远程认知行为治疗对高血压共病性失眠的疗效研究

摘要

Objective To evaluate the effectiveness of internet-based cognitive behavior therapy (CBT-I) on blood pressure in patients with hypertension comorbid with insomnia.Methods One hundred and six patients met the JNC-8 diagnostic criteria for hypertension and DSM-5 diagnostic criteria for insomnia were selected,and randomly assigned to CBT-I group (n=53) and regular treatment group (n=53).All the patients accepted relevant treatment for 8 consecutive weeks.Changes of systolic blood pressure (SBP),diastolic blood pressure (DBP),the sleep parameters and the anxiety and depression levels were observed between baseline and 8 weeks of follow-up.Results Compared with pre-treatment,SBP and DBP decreased significantly in both CBT-I group and regular treatment group (P＜0.01),the decrease was more significant in CBT-I group than in regular treatment group (P＜0.01).The sleep latency,sleep efficiency,bed time and rating anxiety scale were improved more significantly in CBT-I group than in regular treatment group (44.49 ± 22.75min vs.55.50 ± 34.96min;72.31％ ± 9.15％ vs.57.70％ ± 11.53％;302.65 ± 43.76min vs.262.70 ± 50.64min and 17.14 ± 6.45 vs.21.02 ± 6.64,respectively),the differences were of statistical significance (P＜0.05).In addition,no significant difference was found in the level of depression between CBT-I group and regular treatment group.Conclusion CBT-I can effectively shorten sleep latency,improve sleep efficiency,extend bed time and improve anxiety,meanwhile effectively lower the blood pressure of patients with hypertension comorbid with insomnia by optimizing sleep quality.%目的 观察远程认知行为治疗(CBT-I)对高血压共病性失眠的疗效.方法 收集符合JNC-8高血压诊断标准和DSM-5失眠诊断标准的高血压共病性失眠患者106例,随机分为远程CBTI治疗组(n=53)和常规高血压治疗组(n=53),进行8周治疗,观察8周后两组收缩压(SBP)、舒张压(DBP)的下降幅度、睡眠参数及焦虑抑郁状态水平的差异.结果 与治疗前相比,治疗8周后两组SBP、DBP均下降(P＜0.0l),远程CBTI组SBP下降幅度较常规高血压治疗组明显(P＜0.0l).在睡眠指标上,治疗8周后,远程CBTI组睡眠潜伏期(44.49 ± 22.75min)、睡眠效率(72.31％±9.15％)、睡眠时间(302.65±43.76min)、焦虑水平评分(17.14±6.45)均较常规高血压治疗组改善更为显著(55.50±34.96min、57.70％±11.53％、262.70±50.64min、21.02±6.64),差异具有统计学意义(P＜0.05).结论 远程CBTI能有效缩短睡眠潜伏期、改善睡眠效率、延长睡眠时间、改善焦虑情绪,同时通过CBT-I优化睡眠能有效降低高血压共病性失眠患者的血压.