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目的 探索在线失眠认知行为治疗(e?aid cognitive behavioral therapy for insomnia, eCBTI)对慢性失眠患者的疗效和治疗依从性.方法 本研究是4周的开放性随机对照研究.通过微信平台募集受试者,纳入符合DSM?5中慢性失眠诊断标准的190例患者,通过简单随机方法分为eCBTI组(n=95)和治疗等待组(n=95).入组后2组均进行失眠严重程度指数(insomnia severity index, ISI)的评估并记录连续1周的睡眠日记,eCBTI组经4周包括5个CBTI核心模块的治疗,治疗等待组不做任何干预,第4周2组再次记录1周的睡眠日记并进行ISI的评估.分别以睡眠效率(sleep efficiency,SE)>85%和ISI<8为失眠痊愈指标进行疗效评估.组间睡眠评估指标的比较采用t检验,痊愈率比较采用χ2检验.结果 eCBTI组55例完成4周治疗,治疗等待组78例完成了2次评估.4周治疗后,eCBTI组与治疗等待组的睡眠效率(11.6%±3.9%与2.9%±1.1%,t=4.63,P=0.036)、睡眠潜伏期(-57.0%±-14.7%与-19.8%±-8.5%,t=13.44,P<0.01)、觉醒次数(-43.4%±-13.0%与-12.2%±-6.1%, t=3.73,P=0.042)、ISI分值(-49.7%±-15.7%与-16.4%±-8.3%,t=11.72,P85%为失眠痊愈指标,eCBTI组和治疗等待组痊愈率分为67.3%与26.9% (χ2=21.36,P<0.01);以ISI<8为失眠痊愈指标,eCBTI组和治疗等待组的痊愈率分为43.6%与6.4% (χ2=26.22,P85% and ISI<8 separately. T test was used to compare the sleep parameters between two groups, and χ2 test was used to compare the remission rate. Results Fifty-five patients in eCBTI group and 78 patients of the waiting?list group completed the entire treatment and all of evaluations. After 4 weeks of treatment, the score?reducing rate of following index: sleep efficiency (11.6% ± 3.9% vs. 2.9% ± 1.1%, t=4.63, P=0.036), sleep onset latency (-57.0% ±-14.7% vs . -19.8% ±-8.5%, t=13.44, P<0.01), number of awakenings (-43.4% ±-13.0% vs .-12.2% ±-6.1%, t=3.73, P=0.042) and ISI scores (-49.7% ±-15.7% vs .-16.4% ±-8.3%, t=11.72, P85% was used as the recovery index for insomnia, the recovery rate of eCBTI group was 67.3%, and that of waiting?list group was 26.9% (χ2=21.36, P<0.01). when ISI<8 was used as the recovery index for insomnia, the recovery rate of eCBTI group was 43.6%, and that of waiting?list group was 6.4% (χ2=26.22, P<0.01). Conclusion This study supported that eCBTI had good therapeutic effects on Chinese patients with chronic insomnia disorder, but the treatment compliance should be further improved.