| 摘要: |
| ［摘要］ 目的 探讨失眠认知行为治疗（CBTI）对不同人格特质慢性失眠障碍患者的疗效差异。方法 招募2018年1月至2021年8月贵州省第二人民医院收治的慢性失眠障碍患者60例，根据龚耀先修订的艾森克个性问卷（EPQ）评价结果将其分为神经质组、外向性组和精神质组，每组20例。三组均接受为期8周的CBTI。采用睡眠日记评估三组患者治疗前（T0）、治疗结束时（T1）以及治疗结束后第3个月（T2）的主客观睡眠质量指标变化。比较三组T0、T1时间点多导睡眠监测（PSG）相关指标及血清皮质醇水平。结果 根据睡眠日记，神经质组入睡潜伏期（SL）、入睡后清醒时间（WASO）、睡眠效率（SE）以及总睡眠时间（TST）在治疗前后变化不显著（P>0.05）。治疗后，外向性组和精神质组SL、WASO逐渐减少，SE、TST逐渐增加，与T0时间点比较差异有统计学意义（P<0.05）。与神经质组相比，外向性组和精神质组在T1、T2时间点的SL更短，TST更长，SE更高，差异有统计学意义（P<0.05），外向性组和精神质组各指标比较差异无统计学意义（P>0.05）。根据PSG结果，神经质组治疗前后各指标变化不显著（P>0.05）。与T0时间点相比，外向性组T1时间点WASO、N2期占比减少，SE、N3期占比、TST及快速眼球运动（REM）期占比显著增加（P<0.05）。与T0时间点相比，精神质组T1时间点TST、SE、N3期占比增加，WASO减少，差异有统计学意义（P<0.05）。组间比较结果显示，三组T0时间点SL、WASO、TST、SE以及N1期、N2期、N3期占比比较差异无统计学意义（P>0.05）。在T1时间点，与神经质组相比，外向性组N2期占比减少，REM期占比增加，精神质组WASO、N2期占比减少，SE、N3期占比增加，差异有统计学意义（P<0.05）。与T0时间点相比，神经质组T1时间点血清皮质醇水平升高，精神质组降低，差异有统计学意义（P<0.05），但外向性组治疗前后变化不显著（P>0.05）。组间比较结果显示，三组治疗前后的血清皮质醇水平比较差异无统计学意义（P>0.05）。结论 CBTI对不同人格特质慢性失眠障碍患者的疗效存在显著差异，其对精神质人格和外向性人格失眠患者疗效更佳，对神经质人格失眠患者的疗效不理想。 |
| 关键词: 人格特质 失眠障碍 失眠认知行为治疗 疗效 |
| DOI：10.3969/j.issn.1674-3806.2024.11.12 |
| 分类号:R 749.99 |
| 基金项目:贵州省卫生计生委科学技术基金项目（编号：gzwjkj2017-1-026） |
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| An analysis on the differences in therapeutic effects of cognitive behavioral therapy for insomnia in chronic insomnia disorder patients with different personality traits |
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FENG Xia1, WANG Ying1, FANG Chao1, SHANG Yuanhao2, WANG Ziyun2, HU Jin2
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1.Department of Sleep Medicine, the Second People′s Hospital of Guizhou Province, Guiyang 550000, China; 2.School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang 561113, China
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| Abstract: |
| ［Abstract］ Objective To explore the differences in therapeutic effects of cognitive behavioral therapy for insomnia(CBTI) in chronic insomnia disorder patients with different personality traits. Methods Sixty patients with chronic insomnia disorder who were admitted to the Second People′s Hospital of Guizhou Province from January 2018 to August 2021 were recruited. According to the results of the Eysenck Personality Questionnaire(EPQ) revised by Gong Yaoxian, the patients were divided into neuroticism group, extraversion group and psychoticism group, with 20 cases in each group. All the three groups received CBTI for 8 weeks. Sleep diaries were used to assess the changes in subjective and objective sleep quality indicators in the patients of the three groups before treatment(T0), at the end of treatment(T1), and three months after the end of treatment(T2). The relevant indicators of polysomnography(PSG) and serum cortisol levels were compared among the three groups at the time points of T0 and T1. Results According to the sleep diaries, sleep latency(SL), wake after sleep onset(WASO), sleep efficiency(SE) and total sleep time(TST) in the neuroticism group after treatment did not change significantly compared with those before treatment(P>0.05). After treatment, SL and WASO gradually decreased, while SE and TST gradually increased in the extraversion group and the psychoticism group, and there were significant differences compared with those at the time point of T0(P<0.05). Compared with the neuroticism group, the extraversion group and the psychoticism group had shorter ST, longer TST and higher SE at T1 and T2 time points, and the differences were statistically significant(P<0.05). However, there was no statistically significant difference in each indicator between the extraversion group and the psychoticism group(P>0.05). According to the PSG results, there was no significant difference in the change of each indicator in the neuroticism group before and after treatment(P>0.05). In the extraversion group, compared with those at the time point of T0, WASO and the proportion of N2 stage decreased, while SE and the proportion of N3 stage, TST and the proportion of rapid eye movement(REM) stage increased significantly at the time point of T1(P<0.05). In the psychoticism group, comopared with those at the time point of T0, TST, SE and the proportion of N3 stage increased, and WASO decreased at the time point of T1, and the differences were statistically significant(P<0.05). The results of inter-group comparison showed that there were no statistically significant differences in SL, WASO, TST, SE, and proportions of N1 stage, N2 stage and N3 stage among the three groups at the time point of T0(P>0.05). At the time point of T1, compared with the neuroticism group, the extraversion group had a decrease in the proportion of N2 stage and an increase in the proportion of REM, and compared with the neuroticism group, the psychoticism group had decreases in WASO and the proportion of N2 stage and increases in SE and the proportion of N3 stage, and the differences were significant(P<0.05). Compared with that at the time point of T0, the serum cortisol level in the neuroticism group increased while the serum cortisol level in the psychoticism group decreased at the time point of T1, and the differences were significant(P<0.05), but the serum cortisol level of the extraversion group after treatment did not change significantly compared with that before treatment(P>0.05). The results of inter-group comparison showed that the serum cortisol levels in the three groups did not change significantly compared with those before treatment(P>0.05). Conclusion There are significant differences in therapeutic effects of CBTI in chronic insomnia disorder patients with different personality traits. The effects of CBTI in the insomnia patients with psychopathic personality and extraverted personality are better, but the effect of CBTI in the insomnia patients with neurotic personality is unsatisfactory. |
| Key words: Personality traits Insomnia disorder Cognitive behavioral therapy for insomnia(CBTI) Therapeutic effect |
