Effect of cognitive behavioral therapy for insomnia in esophageal cancer patients with insomnia
-
摘要:目的 探讨失眠的认知行为治疗(CBT-I)对食道癌伴失眠患者的疗效。方法 将66例食道癌伴失眠患者随机分为CBT-I治疗组和药物(唑吡坦)治疗组，进行6周治疗，观察治疗第2、4、6周以及治疗后第2、4周匹兹堡睡眠质量指数(PSQI)、汉密尔顿焦虑量表(HAMA)评分、汉密尔顿抑郁量表(HAMD)评分、入睡时间(SOL)、实际睡眠时间(AST)、睡眠效率(SE)的变化。结果 ① 药物组治疗第2、4、6周, PSQI、HAMA、HAMD、SOL、AST、SE均较治疗前显著改善(P < 0.05), 疗效第2周达到高峰，后逐渐下降; 治疗后第2、4周的疗效与治疗前比较无显著差异(P>0.05)。② CBT-I组治疗第2周, HAMA、SOL较治疗前有显著差异(P < 0.05); 治疗第4、6周，PSQI、HAMA、HAMD、SOL、AST、SE较治疗前有显著差异(P < 0.05); 治疗第6周，疗效达到最高峰; 治疗后第2、4周的疗效与治疗第6周相比，差异无统计学意义(P>0.05)。③治疗第6周以及治疗后第2、4周, 2组间PSQI、HAMA、HAMD、SOL、AST、SE均有显著差异(P < 0.05)。结论 采用催眠类药物治疗食道癌伴失眠患者，起效快但疗效持续时间短，采用CBT-I则起效稍慢但疗效持续时间长，停止治疗后仍有较好的疗效。Abstract:Objective To investigate the effect of cognitive behavioral therapy for insomnia(CBT-I)in esophageal cancer patients with insomnia.Methods A total of 66 esophageal cancer patients with insomnia were randomly divided into CBT-I treatmentgroup and drug (zolpidem) treatment group, and received 6 weeks of treatment. The changes of Pittsburgh Sleep Quality Index(PSQI), Hamilton Anxiety Scale (HAMA) score, Hamilton Depression Rating Scale (HAMD) score, sleep time (SOL), actual sleep time (AST), sleep efficiency (SE) were observed at the 2nd, 4th and 6th week of treatment and the 2nd and 4th week after treatment.Results Drug group had improved PSQI, HAMA, HAMD, SOL, AST, SE at the 2nd, 4th and 6th week of treatment, the curative effect reached the peak in the 2nd week, and then decreased gradually. There was no significant difference in curative effect at the 2nd and 4th week after treatment compared to before treatment. HAMA and SOL showed significant difference in CBT-I group at the 2nd week of treatment compared to before treatment. PSQI, HAMA, HAMD, SOL, AST and SE showed significant difference at the 4th and 6th week of treatment compared to before treatment. The curative effect reached the peak at the 6th week of treatment. There was no significant difference in the curative effect at the 6th week of treatment compared to the 2nd and 4th week of treatment. There were significant differences in PSQI, HAMA, HAMD, SOL, AST and SE in the two groups at the 6th week of treatment, the 2nd and 4th week after treatment (P < 0.05).Conclusion Hypnotic drugs are effective in the treatment of esophageal cancer complicated with insomnia, but has shorter curative effect, while CBT-I is on the contrary, and the treatment efficacy lasts after the therapy completion.
-
Keywords:
- insomnia /
- cognitive-behavioral therapy /
- esophageal cancer /
- anxiety /
- depression /
- sleep efficiency
-
-
表 1 2组患者不同时点相关观察指标结果比较(x±s)
组别 时点 PSQI HAMA评分/分 HAMD评分/分 SOL/h AST/h SE/% 药物组(n=33) 治疗前 13.80±2.01 14.05±1.76 15.35±2.47 0.89±0.27 5.34±0.32 62.15±7.83 治疗第2周 9.40±1.65* 9.60±1.17* 11.13±1.67* 0.28±0.11* 6.80±0.30* 78.47±6.36* 治疗第4周 10.12±1.44* 10.96±1.53* 12.55±1.96* 0.33±0.22* 6.48±0.19* 71.19±5.08* 治疗第6周 11.14±1.73*▲ 11.89±1.26*▲ 13.09±1.77*▲ 0.43±0.18*▲ 6.17±0.13*▲ 68.85±6.11*▲ 治疗后第2周 12.81±1.63 12.91±1.16 13.97±1.51 0.68±0.17 5.88±0.15 64.78±6.54 治疗后第4周 13.11±1.83 13.25±1.96 14.56±2.18 0.71±0.19 5.66±0.21 64.13±6.63 CBT-I组(n=33) 治疗前 14.70±2.56 13.92±1.85 15.77±2.75 0.92±0.28 5.43±0.37 63.38±7.18 治疗第2周 13.10±2.26 10.02±1.12* 14.56±2.35 0.58±0.15* 5.68±0.23 65.15±6.90 治疗第4周 11.23±1.85*▲ 8.70±1.33*▲△ 11.07±2.11*▲ 0.38±0.16*▲ 6.50±0.22*▲ 71.22±5.12*▲ 治疗第6周 8.15±1.64*▲#△ 7.50±1.48*▲#△ 9.22±1.85*▲#△ 0.25±0.10*▲#△ 7.08±0.15*▲#△ 78.85±6.95*▲#△ 治疗后第2周 8.25±1.54#△ 7.35±1.22#△ 8.98±1.73#△ 0.23±0.15#△ 7.12±0.16#△ 78.93±6.77#△ 治疗后第4周 8.35±1.71#△ 7.76±1.31#△ 8.75±1.59#△ 0.26±0.17#△ 7.11±0.19#△ 78.88±6.46#△ PSQI: 匹兹堡睡眠质量指数; HAMA: 汉密尔顿焦虑量表; HAMD: 汉密尔顿抑郁量表; SOL: 入睡时间; AST: 实际睡眠时间; SE: 睡眠效率。与治疗前比较, *P < 0.05; 与治疗第2周比较, ▲P < 0.05; 与治疗第4周比较, #P < 0.05; 与药物组比较, △P < 0.05。 
下载: 导出CSV
-
[1] Torre L A, Bray F, Siegel R L, et al. Global cancer statistics, 2012[J]. CA: A Cancer Journal for Clinicians, 2015, 65(2): 87-108. doi: 10.3322/caac.21262
[2] Gil F, Costa G, Hilker I, et al. First anxiety, afterwards depression: psychological distress in cancer patients at diagnosis and after medical treatment[J]. Stress Health, 2012, 28(5): 362-367. doi: 10.1002/smi.2445
[3] 张斌, 荣润国. 失眠的认知行为治疗[J]. 中国心理卫生杂志, 2004, 18(12): 882-884. doi: 10.3321/j.issn:1000-6729.2004.12.021 [4] Manber R, Carney C, Edinger J, et al. Dissemination of CBTI to the non-sleep specialist: protocol development and training issues[J]. J Clin Sleep Med, 2012, 8(2): 209-218. doi: 10.5664/jcsm.1786
[5] Morin C M. Cognitive-behavioral approaches to the treatment of insomnia[J]. J Clin Psychiatry, 2004, 65(Suppl 16): 33-40.
[6] 杨丽萍, 唐向东. 慢性失眠的研究进展[J]. 临床精神医学杂志, 2014, 24(2): 139-140. https://www.cnki.com.cn/Article/CJFDTOTAL-LCJS201402033.htm [7] Morgenthaler T, Kramer M, Alessi C, et al. Practice parameters for the psychological and behavioral treatment of insomnia: an update. An american academy of sleep medicine report[J]. Sleep, 2006, 29(11): 1415-1419. doi: 10.1093/sleep/29.11.1415
[8] Manber R, Carney C, Edinger J, et al. Dissemination of CBTI to the non-sleep specialist: protocol development and training issues[J]. J Clin Sleep Med, 2012, 8(2): 209-218. doi: 10.5664/jcsm.1786
[9] 刘贤臣, 唐茂芹. 匹兹堡睡眠质量指数的信度和效度研究[J]. 中华精神科杂志, 1996, 29(2): 103-107. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHMA199602018.htm [10] Carney C E, Buysse D J, Ancoli-Israel S, et al. The consensus sleep diary: standardizing prospective sleep self-monitoring[J]. Sleep, 2012, 35(2): 287-302. doi: 10.5665/sleep.1642
[11] 王波帆, 张斌. 原发性失眠的认知行为治疗[J]. 广东医学, 2012, 33(23): 3656-3658. doi: 10.3969/j.issn.1001-9448.2012.23.059 [12] Schutte-Rodin S, Broch L, Buysse D, et al. Clinical guideline for the evaluation and management of chronic insomnia in adults[J]. J Clin Sleep Med, 2008, 4(5): 487-504. doi: 10.5664/jcsm.27286
[13] Wilson S J, Nutt D J, Alford C, et al. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders[J]. J Psychopharmacol (Oxford), 2010, 24(11): 1577-1601. doi: 10.1177/0269881110379307
[14] 中华医学会神经病学分会睡眠障碍学组. 中国成人失眠诊断与治疗指南[J]. 中华神经科杂志, 2012, 45(7): 534-540. doi: 10.3760/cma.j.issn.1006-7876.2012.07.022 [15] Morin C M, Bastien C, Guay B, et al. Randomized clinical trial of supervised tapering and cognitive behavior therapy to facilitate benzodiazepine discontinuation in older adults with chronic insomnia[J]. Am J Psychiatry, 2004, 161(2): 332-342. doi: 10.1176/appi.ajp.161.2.332
[16] Zavesicka L, Brunovsky M, Matousek M, et al. Discontinuation of hypnotics during cognitive behavioural therapy for insomnia[J]. BMC Psychiatry, 2008, 8: 80-80.
计量
- 文章访问数:
- HTML全文浏览量:
- PDF下载量:
苏公网安备 32100302010246号
