Clinical Study on the Effect of Cognitive Behavioral Therapy for Insomnia on Patients with Parkinson’s Disease with Insomnia
-
摘要:
目的 探讨失眠的认知行为疗法（CBT-I）对帕金森病伴失眠患者睡眠质量及情绪的干预效果。 方法 选取2021年1月至2022年3月在河北省某三甲医院住院的帕金森病伴失眠患者作为研究对象。采用随机数字表法进行随机分组，对照组给予常规护理，试验组在此基础上给予为期8周的CBT-I。所有的患者常规服用抗帕金森病药物。采用匹兹堡睡眠质量指数（PSQI）量表、失眠严重程度指数（ISI）量表、睡眠日志、汉密尔顿抑郁量表（HAMD17）以及汉密尔顿焦虑量表（HAMA14）对患者的睡眠和情绪进行评估。 结果 干预后试验组PSQI量表、ISI量表、入睡潜伏期（SOL）、总睡眠时间（TST）、HAMD17以及HAMA14分值与对照组相比差异有统计学意义（P < 0.05），而两组间睡眠效率（SE），差异无统计学意义（P > 0.05）。 结论 失眠的认知行为疗法能够有效提高帕金森病伴失眠患者的睡眠质量，改善患者的焦虑抑郁情绪。 Abstract:Objective To investigate the effect of cognitive behavioural therapy for insomnia （CBT-I） intervention on sleep quality and mood in Parkinson’s disease patients with insomnia. Methods Parkinson’s disease patients with insomnia who were hospitalized in a tertiary hospital in Hebei from January 2021 to March 2022 were selected as the study subjects. A random number table method was used for randomization. The control group was given conventional care, while the experimental group was given cognitive behavioural therapy of CBT-I insomnia for 8 weeks on top of this. All patients were routinely given anti-Parkinson’s disease medication. The Pittsburgh Sleep Quality Index （PSQI） scale, Insomnia Severity Index （ISI） scale, sleep log, Hamilton Depression Inventory （HAMD17） and Hamilton Anxiety Inventory （HAMA14） were used for outcome assessment before and after the intervention. Results The differences in PSQI scale, ISI scale, sleep latency （SOL）, total sleep time （TST）, HAMD17 and HAMA14 scores between the test group and the control group after the intervention were statistically significant （P < 0.05）, while the differences in sleep efficiency （SE） between the two groups were not statistically significant （P > 0.05）. Conclusion Cognitive behavioural therapy for insomnia is effective in improving sleep quality and improving anxiety and depression in patients with Parkinson’s disease with insomnia. -
表 1 2组一般资料情况比较（
$ \bar x \pm s$ ）Table 1. Comparison of clinical data between two groups （
$ \bar x \pm s$ ）项目 试验组（n = 33） 对照组（n = 33） χ2/t P 性别[n（%）] 0.061 0.805 男 15（45.5） 16（48.5） 女 18（54.5） 17（51.5） 年龄（岁） 63.06 ± 7.97 61.42 ± 9.72 −0.748 0.457 帕金森病病程（a） 4.33 ± 1.50 4.30 ± 1.56 −0.075 0.940 失眠病程[岁，M（P25，P75）] 2（1，6.5） 3（1，5.5） −0.155 0.877 Hoehn-Yahr分级[n（%）] −0.246 0.806 1级 5（15.2） 5（15.2） 1.5级 6（18.2） 6（18.2） 2级 13（39.4） 12（36.4） 2.5级 6（18.2） 5（15.2） 3级 3（9.1） 5（15.2） 
下载: 导出CSV
表 2 2组患者干预前后PSQI、ISI评分比较[（
$ \bar x \pm s$ ），分]Table 2. Comparison of PSQI and ISI sores between two groups of Patients [（
$ \bar x \pm s$ ），points]组别 n PSQI总分 ISI总分 干预前 干预后 干预前 干预后 试验组 33 12.21 ± 2.32 8.12 ± 1.93# 15.61 ± 3.22 9.88 ± 3.67# 对照组 33 12.12 ± 1.69 10.27 ± 1.84# 15.24 ± 3.54 13.40 ± 3.41# t 0.182 −4.630 0.437 −4.030 P 0.856 < 0.001* 0.664 < 0.001* 注：PSQI = 匹兹堡睡眠质量指数量表，ISI = 失眠严重指数量表。与同组干预前比较，#P < 0.05；组间比较，*P < 0.05。
下载: 导出CSV
表 3 2组患者干预前后睡眠日记各因子（SE、SOL、TST）比较（
$ \bar x \pm s$ ）Table 3. Comparison of sleep diary factors （SE，SOL，TST） before and after intervention in 2 groups of patients （
$ \bar x \pm s$ ）组别 n SE（%） SOL（min） TST（min） 干预前 干预后 干预前 干预后 干预前 干预后 试验组 33 0.78 ± 0.10 0.87 ± 0.06# 44.61 ± 13.46 30.47 ± 7.13# 343.84 ± 78.48 407.17 ± 48.18# 对照组 33 0.76 ± 0.11 0.85 ± 0.06# 44.06 ± 19.24 36.36 ± 13.84# 324.95 ± 57.14 372.50 ± 35.20# t值 0.815 0.991 0.135 −2.164 1.413 3.338 P值 0.418 0.326 0.893 0.034* 0.163 0.001* 注：SE = 睡眠效率，SOL = 入睡潜伏期，TST=总睡眠时间。与同组干预前比较，#P < 0.05；组间比较，*P < 0.05。
下载: 导出CSV
表 4 2组患者干预前后HAMA14、HAMD17评分比较[（
$ \bar x \pm s$ ），分]Table 4. Comparison of HAMA14 and HAMD17 sores between two groups of Patients [（
$ \bar x \pm s$ ），points]组别 n HAMA14总分 HAMD17总分 干预前 干预后 干预前 干预后 试验组 33 13.03 ± 2.90 9.73 ± 2.21# 13.70 ± 5.37 10.00 ± 3.79# 对照组 33 13.30 ± 3.03 11.24 ± 2.50# 14.48 ± 4.14 12.39 ± 3.53# t −0.374 −2.607 −0.668 −2.656 P 0.710 0.011* 0.507 0.010* 注: HAMA14=汉密尔顿焦虑量表，HAMD17 = 汉密尔顿抑郁量表。与同组干预前比较，#P < 0.05；组间比较，*P < 0.05。
下载: 导出CSV
-
[1] 郭配,张晓韬,李秀华. 帕金森病睡眠障碍的研究进展[J]. 国际神经病学神经外科学杂志,2017,44(3):332-335. doi: 10.16636/j.cnki.jinn.2017.03.025 [2] 中华医学会神经病学分会帕金森病及运动障碍学组,中国医师协会神经内科医师分会帕金森病及运动障碍学组. 中国帕金森病睡眠障碍管理专家共识[J]. 中华神经科杂志,2022,55(5):441-451. doi: 10.3760/cma.j.cn113694-20211123-00828 [3] Liu C F,Wang T,Zhan S Q,et al. Management Recommendations on Sleep Disturbance of Patients with Parkinson’s Disease[J]. Chin Med J (Engl),2018,131(24):2976-2985. doi: 10.4103/0366-6999.247210 [4] Rutten S,Vriend C,Berendse H W,et al. Anxiety,depression and sleep disorders in Parkinson’s disease:A complex interaction between body and mind[J]. Tijdschr Psychiatr,2020,62(1):62-72. [5] Chan N Y,Chan JWY,Li SX,et al. Non-pharmacological Approaches for Management of Insomnia[J]. Neurotherapeutics,2021,18(1):32-43. doi: 10.1007/s13311-021-01029-2 [6] 肖敏,黄金,赵雪. 认知行为疗法在成人慢性失眠中的应用现状[J]. 护理研究,2018,32(16):2514-2517. doi: 10.12102/j.issn.1009-6493.2018.16.007 [7] 中华医学会神经病学分会帕金森病及运动障碍学组,中国医师协会神经内科医师分会帕金森病及运动障碍专业委员会. 中国帕金森病的诊断标准(2016版)[J]. 中华神经科杂志,2016,49(4):268-271. doi: 10.3760/cma.j.issn.1006-7876.2016.04.002 [8] 中国失眠症诊断和治疗指南（一）[J]. 临床医学研究与实践, 2017, 2（27）: 201. [9] Hoehn M M,Yahr M D. Parkinsonism: onset,progression and mortality[J]. Neurology,1967,17(5):427-442. doi: 10.1212/WNL.17.5.427 [10] Spielman A J,Caruso L S,Glovinsky P B. A behavioral perspective on insomnia treatment[J]. Psychiatr Clin North Am,1987,10(4):541-53. doi: 10.1016/S0193-953X(18)30532-X [11] 马桂月,沈志莹,乔莉,等. 认知行为疗法对高血压焦虑抑郁患者干预效果研究进展[J]. 中华高血压杂志,2021,29(4):328-332. doi: 10.16439/j.issn.1673-7245.2021.04.005 [12] Tsai P S,Wang S Y,Wang M Y,et al. Psychometric evaluation of the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) in primary insomnia and control subjects[J]. Qual Life Res,2005,14(8):1943-1952.、. doi: 10.1007/s11136-005-4346-x [13] Bastien C H,Vallières A,Morin C M. Validation of the Insomnia Severity Index as an outcome measure for insomnia research[J]. Sleep Med,2001,2(4):297-307. doi: 10.1016/S1389-9457(00)00065-4 [14] Hamilton M. A rating scale for depression[J]. Neurol Neurosurg Psychiatry,1960,23(1):56-62. doi: 10.1136/jnnp.23.1.56 [15] Hamilton M. The assessment of anxiety states by rating[J]. Br J Med Psychol,1959,32(1):50-55. doi: 10.1111/j.2044-8341.1959.tb00467.x [16] Stefani A,Högl B. Sleep in Parkinson's disease[J]. Neuropsychopharmacology,2020,45(1):121-128. doi: 10.1038/s41386-019-0448-y [17] Pont-Sunyer C,Iranzo A,Gaig C,et al. Sleep disorders in Parkinsonian and nonparkinsonian LRRK2 mutation carriers[J]. PLoS One,2015,10(7):e132368. [18] O’Dowd S,Galna B,Morris R,et al. Poor sleep quality and progression of gait impairment in an incident Parkinson’s disease cohort[J]. J Parkinsons Dis,2017,7(3):465-470. doi: 10.3233/JPD-161062 [19] Adler C H, Thorpy M J. Sleep issues in Parkinson’s disease[J]. Neurology, 2005, 64（12 Suppl 3）: S12-20. [20] Kaynak D, Kiziltan G, Kaynak H, Benbir G, Uysal O. Sleep and sleepiness in patients with Parkinson’s disease before and after dopaminergic treatment[J]. Eur J Neurol, 2005, 12（3）: 199-207. [21] Zhang Y,Zhao J H,Huang D Y,et al. Multiple comorbid sleep disorders adversely affect quality of life in Parkinson’s disease patients[J]. NPJ Parkinsons Dis,2020,6:25. doi: 10.1038/s41531-020-00126-x [22] Rios Romenets S,Creti L,Fichten C,et al. Doxepin and cognitive behavioural therapy for insomnia in patients with Parkinson’s disease - a randomized study[J]. Parkinsonism Relat Disord,2013,19(7):670-675. [23] İçel S,Başoğul C. Effects of progressive muscle relaxation training with music therapy on sleep and anger of patients at Community Mental Health Center[J]. Complement Ther Clin Pract,2021,43:101338. doi: 10.1016/j.ctcp.2021.101338 [24] Sun J,Kang J,Wang P,et al. Self-relaxation training can improve sleep quality and cognitive functions in the older: a one-year randomised controlled trial[J]. J Clin Nurs,2013,22(9-10):1270-1280. doi: 10.1111/jocn.12096 [25] Yang H,Petrini M. Effect of cognitive behavior therapy on sleep disorder in Parkinson’s disease in China:a pilot study:treatment for Parkinson’s disease[J]. Nurs Health Sci,2012,14(4):458-463. [26] Herath T B,Withana M,Rodrigo C,et al. Prevalence and associations for symptoms of depression in patients with Parkinson’s disease: a Sri Lankan experience[J]. Int J Ment Health Syst,2016,10:47. doi: 10.1186/s13033-016-0079-1 [27] Upneja A,Paul B S,Jain D,et al. Anxiety in Parkinson’s Disease: Correlation with Depression and Quality of Life[J]. J Neurosci Rural Pract,2021,12(2):323-328. [28] Braak H,Del Tredici K,Rüb U,et al. Staging of brain pathology related to sporadic Parkinson’s disease[J]. Neurobiol Aging,2003,24(2):197-211. doi: 10.1016/S0197-4580(02)00065-9 [29] Lebrun C,G´ely-Nargeot MC,Rossignol A,et al. Efficacy of cognitive behavioral therapy for insomnia comorbid to Parkinson’s disease:a focus on psychological and daytime functioning with a single-case design with multiple baselines[J]. J Clin Psychol,2020,76(3):356-376. [30] Alvaro P K,Roberts R M,Harris J K. A Systematic Review Assessing Bidirectionality between Sleep Disturbances,Anxiety,and Depression[J]. Sleep,2013,36(7):1059-1068. doi: 10.5665/sleep.2810 -
