Background Cognitive behavioral therapy for insomnia (CBTI) targets changing dysfunctional sleep-related beliefs. The impact of these changes on daytime functioning in older adults is unknown. Purpose We examined whether changes in sleep-related beliefs from pre- to post-CBTI predicted changes in sleep and other outcomes in older adults. Method Data included 144 older veterans with insomnia from a randomized controlled trial testing CBTI. Sleep-related beliefs were assessed with the Dysfunctional Beliefs and Attitudes about Sleep-16 (DBAS-16, subscales: Consequences, Worry/Helplessness, Sleep Expectations, Medication). Outcomes included sleep diary variables, actigraphy-measured sleep efficiency, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Flinders Fatigue Scale (FFS), Patient Health Questionnaire-9, and health-related quality of life. Analyses compared slope of change in DBAS subscales from baseline to posttreatment between CBTI and control, and assessed the relationship between DBAS change and the slope of change in outcomes from baseline to 6 months. Results Compared to controls, the CBTI group demonstrated stronger associations between improvement in DBAS-Consequences and subsequent improvement in PSQI, ISI, ESS, and FFS. The CBTI group also demonstrated stronger associations between improvement in DBAS-Worry/Helplessness and subsequent improvements in PSQI, ISI, and FFS; improvements in DBAS-Medication and PSQI; and improvements in DBAS-Sleep Expectations and wake after sleep onset (sleep diary) and FFS (all p < .05). Conclusions Significant reduction in dysfunctional sleep-related beliefs following CBTI in older adults predicted improvement in several outcomes of sleep and daytime functioning. This suggests the importance of addressing sleep-related beliefs for sustained improvement with CBTI in older veterans. Trial Registration ClinicalTrials.gov Identifier: NCT00781963.

中文翻译：

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功能失调的睡眠相关信念的变化与老年失眠退伍军人的睡眠和其他健康结果的变化有关：随机对照试验的结果

背景 失眠认知行为疗法 (CBTI) 的目标是改变功能失调的睡眠相关信念。这些变化对老年人白天功能的影响尚不清楚。目的 我们检查了 CBTI 前后睡眠相关信念的变化是否可以预测老年人睡眠和其他结果的变化。方法数据包括来自一项测试 CBTI 的随机对照试验的 144 名失眠的老年退伍军人。与睡眠相关的信念通过关于 Sleep-16 的功能失调信念和态度（DBAS-16，分量表：后果、担忧/无助、睡眠预期、药物）进行评估。结果包括睡眠日记变量、活动记录仪测量的睡眠效率、匹兹堡睡眠质量指数 (PSQI)、失眠严重程度指数 (ISI)、爱华嗜睡量表 (ESS)、弗林德斯疲劳量表 (FFS)、患者健康问卷 9，以及与健康相关的生活质量。分析比较了 CBTI 和对照之间 DBAS 分量表从基线到治疗后的变化斜率，并评估了 DBAS 变化与从基线到 6 个月的结果变化斜率之间的关系。结果 与对照组相比，CBTI 组在 DBAS-Consequences 的改善与 PSQI、ISI、ESS 和 FFS 的后续改善之间表现出更强的关联。CBTI 小组还证明了 DBAS-Worry/Helplessness 的改善与 PSQI、ISI 和 FFS 的后续改善之间存在更强的关联；DBAS-Medication 和 PSQI 的改进；DBAS-Sleep Expectations 和入睡后醒来（睡眠日记）和 FFS 的改善（所有 p < .05）。结论 老年人 CBTI 后功能失调的睡眠相关信念的显着降低预示着睡眠和日间功能的若干结果的改善。这表明解决与睡眠相关的信念对于老年退伍军人使用 CBTI 持续改善的重要性。试验注册 ClinicalTrials.gov 标识符：NCT00781963。