单纯认知行为疗法与认知行为疗法结合催眠药物递减方案治疗失眠障碍的疗效观察

摘要

目的 探讨认知行为疗法(CBT-i)结合催眠药物递减方案治疗失眠障碍患者的疗效.方法 2016年3—9月中国中医科学院广安门医院心理科门诊就诊的75例失眠障碍患者,采用随机数字表法随机分为CBT-i组(37例)和联合组(38例).CBT-i组仅给予CBT-i干预,联合组给予CBT-i结合催眠药物递减方案干预.于基线、治疗第4周、治疗结束(治疗第8周)时,记录各组的匹兹堡睡眠质量指数(PSQI)、贝克抑郁量表(BDI)、贝克焦虑量表(BAI)、睡眠日记各因子,采用重复测量方差分析比较2组患者不同时点评分的情况.结果(1)2组患者治疗结束时PSQI、BDI、BAI较基线总分显著下降:CBT-i组,PSQI(4.7±2.5)分比(12.9±3.5)分,BDI(3.2±4.4)分比(9.7±6.4)分,BAI(4.2±5.6)分比(10.7±8.1)分;联合组,PSQI(5.8±2.8)分比(13.9±3.1)分,BDI(4.5±4.8)分比(13.8±8.7)分,BAI (4.4±4.0)分比(14.1±6.3)分(P值均<0.01).(2)与基线相比,联合组治疗第4周、治疗结束时PSQI主观睡眠质量、入睡时间、睡眠效率、睡眠障碍和催眠药物使用频率因子的评分显著下降(P值均<0.05),治疗结束时总睡眠时间和日间功能障碍因子评分显著下降(P值均<0.05).(3)CBT-i组PSQI的入睡时间和睡眠效率两个因子在基线与治疗结束时的差值均显著高于联合组(均为P=0.01).结论 CBT-i组与联合组治疗方案对失眠障碍治疗均有效,前者在缩短入睡时间、提高睡眠效率方面优于后者,后者的治疗方案可有效降低催眠药物使用频率.%Objective To investigate the efficacy of cognitive-behavioral therapy for insomnia (CBT-i) or combination with tapered hypnotic agents. Methods Seventy-five patients were randomized into either CBT-i group (n=37) or combination group (n=38). The duration of treatment lasted for 8 weeks. The efficacy was evaluated by Pittsburgh sleep quality index (PSQI),Beck depression index (BDI),Beck anxiety inventory(BAI) and sleep diary variables at baseline, middle and end of treatment. Results (1)Compared with the results at baseline, the total scores of PSQI,BDI and BAI in both groups significantly decreased at the end of treatment: CBT-i group, PSQI (4.7±2.5) vs. (12.9±3.5); BDI (3.2±4.4) vs. (9.7±6.4); BAI (4.2±5.6) vs. (10.7±8.1); and combination group, PSQI (5.8±2.8) vs. (13.9±3.1); BDI (4.5±4.8) vs. (13.8±8.7); BAI (4.4±4.0) vs. (14.1±6.3) (all P<0.01). (2) Compared with the results at baseline, subjective sleep quality (SQ), sleep onset latency (SOL), sleep efficiency (SE), sleep disturbance (SD) and used sleep medication (USM) in PSQI in combination group significantly decreased at week 4 and 8 (all P<0.05). The total sleep time (TST) and daytime dysfunction (DF) in PSQI significantly decreased at week 8 (both P<0.05). (3) Compared with combination group, improvement of SOL and SE in CBT-i group was superior (both P=0.01). Conclusions CBT-i for chronic insomnia is effective in both CBT-i alone and combination with tapered hypnotic agents. CBT-i group is superior in improving SOL and SE. Combination regimen in our study can significantly reduce the doses of medication.