Chronotype and Improved Sleep Efficiency Independently Predict Depressive Symptom Reduction after Group Cognitive Behavioral Therapy for Insomnia
Chronotype and Improved Sleep Efficiency Independently Predict Depressive Symptom Reduction after Group Cognitive Behavioral Therapy for Insomnia
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DOI：
10.5664/jcsm.5018
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发表时间：
2015-01-01
影响因子：
4.3
通讯作者：
Manber, Rachel
中科院分区：
文献类型：
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作者：
Bei, Bei;Ong, Jason C.;Manber, Rachel
研究目的：失眠的认知行为疗法(CBT-I)已被证明可以改善睡眠和抑郁症状，但CBT-I后抑郁结局的预测因素尚未得到很好的检验。本研究调查了接受CBT-I治疗的患者的时间类型(即早晚特质)和睡眠效率变化(SE)与抑郁症状变化的关系。方法：纳入419名来自睡眠障碍门诊的成人失眠患者(43.20%男性，年龄平均+/-标准差=48.14+/-14.02)。所有参与者都完成了清晨综合评定量表，并参加了CBT-I 6节课的至少4节课。从睡眠日记中提取SE；在干预前(基线)和干预结束时(结束)使用Beck抑郁量表(BDI)评估抑郁症状。结果：多水平结构方程模型显示，从基线到干预结束，SE增加，BDI减少。控制基线时的年龄、性别、BDI和SE，晚间时型较强和SE改善较少显著且唯一地预测从基线到结束时BDI减少较少。结论：在失眠门诊样本中，在CBT-I组干预后，SE和抑郁症状显著改善。所有的时型都受益于睡眠改善，但那些夜晚时间更长和/或睡眠改善更少的人抑郁症状严重程度的降低较少。这表明晚上的喜好和失眠症状可能与情绪有明显的关系，这增加了CBT-I对抑郁症状的效果可以通过评估和解决昼夜因素来增强的可能性。
Study Objectives: Cognitive behavioral therapy for insomnia (CBT-I) has been shown to improve both sleep and depressive symptoms, but predictors of depression outcome following CBT-I have not been well examined. This study investigated how chronotype (i.e., morningness-eveningness trait) and changes in sleep efficiency (SE) were related to changes in depressive symptoms among recipients of CBT-I.Methods: Included were 419 adult insomnia outpatients from a sleep disorders clinic (43.20% males, age mean +/- standard deviation = 48.14 +/- 14.02). All participants completed the Composite Scale of Morningness and attended at least 4 sessions of a 6-session group CBT-I. SE was extracted from sleep diary; depressive symptoms were assessed using the Beck Depression Inventory (BDI) prior to (Baseline), and at the end (End) of intervention.Results: Multilevel structural equation modeling revealed that from Baseline to End, SE increased and BDI decreased significantly. Controlling for age, sex, BDI, and SE at Baseline, stronger evening chronotype and less improvement in SE significantly and uniquely predicted less reduction in BDI from Baseline to End. Chronotype did not predict improvement in SE.Conclusions: In an insomnia outpatient sample, SE and depressive symptoms improved significantly after a CBT-I group intervention. All chronotypes benefited from sleep improvement, but those with greater eveningness and/or less sleep improvement experienced less reduction in depressive symptom severity. This suggests that evening preference and insomnia symptoms may have distinct relationships with mood, raising the possibility that the effect of CBT-I on depressive symptoms could be enhanced by assessing and addressing circadian factors.