Improving perinatal sleep via a scalable cognitive behavioural intervention: findings from a randomised controlled trial from pregnancy to 2 years postpartum.
Improving perinatal sleep via a scalable cognitive behavioural intervention: findings from a randomised controlled trial from pregnancy to 2 years postpartum.
复制标题
通过可扩展的认知行为干预改善围产期睡眠：从怀孕到产后2年的随机对照试验的发现。
DOI：
10.1017/s0033291721001860
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发表时间：
2023-01
影响因子：
6.9
通讯作者：
Manber R
中科院分区：
文献类型：
--
作者：
Bei B;Pinnington DM;Quin N;Shen L;Blumfield M;Wiley JF;Drummond SPA;Newman LK;Manber R
睡眠障碍是常见的妊娠父母在怀孕期间和产后期间。这项研究评估了针对这些时期的可扩展认知行为疗法（CBT）睡眠干预的可行性和有效性。这是一项双臂、平行组、单盲、优效性随机对照试验。将无严重医学/精神疾病的未生育女性以1：1的比例随机分配至CBT或注意力和时间匹配的对照组。所有参与者从第三个三个月到产后6个月接受了1小时的电话会议和自动多媒体电子邮件。在妊娠第30周（基线）和35周（妊娠终点）以及产后1.5、3、6个月（产后终点）、12和24个月，使用经验证的工具评估结局。163例合格受试者（年龄M ± SD = 33.35 ± 3.42）接受随机化。CBT干预被广泛接受，没有报告不良反应。意向治疗分析显示，与对照组相比，接受CBT与失眠严重程度和睡眠障碍（两个主要结局）降低相关，在妊娠终点（p值≤.001）以及产后24个月（p范围.012-.052）时睡眠相关损害降低。产后第一年的组间差异不显著。基线时失眠症状升高的参与者从CBT（与对照组相比）中获益更多，包括在产后第一年失眠症状显着降低。抑郁或焦虑症状的组间差异不显著。可扩展的CBT睡眠干预可有效缓冲怀孕期间的睡眠障碍，并在产后2年改善睡眠，特别是对于怀孕期间有失眠症状的人。该干预措施有望在常规围产期护理中实施。
Sleep disturbance is common in gestational parents during pregnancy and postpartum periods. This study evaluated the feasibility and efficacy of a scalable cognitive behavioural therapy (CBT) sleep intervention tailored for these periods. This is a two-arm, parallel-group, single-blind, superiority randomised controlled trial. Nulliparous females without severe medical/psychiatric conditions were randomised 1:1 to CBT or attention- and time-matched control. All participants received a 1-hr telephone session and automated multimedia emails from the 3rd trimester until 6 months postpartum. Outcomes were assessed with validated instruments at gestation weeks 30 (baseline) and 35 (pregnancy endpoint), and postpartum months 1.5, 3, 6 (postpartum endpoint), 12, and 24. 163 eligible participants (age M±SD=33.35±3.42) were randomised. The CBT intervention was well accepted, with no reported adverse effect. Intention-to-treat analyses showed that compared to control, receiving CBT was associated with lower insomnia severity and sleep disturbance (two primary outcomes), and lower sleep-related impairment at the pregnancy endpoint (p-values ≤ .001), as well as at 24 months postpartum (p ranges .012–.052). Group differences across the first postpartum year were nonsignificant. Participants with elevated insomnia symptoms at baseline benefitted substantially more from CBT (vs control), including having significantly lower insomnia symptoms throughout the first postpartum year. Group differences in symptoms of depression or anxiety were nonsignificant. A scalable CBT sleep intervention is efficacious in buffering against sleep disturbance during pregnancy and benefitted sleep at 2-year postpartum, especially for individuals with insomnia symptoms during pregnancy. The intervention holds promise for implementation into routine perinatal care.