Analysis of the Improvement Sequence in Insomnia Symptoms and Factors Influencing the Treatment Outcomes of Smartphone-Delivered CBT in Patients with Insomnia Disorder

IF 3 2区医学 Q2 CLINICAL NEUROLOGY

Nature and Science of Sleep Pub Date : 2024-09-13 DOI:10.2147/nss.s486288

Jia Wei, Mingfen Song, Hong Jing Mao, Ruobing Qi, Lili Yang, You Xu, Pan Yan, Linlin Hu

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Abstract

Background: The effectiveness of medication combined with smartphone-delivered cognitive behavioral therapy for insomnia (CBT-I) has been well verified, but there are few studies on the sequence of remission of insomnia symptoms. This study aims to understand the sequence of symptom improvement and the factors influencing the treatment effectiveness in patients with insomnia.
Methods: Smartphone-delivered CBT, as a form of Online CBT, allows for training through mobile devices at any time and place. We utilized the Good Sleep 365 app to conduct a survey, involving 2820 patients who met the baseline inclusion criteria. These patients were assessed using a general demographic questionnaire and the Pittsburgh Sleep Quality Index (PSQI) to evaluate general demographic information and insomnia symptoms, and subsequently underwent CBT training using the Good Sleep 365 app. A total of 1179 patients completed follow-ups at 4 weeks, 8 weeks, 16 weeks, and 24 weeks.
Results: At 4 weeks and 8 weeks, the descending order of the reduction rates of PSQI components (excluding component 6: use of sleeping medication) was: sleep latency, subjective sleep quality, sleep efficiency, sleep disturbance, sleep maintenance, and daytime dysfunction. At 16 weeks and 24 weeks, the descending order was subjective sleep quality, sleep latency, sleep efficiency, daytime dysfunction, sleep maintenance, and sleep disturbance. There were significant differences in the reduction rates of PSQI components (excluding component 6: use of sleeping medication) both at the same follow-up times and at different follow-up times (all P< 0.05). Multivariable logistic regression analysis showed that patients older than 30 years and those with a college degree or above had better treatment outcomes, whereas those with a disease duration of more than three years had worse outcomes.
Conclusion: The sequence of symptom improvement in patients with insomnia changes over time, and age, educational level, and duration of disease are factors influencing treatment outcomes.

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失眠症患者失眠症状改善顺序及智能手机辅助 CBT 治疗效果影响因素分析

背景：药物治疗结合智能手机认知行为疗法治疗失眠（CBT-I）的有效性已得到充分验证，但有关失眠症状缓解顺序的研究却很少。本研究旨在了解失眠患者症状改善的顺序以及影响治疗效果的因素：方法：智能手机提供的 CBT 作为在线 CBT 的一种形式，允许在任何时间和地点通过移动设备进行培训。我们利用 "良好睡眠 365 "应用程序开展了一项调查，共有 2820 名符合基线纳入标准的患者参与了调查。我们使用一般人口统计学问卷和匹兹堡睡眠质量指数（PSQI）对这些患者进行了评估，以了解他们的一般人口统计学信息和失眠症状，随后使用 "好睡眠 365 "应用程序对他们进行了 CBT 培训。共有1179名患者完成了4周、8周、16周和24周的随访：在 4 周和 8 周时，PSQI 各项指标（不包括指标 6：使用安眠药）的下降率从高到低依次为：睡眠潜伏期、主观睡眠质量、睡眠效率、睡眠障碍、睡眠维持和日间功能障碍。在 16 周和 24 周时，降序依次为主观睡眠质量、睡眠潜伏期、睡眠效率、日间功能障碍、睡眠维持和睡眠障碍。在相同的随访时间和不同的随访时间，PSQI 各项指标（不包括第 6 项：使用安眠药）的下降率均存在明显差异（P< 0.05）。多变量逻辑回归分析显示，30 岁以上和大专及以上学历的患者治疗效果较好，而病程超过 3 年的患者治疗效果较差：结论：失眠患者症状改善的顺序会随着时间的推移而改变，年龄、教育程度和病程是影响治疗效果的因素。

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来源期刊

Nature and Science of Sleep Neuroscience-Behavioral Neuroscience

CiteScore

5.70

自引率

5.90%

发文量

245

审稿时长

16 weeks

期刊介绍： Nature and Science of Sleep is an international, peer-reviewed, open access journal covering all aspects of sleep science and sleep medicine, including the neurophysiology and functions of sleep, the genetics of sleep, sleep and society, biological rhythms, dreaming, sleep disorders and therapy, and strategies to optimize healthy sleep. Specific topics covered in the journal include: The functions of sleep in humans and other animals Physiological and neurophysiological changes with sleep The genetics of sleep and sleep differences The neurotransmitters, receptors and pathways involved in controlling both sleep and wakefulness Behavioral and pharmacological interventions aimed at improving sleep, and improving wakefulness Sleep changes with development and with age Sleep and reproduction (e.g., changes across the menstrual cycle, with pregnancy and menopause) The science and nature of dreams Sleep disorders Impact of sleep and sleep disorders on health, daytime function and quality of life Sleep problems secondary to clinical disorders Interaction of society with sleep (e.g., consequences of shift work, occupational health, public health) The microbiome and sleep Chronotherapy Impact of circadian rhythms on sleep, physiology, cognition and health Mechanisms controlling circadian rhythms, centrally and peripherally Impact of circadian rhythm disruptions (including night shift work, jet lag and social jet lag) on sleep, physiology, cognition and health Behavioral and pharmacological interventions aimed at reducing adverse effects of circadian-related sleep disruption Assessment of technologies and biomarkers for measuring sleep and/or circadian rhythms Epigenetic markers of sleep or circadian disruption.