The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis.
The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis.
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DOI：
10.1016/s2215-0366(17)30328-0
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发表时间：
2017-10
期刊：
影响因子：
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通讯作者：
Espie CA
中科院分区：
文献类型：
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作者：
Freeman D;Sheaves B;Goodwin GM;Yu LM;Nickless A;Harrison PJ;Emsley R;Luik AI;Foster RG;Wadekar V;Hinds C;Gumley A;Jones R;Lightman S;Jones S;Bentall R;Kinderman P;Rowse G;Brugha T;Blagrove M;Gregory AM;Fleming L;Walklet E;Glazebrook C;Davies EB;Hollis C;Haddock G;John B;Coulson M;Fowler D;Pugh K;Cape J;Moseley P;Brown G;Hughes C;Obonsawin M;Coker S;Watkins E;Schwannauer M;MacMahon K;Siriwardena AN;Espie CA
睡眠困难可能是精神健康问题发生的一个促成因素。如果这是真的，改善睡眠应该有益于心理健康。我们的目的是确定治疗失眠是否会减少偏执和幻觉。我们在26所英国大学进行了这项单盲随机对照试验（OASIS）。患有失眠症的大学生被随机分配（1：1），接受数字认知行为疗法（CBT）治疗失眠或常规护理，研究小组对治疗方法不知情。在线评估在第0、3、10（治疗结束）和22周进行。主要结局指标为失眠、偏执和幻觉经历。我们做了意向治疗分析。该试验已在ISRCTN登记处注册，编号为ISRCTN 61272251。在2015年3月5日至2016年2月17日期间，我们随机分配了3755名参与者接受数字CBT治疗失眠（n=1891）或常规治疗（n=1864）。与通常的做法相比，第10周的睡眠干预减少了失眠（校正差异4.78，95% CI 4.29至5.26，Cohen's d= 1.11; p<0.0001），偏执（−2·22，−2·98 ~ −1·45，科恩d=0·19; p<0·0001）和幻觉（−1·58，−1·98 ~ −1·18，科恩d=0·24; p<0·0001）。偏执狂和幻觉的变化是一个中介。未报告不良事件。据我们所知，这是对心理健康问题进行心理干预的最大随机对照试验。它提供了强有力的证据，证明失眠是精神病经历和其他心理健康问题发生的一个因果因素。研究结果是否适用于学生群体以外的人群，需要进行测试。睡眠中断的治疗可能需要在心理健康方面给予更高的优先级。Wellcome Trust.
Sleep difficulties might be a contributory causal factor in the occurrence of mental health problems. If this is true, improving sleep should benefit psychological health. We aimed to determine whether treating insomnia leads to a reduction in paranoia and hallucinations. We did this single-blind, randomised controlled trial (OASIS) at 26 UK universities. University students with insomnia were randomly assigned (1:1) with simple randomisation to receive digital cognitive behavioural therapy (CBT) for insomnia or usual care, and the research team were masked to the treatment. Online assessments took place at weeks 0, 3, 10 (end of therapy), and 22. The primary outcome measures were for insomnia, paranoia, and hallucinatory experiences. We did intention-to-treat analyses. The trial is registered with the ISRCTN registry, number ISRCTN61272251. Between March 5, 2015, and Feb 17, 2016, we randomly assigned 3755 participants to receive digital CBT for insomnia (n=1891) or usual practice (n=1864). Compared with usual practice, the sleep intervention at 10 weeks reduced insomnia (adjusted difference 4·78, 95% CI 4·29 to 5·26, Cohen's d=1·11; p<0·0001), paranoia (−2·22, −2·98 to −1·45, Cohen's d=0·19; p<0·0001), and hallucinations (−1·58, −1·98 to −1·18, Cohen's d=0·24; p<0·0001). Insomnia was a mediator of change in paranoia and hallucinations. No adverse events were reported. To our knowledge, this is the largest randomised controlled trial of a psychological intervention for a mental health problem. It provides strong evidence that insomnia is a causal factor in the occurrence of psychotic experiences and other mental health problems. Whether the results generalise beyond a student population requires testing. The treatment of disrupted sleep might require a higher priority in mental health provision. Wellcome Trust.