Abstract

Introduction

The long-term impact of addressing sleep-related cognitions, which is an important component of cognitive behavioral therapy for insomnia (CBTI), has not been established, particularly in older adults. We examined whether specific changes in sleep-related cognitions predicted long-term changes in sleep and other outcomes following CBTI in older adults.

Methods

We analyzed data from a randomized controlled trial testing CBTI in older veterans with insomnia (N=159, mean age 72 years). Sleep-related cognitions were assessed with the Dysfunctional Beliefs and Attitudes about Sleep scale (DBAS, subscales: Consequences, Worry/Helplessness, Sleep Expectations, Medication). Outcome measures included the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), sleep diary variables, Flinders Fatigue Scale (FFS), and Short Form-12 health-related quality of life (QOL). Analyses completed slope of change in DBAS subscales (baseline to post-treatment: T1) between CBTI and control with respect to slope of change in sleep and other outcomes from post-treatment to 6-months (T2).

Results

Compared to controls, the CBTI group had significantly stronger associations between improvement (T1) in DBAS-Consequences and subsequent (T2) improvement in PSQI (difference in slopes [DIS]=0.9, 95%CI=[.29, 1.43], p=0.004), ISI (DIS=1.1, 95%CI=[.18, 2.0], p=0.019), ESS (DIS=0.6, 95%CI=[.10, 1.18], p=0.020), and FFS (DIS=1.9, 95%CI=[.76, 3.09], p=0.001). The CBTI group also had significantly stronger associations between improvement in DBAS-Worry/Helplessness and subsequent improvements in PSQI, ISI, and FFS; improvement in DBAS-Medication and PSQI and ISI; and improvement in DBAS-Sleep Expectations and improved FFS. Slopes were not different between groups for sleep diary variables or QOL.

Conclusion

Significant improvements in sleep-related cognitions with CBTI across DBAS subscales in older adults predicted improvement in several outcomes of nighttime sleep and daytime consequences. These findings suggest the importance of addressing dysfunctional sleep-related cognitions for sustained improvement with CBTI in older adults

Support

The study was supported by VA Health Services, Research and Development (Alessi, IIR 08-295), National Institute on Aging (K23AG055668, Song), National Heart, Lung, and Blood Institute (K24HL 143055, Martin) of the National Institutes of Health and VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center.

中文翻译：

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0475减少失眠相关的认知，改善失眠老年人的夜间睡眠和白天后果

摘要

介绍

尚未解决解决睡眠相关认知的长期影响，这是失眠认知行为疗法（CBTI）的重要组成部分，尤其是在老年人中。我们检查了与睡眠有关的认知的特定变化是否预示了老年人在CBTI后睡眠和其他结局的长期变化。

方法

我们分析了失眠（N = 159，平均年龄72岁）的老年退伍军人的CBTI随机对照试验数据。通过关于睡眠量表的功能障碍信念和态度（DBAS，子量表：后果，忧虑/无助，睡眠期望，药物治疗）评估与睡眠有关的认知。结果指标包括匹兹堡睡眠质量指数（PSQI），失眠严重度指数（ISI），爱泼华嗜睡量表（ESS），睡眠日记变量，弗林德斯疲劳量表（FFS）和12型健康相关的生活质量（QOL） ）。分析从治疗后到6个月（T2）的睡眠和其他结局变化的斜率，CBTI和对照之间DBAS子量表的完整变化斜率（基线至治疗后：T1）。

结果

与对照组相比，CBTI组在DBAS结果的改善（T1）与PSQI的后续改善（T2）之间具有更强的关联性（斜率差异[DIS] = 0.9，95％CI = [。29，1.43]，p = 0.004），ISI（DIS = 1.1、95％CI = [。18、2.0]，p = 0.019），ESS（DIS = 0.6、95％CI = [。10、1.18]，p = 0.020）和FFS （DIS ＝ 1.9，95％CI ＝ [。76，3.09]，p ＝ 0.001）。CBTI组在DBAS担心/无助的改善与PSQI，ISI和FFS的后续改善之间也具有明显更强的关联。改善DBAS-Medication和PSQI和ISI；以及提高DBAS睡眠期望和改进FFS。两组间的睡眠日记变量或QOL斜率没有差异。

结论

跨DBAS量表的老年人中与CBTI有关的睡眠相关认知的显着改善预示了夜间睡眠和白天后果的几种结果将有所改善。这些发现表明，应对功能障碍的睡眠相关认知对于老年人CBTI持续改善的重要性

支持

该研究得到了美国国立卫生研究院的VA卫生服务，研究与开发（Alessi，IIR 08-295），美国国立老龄研究所（K23AG055668，Song），美国国立心脏，肺和血液研究所（K24HL 143055，Martin）的支持。 Health and VA Greater Los Angeles医疗保健系统，老年医学研究，教育和临床中心。