed in favor of the combination group on both the total GRID-HAMD scores (P=.013) and the GRID-HAMD scores after removing the 3 sleep items (P=.008). The combination treatment produced higher rates of remission than TAU alone, both in terms of insomnia (50% vs 0%), with a number needed to treat (NNT) of 2(95% CI, 1-4), and in terms of depression (50% vs 6%), with an NNT of 2 (95% CI, 1-5).Conclusions: In patients with residual depression and treatment refractory insomnia, adding brief behavioral therapy for insomnia to usual clinical care produced statistically significant and clinically substantive added benefits. Trial Registration: clinicaltrials.gov Identifier: NCT00610259 J Clin Psychiatry 2011;72(12):1651-1658 (C) Copyright 2011 Physicians Postgraduate Press, Inc.