失眠的在线简版行为疗法对失眠障碍的干预效果研究

doi:10.12114/j.issn.1007-9572.2024.0052

中国全科医学 ›› 2024, Vol. 27 ›› Issue (35): 4370-4375.DOI: 10.12114/j.issn.1007-9572.2024.0052

• 论著·健康问题研究·睡眠健康 • 上一篇下一篇

失眠的在线简版行为疗法对失眠障碍的干预效果研究

陈鹏飞¹^,², 刘雅茜¹, 王途之¹, 张桂梅¹, 蔡艺娴¹, 潘集阳¹^,^*()

1．510630　广东省广州市，暨南大学附属第一医院睡眠医学中心
2．510630　广东省广州市，暨南大学管理学院

收稿日期:2024-04-10 修回日期:2024-07-01 出版日期:2024-12-15 发布日期:2024-09-13
通讯作者: 潘集阳
作者贡献：
陈鹏飞进行文章的构思与设计，研究方案设计，资料收录，文献/资料收集、整理，撰写论文，对文章整体负责；潘集阳在研究方向和宏观质量把控上提供指导，负责受试者诊断和教育工作；刘雅茜、王途之、张桂梅和蔡艺娴为研究方案提供意见和指导，参与到受试者诊断和收录工作中，对文章的知识性内容做批评性审阅，质量控制及审校。
基金资助:
国家重点研发计划项目(2022YFC2503900)

The Effect of E-aid Brief Behavioral Therapy for Insomnia on Insomnia Disorders

CHEN Pengfei¹^,², LIU Yaxi¹, WANG Tuzhi¹, ZHANG Guimei¹, CAI Yixian¹, PAN Jiyang¹^,^*()

1. Sleep Medical Center, the First Affiliated Hospital of Jinan University, Guangzhou 510630, China
2. School of Management, Jinan University, Guangzhou 510630, China

Received:2024-04-10 Revised:2024-07-01 Published:2024-12-15 Online:2024-09-13
Contact: PAN Jiyang

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摘要/Abstract

摘要： 背景失眠障碍是一种常见的精神疾病，给患者的生活和健康带来严重的负面影响。传统的认知行为疗法（CBT-I）是一种有效的非药物治疗方法，但其操作复杂、耗时长、依从性低等缺点限制了其在真实世界的应用。简版行为疗法（BBT-I）是一种基于CBT-I的简化治疗方法，其疗效与CBT-I相当，更适合在真实世界中推广。然而，BBT-I是否适用于中国失眠障碍人群暂不明确，而通过线上方式进行BBT-I的研究更是缺乏。目的本研究旨在探讨通过微信小程序进行的在线BBT-I（eBBT-I）对中国失眠障碍患者失眠改善的疗效，以及其对患者睡眠信念和态度的影响。方法本研究采用前瞻性非随机对照研究的设计，将2023年2—11月来自暨南大学附属第一医院精神医学科睡眠门诊的失眠障碍患者设为干预组，将线上和线下招募的失眠障碍志愿者设为对照组，干预组接受为期2周的eBBT-I治疗，对照组接受精神卫生教育的伪干预。在干预前后分别测量患者的失眠严重程度指数量表（ISI）和简版睡眠信念与态度问卷（DBAS-16）得分，以评估干预效果。结果研究最终共纳入35例干预组患者和30例对照组患者。主要结局指标：组别与时间对ISI得分存在交互作用（P<0.05）；组别与时间分别对ISI得分主效应显著（P<0.05）。干预前3 d（基线）两组ISI得分比较，差异无统计学意义（P>0.05）；干预后14 d干预组ISI得分低于对照组（P<0.05）；干预组干预后14 d ISI得分低于组内干预前（P<0.05）。次要结局指标：组别与时间对DBAS-16得分不存在交互作用（P>0.05）；时间对DBAS-16得分主效应显著（P<0.05）；组别对DBAS-16得分主效应不显著（P>0.05）。干预前3 d（基线）、干预后14 d两组DBAS-16得分比较，差异无统计学意义（P>0.05）；干预组干预后14 d DBAS-16得分高于组内干预前（P<0.05）。结论 eBBT-I有效地改善了失眠障碍患者的失眠症状和负面影响，但对睡眠信念与态度的改善效果仍有待提升。本研究支持了eBBT-I在中国失眠障碍患者失眠治疗中的可行性和有效性。

关键词: 失眠障碍, 失眠在线简版行为疗法, 失眠的非药物治疗, 数智化医疗诊疗工具, 失眠严重程度指数, 睡眠信念与态度

Abstract:

Background

Insomnia disorder is a common mental health condition that significantly impacts patients' lives and well-being. Traditional cognitive-behavioral therapy for insomnia (CBT-I) is an effective non-pharmacological treatment method, but its complexity, time-consuming nature, and low compliance limit its real-world application. Brief behavioral therapy for insomnia (BBT-I), based on CBT-I principles, offers comparable efficacy while being more suitable for real-world dissemination. However, the applicability of BBT-I to the Chinese population with insomnia disorder remains unclear, and research on BBT-I conducted online is lacking.

Objective

This study aims to investigate the efficacy of online e-aid brief behavioral therapy for insomnia (eBBT-I) delivered via WeChat Mini Program in improving insomnia symptoms among Chinese patients with insomnia disorder. Additionally, the study explores its impact on patients' sleep beliefs and attitudes.

Methods

This study employed a prospective non-randomized controlled design. Insomnia disorder patients from the Sleep Clinic at the First Affiliated Hospital of Jinan University between February and November 2023 were assigned to the intervention group. Insomnia disorder volunteers recruited online and offline were assigned to the control group. The intervention group received a 2-week eBBT-I (e-aid brief behavioral therapy for insomnia) treatment, while the control group received a sham intervention of mental health education. The severity of insomnia was assessed using the Insomnia Severity Index (ISI) and the Dysfunctional Beliefs and Attitudes about Sleep-16 (DBAS-16) questionnaire before and after the intervention to evaluate its effectiveness.

Results

The study ultimately included 35 patients in the intervention group and 30 patients in the control group. Key outcome measures: there was a significant interaction effect between group and time for ISI scores (P<0.05). Group and time separately had significant main effects on ISI scores (P<0.05). No statistically significant difference in ISI scores was observed between the two groups at baseline (pre-intervention) (P>0.05). After 14 days of intervention, the intervention group had lower ISI scores than the control group (P<0.05). Within the intervention group, ISI scores decreased after 14 days compared to baseline (P<0.05). Secondary outcome measures: there was no interaction effect between group and time for DBAS-16 scores (P>0.05). Time had a significant main effect on DBAS-16 scores (P<0.05). Group did not have a significant main effect on DBAS-16 scores (P>0.05). No statistically significant difference in DBAS-16 scores was found between the two groups at baseline or after 14 days (P>0.05). However, within the intervention group, DBAS-16 scores increased after 14 days compared to baseline (P<0.05) .

Conclusion

This indicates that eBBT-I effectively improved insomnia symptoms and negative impact in patients with insomnia disorder, but further improvement in sleep beliefs and attitudes is still needed. This study supports the feasibility and effectiveness of eBBT-I in the treatment of insomnia disorder among Chinese patients.

Key words: Insomnia disorder, E-aid brief behavioral therapy for insomnia, Non-drug treatment for insomnia, Digital medical diagnostic and treatment tools, Insomnia Severity Index, Sleep beliefs and attitudes

中图分类号:

R 741

陈鹏飞,刘雅茜,王途之,等. 失眠的在线简版行为疗法对失眠障碍的干预效果研究[J]. 中国全科医学, 2024, 27(35): 4370-4375. DOI: 10.12114/j.issn.1007-9572.2024.0052.
CHEN Pengfei,LIU Yaxi,WANG Tuzhi, et al. The Effect of E-aid Brief Behavioral Therapy for Insomnia on Insomnia Disorders[J]. Chinese General Practice, 2024, 27(35): 4370-4375. DOI: 10.12114/j.issn.1007-9572.2024.0052.

图/表 4

图1 睡眠日记和睡眠处方注：A表示睡眠日记，B表示睡眠处方；睡眠日记包含卧床、入睡、醒来和起床时间，以及服用药物、烟酒茶、运动情况和当天睡眠状态，睡眠处方的起床时间由使用者自行设置，卧床时间由系统自动给出。

Figure 1 Sleep diary and sleep prescription

图2 微信提醒和视频学习注：A表示微信聊天界面提醒，B表示进入睡眠管理平台界面，C表示进行视频学习和复习界面。

Figure 2 WeChat reminders and video learning

表1 两组受试者基线数据比较

Table 1 Comparison of baseline data between the two groups of patients

组别	例数	性别（男/女）	年龄（±s，岁）
对照组	30	9/21	30.3±9.8
干预组	35	7/28	34.1±9.5
t（χ²）值		0.871^a	-1.580
P值		0.35	0.12

表2 两组干预前后ISI、DBAS-16得分比较（±s，分）

Table 2 Comparison of ISI and DBAS-16 scores between the two groups before and after intervention

组别	例数	ISI		DBAS-16
组别	例数	干预前3 d	干预后14 d	干预前3 d	干预后14 d
对照组	30	18.60±5.15	18.77±4.99	39.87±8.57	41.83±8.00
干预组	35	16.46±4.92	9.66±4.24^ab	36.17±9.91	40.71±9.05^a
F值		F_组间=25.48，F_时间=56.70，F_交互=62.54		F_组间=1.36，F_时间=15.08，F_交互=2.36
P值		P_组间<0.01，P_时间<0.01，P_交互<0.01		P_组间>0.05，P_时间<0.01，P_交互>0.05

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失眠的在线简版行为疗法对失眠障碍的干预效果研究

The Effect of E-aid Brief Behavioral Therapy for Insomnia on Insomnia Disorders

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