SLEEP:认知行为疗法不仅能治疗失眠,还能改善疲劳和功能!

2021-10-20 MedSci原创 MedSci原创

与包括睡眠卫生教育的强大的HF自我管理计划相比,CBT-I在慢性HF成人的失眠、疲劳、日间嗜睡和客观测量的身体功能方面产生了持续的改善。

认知行为治疗(CBT)由A.T.Beck在60年代发展出的一种有结构、短程、认知取向的心理治疗方法,主要针对抑郁症、焦虑症等心理疾病和不合理认知导致的心理问题。它的主要着眼点,放在患者不合理的认知问题上,通过改变患者对已,对人或对事的看法与态度来改变心理问题。

失眠在患有慢性心力衰竭(HF)的成年人中很常见,并与日间症状和功能减退有关。为了判断CBT对慢性心力衰竭患者失眠、疲劳及日常功能的影响,来自美国耶鲁大学护理学院的专家开展了相关研究,相关研究《睡眠》Sleep杂志上。

这项随机对照试验(RCT)的目的是评估CBT-I(健康睡眠:HS)与HF自我管理教育(健康心;注意控制:HH)对稳定的HF患者的失眠严重程度、睡眠特征、症状和功能的持续效果。主要结果是失眠的严重程度、行动记录仪记录的睡眠效率和疲劳。

研究人员将至少有轻度失眠(失眠严重程度指数>7)的射血分数保留或减少的稳定型HF成人随机分组到HS或HH(4次/8周)。获得了手腕运动图谱,并在基线、治疗后一个月内以及6个月和12个月时测量了失眠严重程度、自我报告的睡眠特征、症状(疲劳、白天过度嗜睡、焦虑、抑郁)以及6分钟步行距离。随后使用一般线性混合模型(GLMM)和广义估计方程(GEE)来评估这些效果。

结果显示,该研究纳入了包括175名参与者(M年龄=63+12.9岁;43%为女性;18%为黑人;68%为纽约心脏协会二级或二级;33%;LVEF<45%),随机接受HS(n=91)或HH(N=84)。在12个月内,HS对失眠严重程度、睡眠质量、自我报告的睡眠潜伏期和效率、疲劳、白天过度嗜睡和六分钟步行距离有持续的影响。

睡眠和生物钟对全身脏器的影响

综上,与包括睡眠卫生教育的强大的HF自我管理计划相比,CBT-I在慢性HF成人的失眠、疲劳、日间嗜睡和客观测量的身体功能方面产生了持续的改善。

 

参考文献:

Cognitive Behavioral Therapy for Insomnia has sustained effects on insomnia, fatigue, and function among people with chronic heart failure and insomnia: The HeartSleep Study. https://doi.org/10.1093/sleep/zsab252

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    2021-10-21 tamgche
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    2021-10-20 ms5000001441360447

    行为管理的提升和认知的改变,对失眠者的脏器和行为能力是有提高

    0

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