慢性疾病患者失眠的认知行为疗法:系统性审查和元分析
Amelia J Scott1, Ashleigh B Correa1, Madelyne A Bisby1
1School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia.
JAMA internal medicine
|September 22, 2025
概括
失眠的认知行为疗法 (CBT-I) 有效地治疗慢性疾病患者的失眠,显示出睡眠质量和可接受性的显著改善. 这一元分析证实了CBT-I.
科学领域:
- 睡眠医学 睡眠医学
- 行为科学 行为科学
- 慢性疾病管理 慢性疾病管理
背景情况:
- 失眠在慢性疾病群体中很普遍,恶化结果和生活质量.
- 失眠的认知行为疗法 (CBT-I) 是推的一线失眠治疗方法.
- 人们对CBT-I在患有慢性疾病的个体中的适用性和有效性存在担忧.
研究的目的:
- 评估CBT-I在患有慢性疾病的成年人中的有效性和可接受性.
- 在这个人群中确定影响CBT-I治疗结果的调节者.
主要方法:
- 在主要数据库 (PsycINFO,Medline,Embase,CENTRAL) 进行了系统的文献搜索.
- 包括接受CBT-I的慢性疾病和失眠的成年人的随机临床试验 (RCT).
- 进行随机效应元分析以计算主要结果的效应大小 (Hedges g).
主要成果:
- 包括67个RCT (5232名参与者),涵盖了癌症,慢性疼痛和中风等疾病.
- CBT-I显著改善了失眠严重程度 (g=0.98),睡眠效率 (g=0.77),以及睡眠开始延迟 (g=0.64).
- 对治疗的满意度很高,治疗中断率很低 (13.3%) 和罕见的不良反应.
结论:
- CBT-I在慢性疾病患者群体中表现出强烈的疗效和可接受性,与一般人群相比.
- 在各种慢性疾病亚组中,疗效一致.
- 未来的研究应该集中在治疗适应和增加在医疗机构中获得CBT-I的机会上.
相关概念视频
01:19Management of Insomnia
495
The sleep cycle, an integral part of human health, consists of several stages with distinct characteristics and functions. It begins with a transition from wakefulness to sleep, known as the light sleep phase, followed by the restorative deep sleep phase, essential for physical recovery and growth. The cycle concludes with the Rapid Eye Movement (REM) phase, characterized by high brain activity and vivid dreaming. Insomnia, a prevalent sleep disorder, involves difficulty falling asleep, staying...
495
01:27Insomnia
374
Insomnia is a prevalent sleep disorder characterized by difficulty falling asleep, frequent awakenings during the night, and waking up too early without being able to return to sleep. People with insomnia often experience these disruptions at least three nights a week for at least one month. Chronic insomnia, which lasts for at least three months, can lead to increased anxiety, which in turn can worsen sleep difficulties, creating a cycle of sleeplessness and stress.
Multiple factors contribute...
Multiple factors contribute...
374
01:24Substance Use Disorders Affecting Sleep
357
Substance use disorders involve a pattern of using drugs more extensively than intended and continuing use despite harmful consequences. This includes legal substances like alcohol and nicotine, as well as illegal drugs. These disorders often involve both physical and psychological dependence, reflecting compulsive use of substances that significantly alter thoughts, feelings, and behaviors, contributing to a major public health issue.
Understanding the concepts of physical dependence,...
Understanding the concepts of physical dependence,...
357
01:13Insufficient Sleep and Sleep Deprivation
800
Insufficient sleep refers to not getting the recommended amount of sleep for optimal functioning, even if it's just slightly less than needed. Sleep insufficiency may occur due to lifestyle choices, such as staying up late for social events or work, resulting in routinely getting less sleep than required. For example, consistently sleeping 6 hours when the body needs 7-9 hours can lead to cumulative effects on health and well-being.
Sleep deprivation is a more severe form of sleep loss...
Sleep deprivation is a more severe form of sleep loss...
800
01:15REM Sleep Behavior Disorder
1.2K
REM Sleep Behavior Disorder (RBD) is a sleep disorder characterized by the absence of muscle paralysis that normally occurs during the REM phase of sleep. This absence allows individuals to physically act out their dreams, which are often vivid and disturbing. Common behaviors exhibited during episodes include kicking, punching, and yelling. These actions can be dangerous, potentially leading to injuries for the person with RBD or their bed partner.
RBD is significantly associated with...
RBD is significantly associated with...
1.2K
01:14CNS Depressants: Barbiturates and Benzodiazepines
1.1K
CNS depressants include drugs from the category of barbiturates and benzodiazepines. They are valuable medications for managing anxiety disorders and insomnia. Barbiturates, once used to induce and maintain sleep, have been replaced mainly by benzodiazepines due to barbiturate's toxicity, tolerance, and overdose risks. They interact with GABAA receptors, leading to sedation at low doses and potentially coma and death at higher doses. Phenobarbital, a long-acting barbiturate, possesses...
1.1K