Behavioral Treatment of Menopausal Insomnia; Sleep, Depression, Daytime Outcomes

更年期失眠的行为治疗；

• 批准号: 8577148
• 负责人: CHRISTOPHER L DRAKE
• 金额: $ 44.15万
• 依托单位: HENRY FORD HEALTH SYSTEM
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-01 至 2018-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8577148
• 关键词: Acute; Address; Adult; Adverse event; Affect; American; Arousal; Behavior Therapy; Biofeedback; Biological; Chronic; Chronic Insomnia; Clinical; Clinical Trials; Cognitive Therapy; Comorbid Insomnia; Depressed mood; Development; Disadvantaged; Disease; Distress; Effectiveness; Endocrinologist; Evidence based treatment; Fatigue; Frequencies; Gonadal Steroid Hormones; Guidelines; Health; Heart Diseases; High Prevalence; Hormone replacement therapy; Hygiene; Impairment; Laboratories; Link; Longevity; Maintenance; Major Depressive Disorder; Malignant Neoplasms; Measures; Menopausal Symptom; Menopause; Mental Depression; Morbidity - disease rate; Outcome; Patient Self-Report; Patients; Pattern; Performance at work; Pharmaceutical Preparations; Pharmacological Treatment; Pharmacotherapy; Placebos; Polysomnography; Population; Postmenopause; Primary Health Care; Primary Insomnia; Psychologist; Quality of life; Relative (related person); Relaxation Therapy; Research; Risk; Sleep; Sleep Disorders; Sleep Initiation and Maintenance Disorders; Sleep disturbances; Sleeplessness; Specialist; Stimulus; Symptoms; Testing; Time; Training; Vasomotor; Woman; base; cancer risk; depressive symptoms; design; economic cost; efficacy testing; evidence base; experience; falls; health care service utilization; heart disease risk; improved; medical specialties; public health relevance; sleep onset; traditional therapy

DESCRIPTION (provided by applicant): Insomnia is recognized as one of the most prevalent and costly sleep disorders and is associated with considerable morbidity including significantly reduced quality of life, impaired work performance, and increased risk for major depressive disorder.1-4 Insomnia is a key symptom of the menopausal transition with 40-50% of postmenopausal women (> 17 million) having insomnia.5,6 Insomnia associated with menopause has a pattern of sleep disturbance predominantly characterized by sleep maintenance difficulties including frequent awakenings and arousals, reduced sleep efficiency, and overall fragmented sleep. It has recently been demonstrated that this pattern of sleep disturbance, difficulty maintaining sleep, increases throughout the progression of menopause.7 We have recently found sleep maintenance problems in menopause are associated with reduced work performance, increased healthcare utilization, and impaired quality of life.8 Historically, menopausal symptoms including sleep disturbance, were treated using hormone replacement therapy (HRT). However, evidence linking HRT to increased risks of heart disease and cancer have led to a 40% reduction in the use of sex steroid hormones by postmenopausal women and highlight the need for alternative approaches to treatment.9 Importantly, the American Association of Clinical Endocrinologists guidelines for management of menopause do not address treatment of menopausal-related insomnia due to the absence of research findings in this area.10 Cognitive-behavioral therapy for insomnia (CBT-I) yields equivalent short-term efficacy and superior long-term durability to pharmacological treatment of insomnia. However, the efficacy of cognitive behavioral therapy for insomnia comorbid with menopause, one of the primary focuses of the present proposal, has not been tested. Traditional CBT-I has disadvantages however, including the need for a trained therapist and significant time commitment on the part of the patient. Therefore, widespread availability of multicomponent CBT-I is limited by the relatively low number of CBT sleep specialists, complexity of therapy, and patient burden. Thus, another aim of this project is to test the acute and long-term efficacy of a single component behavioral therapy for menopausal-related insomnia. Given the significant daytime impairment present in insomnia comorbid with menopause including depression, quality of life, and fatigue, a final aim of this proposal is to determine the efficacyof CBT-I on these measures in women with menopausal-related insomnia.

描述（由申请人提供）： 失眠被认为是最普遍和代价最高的睡眠障碍之一，并与相当大的发病率相关，包括生活质量显著降低、工作表现受损和重度抑郁症风险增加。1 -4失眠是绝经过渡期的关键症状，40-50%的绝经后妇女5，6与更年期相关的失眠症患者具有一种睡眠障碍模式，其主要特征是睡眠维持困难，包括频繁醒来和觉醒，睡眠效率降低，以及整体睡眠碎片。最近的研究表明，这种睡眠障碍的模式，难以维持睡眠，在绝经期的整个过程中增加。7我们最近发现，绝经期的睡眠维持问题与工作表现下降，医疗保健利用增加和生活质量受损有关。8历史上，包括睡眠障碍在内的绝经期症状使用激素替代疗法（HRT）进行治疗。然而，将HRT与心脏病和癌症风险增加联系起来的证据已经导致绝经后妇女使用性类固醇激素减少了40%，并强调了替代治疗方法的必要性。美国临床内分泌学家协会的绝经期管理指南没有涉及绝经期的治疗，10失眠症认知行为疗法（CBT-I）与药物治疗失眠症相比，短期疗效相当，长期持久性上级。然而，认知行为疗法对绝经期失眠症的疗效，目前的建议的主要焦点之一，尚未得到验证。然而，传统的CBT-I有缺点，包括需要训练有素的治疗师和患者的大量时间承诺。因此，多组分CBT-I的广泛可用性受到CBT睡眠专家数量相对较少，治疗复杂性和患者负担的限制。因此，该项目的另一个目的是测试单一成分行为疗法对绝经期相关失眠的急性和长期疗效。考虑到绝经期合并失眠症患者存在显著的日间损害，包括抑郁、生活质量和疲劳，本提案的最终目的是确定CBT-I对绝经期相关失眠女性患者这些措施的疗效。