针对儿童和青少年的远程失眠行为干预结果:随机对照试验的系统回顾

Suncica Lah, Thanh Vinh Cao
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引用次数: 0

摘要

小儿失眠很常见,可以通过面对面的行为疗法进行有效治疗。这种疗法还能改善儿童的情绪、认知能力和生活质量,并提高护理人员的福利。儿科失眠行为疗法的需求量大,但获取途径有限,这两者之间存在差异,而提供技术强化干预措施可改善这一状况。目前还没有研究对儿科失眠症远程心理治疗的随机对照试验(RCT)结果进行回顾。本研究旨在考察(i)针对小儿失眠/失眠症状的远程遥控随机对照试验的结果,以及(ii)在治疗中取得的疗效是否与功能相关。我们根据 Cochrane 和 PRISMA 指南进行了系统性综述。我们在 PsychINFO、PubMed/Medline 和 Cochrane CENTRAL 数据库中检索了有关失眠和失眠症状远程行为治疗的 RCT 报告。2022 年 11 月和 2023 年 11 月对数据进行了摘录和偏倚风险评估。共找到七项 RCT(九篇手稿),涉及 786 名参与者,平均年龄从 19.3 个月到 16.9 岁不等。采用了四种不同的治疗方法。偏倚风险从低到高不等,随机化过程的偏倚风险最高。尽管采用的治疗方法、参与者的年龄和评估结果的工具存在差异,但在所有研究中,某些(但不是所有)睡眠参数都有明显改善,这些参数包括:睡眠质量和睡眠效能问卷调查及动电图。在 3 项研究中,远程治疗与面对面治疗的改善效果进行了比较,发现两者不相上下或略低。无论是客观还是主观的睡眠测量指标都没有出现恶化,只有睡眠开始潜伏期和睡眠开始后的唤醒在问卷调查中有所改善,但在一项研究中,在动觉仪上有所恶化。根据家长和自我报告的测量结果,儿童的情绪在各项研究中均有所改善。其他可能的功能性改善还未得到充分研究。我们的研究提供了初步证据,证明对小儿失眠症进行远程行为治疗后,睡眠得到了改善,儿童的情绪也得到了改善。我们还需要开展进一步的研究,针对不同的发育需求和失眠症状类型开发个性化的治疗方法,不仅要研究群体结果,还要研究个体结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Outcomes of remotely delivered behavioral insomnia interventions for children and adolescents: systematic review of randomized controlled trials
Pediatric insomnia is common and can be effectively treated with behavioral therapies delivered face-to face. Such treatments could also improve children's mood, cognition, and quality of life, and caregivers' wellbeing. There is a discrepancy between high needs and limited access to pediatric behavioral insomnia treatments, which could be improved by provision of technology enhanced interventions. No study reviewed outcomes of randomized controlled trials (RCTs) of remotely delivered psychological treatments for pediatric insomnia. The current study aimed to examine (i) the outcomes of remotely delivered RCTs for pediatric insomnia/insomnia symptoms and (ii) whether gains made in treatment extend to functional correlates. We conducted a systematic review according to Cochrane and PRISMA guidelines. PsychINFO, PubMed/Medline and Cochrane CENTRAL databases were searched for RCTs reporting on remotely delivered behavioral treatments for insomnia and insomnia symptoms. Data was abstracted and the risk of bias were assessed in November 2022 and November 2023. Seven RCTs (nine manuscripts) involving 786 participants, with the mean age from 19.3 months to 16.9 years, were identified. Four different treatments were used. Risk of bias ranged from low to high and was the highest for the randomization process. Across studies, significant improvements were found in some (but not all) sleep parameters, namely: sleep quality and sleep efficacy on questionnaires and on actigraphy, despite heterogeneity of the treatments used, age of participants and instruments employed to assess outcomes. Improvements gained in treatments delivered remotely was compared to treatments delivered face-to-face in 3 studies and were found to be comparable or slightly lower. No worsening was observed on either objective or subjective measures of sleep, except for sleep onset latency and wake after sleep onset that improved on questionnaires but worsened on actigraphy in one study each. Children's mood improved across studies on parent and self-report measures. Other possible functional gains were understudied. Our study provides preliminary evidence of improved sleep following remotely delivered behavioral treatments for pediatric insomnia, and improvements in children's mood. Further research is needed to develop individualized treatments that will cater for different developmental needs and types of insomnia symptoms and examine not only group but also individual outcomes.
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