Background:Sleep disorders frequently occur in posttraumatic stress disorder(PTSD)patients.Chronic insomnia is a common feature of and criteria for the diagnosis of PTSD.Another sleep disorder,obstructive sleep apnea(...Background:Sleep disorders frequently occur in posttraumatic stress disorder(PTSD)patients.Chronic insomnia is a common feature of and criteria for the diagnosis of PTSD.Another sleep disorder,obstructive sleep apnea(OSA),also occurs frequently in PTSD,and emerging research indicates OSA fuels chronic insomnia.Scant research has investigated the impact of OSA treatment on insomnia outcomes(Insomnia Severity Index,ISI)in trauma survivors.Methods:OSA patients with moderately severe posttraumatic stress symptoms were studied in a retrospective chart review.Ninety-six patients who failed CPAP therapy due to expiratory pressure intolerance or complex sleep apnea or both underwent manual titration with advanced PAP modes[autobilevel(ABPAP);adaptive servo-ventilation(ASV)],which were subsequently prescribed.PAP use measured by objective data downloads divided the sample into three groups:compliant regular users(C-RU):n=68;subthreshold users(SC-RU):n=12;and noncompliant users(NC-MU):n=16.The average follow-up was 11.89±12.22 months.Baseline and posttreatment ISI scores were analyzed to assess residual insomnia symptoms as well as cure rates.Results:The C-RU group showed significant improvements in insomnia with very large effects compared to those in the NC-MU reference group(P=0.019).Insomnia severity significantly decreased in all three groups with large effects(C-RU,P=0.001;SC-RU,P=0.027;NC-MU,P=0.007).Hours of weekly PAP use and insomnia severity were inversely correlated(P=0.001,r=–0.321).However,residual insomnia symptoms based on established ISI cut-offs were quite common,even among the C-RU group.Post hoc analysis showed that several categories of sedating medications reported at baseline(hypnotics,anti-epileptic,opiates)as well as actual use of any sedating medication(prescription or nonprescription)were associated with smaller insomnia improvements than those in patients not using any sedating agents.Conclusions:In a retrospective,nonrandomized analysis of a select sample of sleep clinic patients with OSA an展开更多
目的:系统评价失眠认知行为疗法(CBT-I)改善失眠伴抑郁病人的失眠和抑郁效果。方法:检索中国知网、中国生物医学文献数据库、万方和维普数据库、Pub Med、Web of Science、Cochrane Library中建库至2019年8月9日关于CBT-I对失眠伴抑郁...目的:系统评价失眠认知行为疗法(CBT-I)改善失眠伴抑郁病人的失眠和抑郁效果。方法:检索中国知网、中国生物医学文献数据库、万方和维普数据库、Pub Med、Web of Science、Cochrane Library中建库至2019年8月9日关于CBT-I对失眠伴抑郁病人影响的相关文献,提取纳入文献的数据,并评价其质量后,采用Rev Man 5.3软件进行数据分析。结果:共纳入9篇文献,涉及病人816例。Meta分析结果显示,CBT-I可改善失眠伴抑郁病人的失眠症状[SMD=-0.82,95%CI(-1.08,-0.56),P<0.000 01]、抑郁症状[SMD=-1.32,95%CI(-1.88,-0.76),P<0.000 01]。亚组分析显示,CBT-I改善重度抑郁病人的效果更显著(P=0.006),且干预时间在2个月及以上者效果更显著(P<0.000 1)。结论:现有证据表明,CBT-I能够通过治疗失眠改善其不同程度的抑郁症状,对于重度抑郁病人治疗效果更加显著,但干预时间应在2个月及以上。展开更多
基金small private donations to the Sleep&Human Health Institute.
文摘Background:Sleep disorders frequently occur in posttraumatic stress disorder(PTSD)patients.Chronic insomnia is a common feature of and criteria for the diagnosis of PTSD.Another sleep disorder,obstructive sleep apnea(OSA),also occurs frequently in PTSD,and emerging research indicates OSA fuels chronic insomnia.Scant research has investigated the impact of OSA treatment on insomnia outcomes(Insomnia Severity Index,ISI)in trauma survivors.Methods:OSA patients with moderately severe posttraumatic stress symptoms were studied in a retrospective chart review.Ninety-six patients who failed CPAP therapy due to expiratory pressure intolerance or complex sleep apnea or both underwent manual titration with advanced PAP modes[autobilevel(ABPAP);adaptive servo-ventilation(ASV)],which were subsequently prescribed.PAP use measured by objective data downloads divided the sample into three groups:compliant regular users(C-RU):n=68;subthreshold users(SC-RU):n=12;and noncompliant users(NC-MU):n=16.The average follow-up was 11.89±12.22 months.Baseline and posttreatment ISI scores were analyzed to assess residual insomnia symptoms as well as cure rates.Results:The C-RU group showed significant improvements in insomnia with very large effects compared to those in the NC-MU reference group(P=0.019).Insomnia severity significantly decreased in all three groups with large effects(C-RU,P=0.001;SC-RU,P=0.027;NC-MU,P=0.007).Hours of weekly PAP use and insomnia severity were inversely correlated(P=0.001,r=–0.321).However,residual insomnia symptoms based on established ISI cut-offs were quite common,even among the C-RU group.Post hoc analysis showed that several categories of sedating medications reported at baseline(hypnotics,anti-epileptic,opiates)as well as actual use of any sedating medication(prescription or nonprescription)were associated with smaller insomnia improvements than those in patients not using any sedating agents.Conclusions:In a retrospective,nonrandomized analysis of a select sample of sleep clinic patients with OSA an
文摘目的:系统评价失眠认知行为疗法(CBT-I)改善失眠伴抑郁病人的失眠和抑郁效果。方法:检索中国知网、中国生物医学文献数据库、万方和维普数据库、Pub Med、Web of Science、Cochrane Library中建库至2019年8月9日关于CBT-I对失眠伴抑郁病人影响的相关文献,提取纳入文献的数据,并评价其质量后,采用Rev Man 5.3软件进行数据分析。结果:共纳入9篇文献,涉及病人816例。Meta分析结果显示,CBT-I可改善失眠伴抑郁病人的失眠症状[SMD=-0.82,95%CI(-1.08,-0.56),P<0.000 01]、抑郁症状[SMD=-1.32,95%CI(-1.88,-0.76),P<0.000 01]。亚组分析显示,CBT-I改善重度抑郁病人的效果更显著(P=0.006),且干预时间在2个月及以上者效果更显著(P<0.000 1)。结论:现有证据表明,CBT-I能够通过治疗失眠改善其不同程度的抑郁症状,对于重度抑郁病人治疗效果更加显著,但干预时间应在2个月及以上。
