Effects of Pharmacologic and Nonpharmacologic Interventions on Insomnia Symptoms and Self-reported Sleep Quality in Women With Hot Flashes: A Pooled Analysis of Individual Participant Data From Four MsFLASH Trials
Effects of Pharmacologic and Nonpharmacologic Interventions on Insomnia Symptoms and Self-reported Sleep Quality in Women With Hot Flashes: A Pooled Analysis of Individual Participant Data From Four MsFLASH Trials
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DOI：
10.1093/sleep/zsx190
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发表时间：
2018-01-01
期刊：
影响因子：
5.6
通讯作者：
McCurry, Susan M.
中科院分区：
文献类型：
--
作者：
Guthrie, Katherine A.;Larson, Joseph C.;McCurry, Susan M.
研究目的：更年期策略：为症状和健康寻找持久的答案网络进行了三项随机临床试验（RCT），测试了六种治疗血管痉挛症状（VMS）的干预措施，并收集了自我报告的睡眠结果。第四项RCT评估了VMS女性失眠症状的干预措施。我们描述了这七种干预措施相对于对照组的影响，这些干预措施对患有严重失眠症状和VMS.Methods的妇女的影响：我们分析了来自546名围绝经期和绝经后妇女的汇总个人水平数据，这些妇女的失眠严重程度指数（ISI）>= 12，并且在四项RCT中每周有>= 14个令人烦恼的VMS。干预措施包括：艾司西酞普兰10-20 mg/天;瑜伽;有氧运动; 1.8 g/天omega-3脂肪酸;口服17-β-雌二醇0.5 mg/天;文拉法辛XR 75 mg/天;失眠症认知行为治疗（CBT-I）。结果测量ISI和匹兹堡睡眠质量指数（PSQI）超过8-12周的treatment.Results：CBT-I产生的ISI从基线相对于控制在-5.2点（95%CI-7.0至-3.4）的最大减少。运动对ISI的影响在-2.1和文拉法辛在-2.3点相似。艾司西酞普兰、瑜伽和雌二醇组ISI下降幅度较小。CBT-I组PSQI较基线下降最多，为-2.7分（-3.9至-1.5），但艾司西酞普兰、运动、瑜伽、雌二醇和文拉法辛组PSQI下降1.2至1.6分，显著优于对照组。Omega-3补充剂并没有改善失眠symptoms.Conclusions：这项研究的结果支持目前的建议CBT-I作为一线治疗健康的中年妇女失眠症状和中度烦恼VMS。
Study Objectives: The Menopause Strategies: Finding Lasting Answers for Symptoms and Health network conducted three randomized clinical trials (RCTs) testing six interventions treating vasomotor symptoms (VMS), and also collected self-reported sleep outcomes. A fourth RCT assessed an intervention for insomnia symptoms among women with VMS. We describe these seven interventions' effects relative to control in women with comparably severe insomnia symptoms and VMS.Methods: We analyzed pooled individual-level data from 546 peri-and postmenopausal women with Insomnia Severity Index (ISI) >= 12, and >= 14 bothersome VMS/week across the four RCTs. Interventions included the following: escitalopram 10-20 mg/day; yoga; aerobic exercise; 1.8 g/day omega-3 fatty acids; oral 17-beta-estradiol 0.5-mg/day; venlafaxine XR 75-mg/day; and cognitive behavioral therapy for insomnia (CBT-I). Outcome measures were ISI and Pittsburgh Sleep Quality Index (PSQI) over 8-12 weeks of treatment.Results: CBT-I produced the greatest reduction in ISI from baseline relative to control at -5.2 points (95% CI -7.0 to -3.4). Effects on ISI were similar for exercise at -2.1 and venlafaxine at -2.3 points. Comparably small decreases in ISI were observed with escitalopram, yoga, and estradiol. The largest reduction in PSQI from baseline was with CBT-I at -2.7 points (-3.9 to -1.5), although PSQI decreases of 1.2 to 1.6 points were significantly better than control with escitalopram, exercise, yoga, estradiol, and venlafaxine. Omega-3 supplements did not improve insomnia symptoms.Conclusions: This study's findings support current recommendations for CBT-I as a first line treatment in healthy midlife women with insomnia symptoms and moderately bothersome VMS.