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减少镇静剂使用和改善睡眠的患者自导干预:YAWNS NB随机临床试验
David M Gardner1, Justin P Turner2, Sandra Magalhaes3
1Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
像YAWNS-1这样的直接对患者进行的干预可以帮助老年人减少长期使用二二胺受体激动剂 (BZRA) 并改善睡眠. 这种方法提供了一个可扩展的解决方案,可以在不需要临床医生的参与的情况下改变失眠护理.
科学领域:
- 老年学是指老年学的学科.
- 睡眠医学 睡眠医学
- 行为科学 行为科学
背景情况:
- 在老年人中长期使用二氨酸受体激活剂 (BZRA) 与严重的危害有关.
- 过渡到非药物失眠治疗,如失眠认知行为疗法 (CBTI) 是一个挑战.
- 直接对患者进行干预可能有助于停止使用BZRA并改善睡眠结果.
研究的目的:
- 为了比较两个邮寄的,直接对患者进行的行为改变干预,与使用BZRA的老年人通常治疗 (TAU) 相比.
- 评估对BZRA使用,CBTI吸收,睡眠质量和其他健康结果的影响.
- 评估可扩展性,低接触性干预措施的可行性,用于失眠管理.
主要方法:
- 一项三臂实用性随机临床试验 (Your Answers When Needing Sleep in New Brunswick - YAWNS NB研究) 涉及65岁以上长期使用BZRA的成年人.
- 干预包括两个不同的邮寄包裹 (YAWNS-1和YAWNS-2) 或TAU.
- 主要结局是6个月后使用BZRA;次要结局包括CBTI使用,睡眠参数和安全性.
主要成果:
- 与YAWNS-2 (34.8%) 和TAU (20.3%) 相比,YAWNS-1干预导致BZRA中止或剂量减少率最高 (46.6%).
- 与YAWNS-2 (-1.7%的变化) 相比,YAWNS-1显示了CBTI技术的优越吸收和改善睡眠效率 (4.1%的变化).
- 与TAU相比,YAWNS-1显著降低了失眠的严重程度和白天的嗜睡.
结论:
- YAWNS-1干预是一种有效的,可扩展的,直接对患者的方法,用于减少老年人使用BZRA.
- 这种方法有可能显著改善睡眠结果,并在人口层面转变失眠护理.
- 最少接触,邮寄干预措施可以成功地促进过渡到基于证据的失眠治疗.
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