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

更年期失眠的行为治疗；

• 批准号: 8891966
• 负责人: CHRISTOPHER L DRAKE
• 金额: $ 39.33万
• 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 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8891966
• 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且代价最高的睡眠障碍之一，与相当大的发病率相关，包括生活质量显着下降、工作表现受损以及患重度抑郁症的风险增加。1-4 失眠是绝经过渡期的一个关键症状，40-50% 的绝经后妇女（> 1700 万）患有失眠。5,6 更年期有一种睡眠障碍模式，主要特征是睡眠维持困难，包括频繁醒来和觉醒、睡眠效率降低和整体睡眠碎片化。最近已经证明，这种睡眠障碍（难以维持睡眠）的模式在整个更年期的过程中都会增加。7 我们最近发现更年期的睡眠维持问题与工作绩效下降、医疗保健利用率增加和生活质量受损有关。8 历史上，包括睡眠障碍在内的更年期症状是通过激素替代疗法 (HRT) 来治疗的。然而，有证据表明 HRT 与心脏病和癌症风险增加有关，已导致绝经后妇女使用性类固醇激素的量减少 40%，并强调需要替代治疗方法。 9 重要的是，由于缺乏该领域的研究结果，美国临床内分泌学家协会绝经期管理指南并未涉及绝经期相关失眠的治疗。 10 失眠认知行为疗法（CBT-I）与失眠药物治疗具有同等的短期疗效和优越的长期持久性。然而，认知行为疗法对绝经合并失眠的疗效（本提案的主要焦点之一）尚未得到测试。然而，传统的 CBT-I 也有缺点，包括需要训练有素的治疗师以及患者投入大量时间。因此，多组分 CBT-I 的广泛应用受到 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成分行为疗法对更年期相关失眠的急性和长期疗效。鉴于与更年期共存的失眠症存在显着的日间损害，包括抑郁、生活质量和疲劳，本提案的最终目的是确定 CBT-I 对患有更年期相关失眠的女性的这些措施的疗效。