본문 바로가기
KERD
논문KCI 등재

불면증 인지행동치료의 효과 및 이와 관련된 인자

The Efficacy of Cognitive Behavioral Therapy for Insomnia and Factors Associated with Favorable Outcome

1

조회

0

다운로드

2

인용

0

참고문헌

초록

Objectives: Cognitive behavioral therapy for insomnia (CBT-I) is a treatment for chronic insomnia via psychological intervention. CBT-I is as effective as pharmacotherapy for insomnia patients. This study investigates the clinical efficacy of CBT-I and factors associated with good outcome. Methods: 27 patients were included in this study, who visited sleep center from October 2011 to June 2012. All patients underwent baseline polysomnography for diagnosis and completed at least three sessions of CBT-I. The sleep scales and sleep diary were done. The clinical efficacy of CBT-I were evaluated by comparing changes of sleep efficacy (SE) between before and after the treatment based on the sleep diary. We grouped these patients into higher SE group and lower SE group according to their final SE. Then we retrospectively reviewed clinical characteristics and polysomnographic parameters in both groups to elucidate the factors associated with favorable outcome of CBT-I. Results: After CBT-I all patients showed significant improvement of sleep parameters (total sleep time, 181 min vs. 308 min; SE, 40% vs. 74%; sleep latency, 100 min vs. 41 min, wakefulness after sleep onset, 185 min vs. 59 min). There were no differences in sleep scales except Beck Depression Inventory between the higher SE group and the lower SE group. There were no differences in subjective sleep parameters of sleep diary between two groups at baseline. Conclusions: At least three sessions of CBT-I at this center was effective. CBT-I was more effective in patients who were depressive.

Abstract

Objectives: Cognitive behavioral therapy for insomnia (CBT-I) is a treatment for chronic insomnia via psychological intervention. CBT-I is as effective as pharmacotherapy for insomnia patients. This study investigates the clinical efficacy of CBT-I and factors associated with good outcome. Methods: 27 patients were included in this study, who visited sleep center from October 2011 to June 2012. All patients underwent baseline polysomnography for diagnosis and completed at least three sessions of CBT-I. The sleep scales and sleep diary were done. The clinical efficacy of CBT-I were evaluated by comparing changes of sleep efficacy (SE) between before and after the treatment based on the sleep diary. We grouped these patients into higher SE group and lower SE group according to their final SE. Then we retrospectively reviewed clinical characteristics and polysomnographic parameters in both groups to elucidate the factors associated with favorable outcome of CBT-I. Results: After CBT-I all patients showed significant improvement of sleep parameters (total sleep time, 181 min vs. 308 min; SE, 40% vs. 74%; sleep latency, 100 min vs. 41 min, wakefulness after sleep onset, 185 min vs. 59 min). There were no differences in sleep scales except Beck Depression Inventory between the higher SE group and the lower SE group. There were no differences in subjective sleep parameters of sleep diary between two groups at baseline. Conclusions: At least three sessions of CBT-I at this center was effective. CBT-I was more effective in patients who were depressive.

참고문헌 (39)

  1. Kraus SS, "Sleep America: managing the crisis of adult chronic insomnia and associated conditions", J Affect Disord, 138, pp.192~212 (2012)
  2. National Institutes of Health, "National Institutes of Health State of the Science Conference statement on Manifestations and Management of Chronic Insomnia in Adults, June 13-15, 2005", Sleep, 28, pp.1049~1057 (2005)
  3. Ohayon MM, "Epidemiology of insomnia: what we know and what we still need to learn", Sleep Med Rev, 6, pp.97~111 (2002)
  4. Taylor DJ, "Comorbidity of chronic insomnia with medical problems", Sleep, 30, pp.213~218 (2007)
  5. Kapur VK, "The relationship between chronically disrupted sleep and healthcare use", Sleep, 25, pp.289~296 (2002)
  6. Kleinman NL, "Health benefit costs and absenteeism due to insomnia from the employer’s perspective: a retrospective, case-control, database study", J Clin Psychiatry, 70, pp.1098~1104 (2009)
  7. Daley M, "Insomnia and its relationship to health-care utilization, work absenteeism, productivity and accidents", Sleep Med, 107, pp.427~438 (2009)
  8. Smith MT, "Comparative meta-analysis of pharmacotherapy and behavior therapy for persistent insomnia", Am J Psychiatry, 159, pp.5~11 (2002)
  9. Riemann D, "The treatments of chronic insomnia: a review of benzodiazepine receptor agonists and psychological and behavioral therapies", Sleep Med Rev, 13, pp.205~214 (2009)
  10. Ebben MR, "Non-pharmacological treatments for insomnia", J Behav Med, 32, pp.244~254 (2009)
  11. Siebern AT, "Insomnia and its effective non-pharmacologic treatment", Med Clin North Am, 94, pp.581~591 (2010)
  12. Morgenthaler T, "Practice parameters for the psychological and behavioral treatment of insomnia: an update. An american academy of sleep medicine report", Sleep, 29, pp.1415~1419 (2006)
  13. Morin CM, "Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial", JAMA, 301, pp.2005~2015 (2009)
  14. Jacobs GD, "Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison", Arch Intern Med, 164, pp.1888~1896 (2004)
  15. Sivertsen B, "Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults: a randomized controlled trial", JAMA, 295, pp.2851~2858 (2006)
  16. Morin CM, "Nonpharmacological interventions for insomnia: a meta-analysis of treatment efficacy", Am J Psychiatry, 151, pp.1172~1180 (1994)
  17. Murtagh DR, "Identifying effective psychological treatments for insomnia: a meta-analysis", J Consult Clin Psychol, 63, pp.79~89 (1995)
  18. Irwin MR, "Comparative meta-analysis of behavioral interventions for insomnia and their efficacy in middle-aged adults and in older adults 55+ years of age", Health Psychol, 25, pp.3~14 (2006)
  19. Chae JH, "Short-term efficacy of cognitivebehavioral thrapeutic interventions for primary insomnia", Korea J Sleep Medicine, 38, pp.38~43 (2001)
  20. 김무경, "만성 공존불면증 환자의 인지행동치료: 세 사례를 중심으로", 인지행동치료, 12(3), pp.225~258 (2012), 한국인지행동치료학회
  21. Choi SJ, "Effects of the abbreviated cognitive behavioral therapy for chronic insomniacs", J Korean Critical Care Nursing, 1, pp.19~31 (2008)
  22. Shin YM, "Clinical efficacy of individual cognitive behavioral therapy for patients with primary or secondary insomnia", Sleep Med Psychophysiol, 17, pp.34~40 (2010)
  23. Choi SJ, "The effects of sleep restriction-emphasized cognitive behavioral therapy for insomnia on sleep with chronic insomniacs: a preliminary study", J Korean Sleep Res Soc, 7, pp.49~56 (2010)
  24. Ong J, "Utilizing cognitive-behavioral therapy for insomnia to facilitate discontinuation of sleep medication in chronic insomnia patients", Sleep Med Res, 38, pp.1~6 (2012)
  25. American Psychiatric Association, "Diagnostic and Statistical Manual of Mental Disorders", pp.553~557 (2000), American Psychiatric Association
  26. Cho YW, "The reliability and validity of the Korean version of the Epworth sleepiness scale", Sleep Breath, 15, pp.377~384 (2011)
  27. Sohn SI, "The reliability and validity of the Korean version of the Pittsburgh Sleep Quality Index", Sleep Breath, 16, pp.803~812 (2012)
  28. Bastien CH, "Validation of the Insomnia Severity Index as an outcome measure for insomnia research", Sleep Med, 2, pp.297~307 (2001)
  29. Léger D, "SF-36:evaluation of quality of life in severe and mild insomniacs compared with good sleepers", Psychosom Med, 63, pp.49~55 (2001)
  30. Rhee MK, "A standardization study of Beck Depression Inventory I-Korean version (K-BDI): reliability and factor analysis", Korean J Psychopathol, 48, pp.77~95 (1995)
  31. Iber C, "The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications" (2007), American Academy of Sleep Medicine
  32. Edinger JD, "Cognitive behavioral therapy for treatment of chronic primary insomnia:a randomized controlled trial", JAMA, 285, pp.1856~1864 (2001)
  33. Harvey AG, "Cognitive approaches to insomnia", Clin Psychol Rev, 25, pp.593~611 (2005)
  34. Edinger JD, "Cognitive-behavioral therapy for primary insomnia", Clin Psychol Rev, 25, pp.539~558 (2005)
  35. Espie CA, "The clinical effectiveness of cognitive behaviour therapy for chronic insomnia: implementation and evaluation of a sleep clinic in general medical practice", Behav Res Ther, 39, pp.45~60 (2001)
  36. Kim JH, "Cognitive Behavioral therapy for chronic insomnia", J Korean Sleep Soc, 1, pp.20~25 (2004)
  37. Taylor DJ, "A pilot study of cognitive-behavioral therapy of insomnia in people with mild depression", Behav Ther, 38, pp.49~57 (2007)
  38. Manber R, "Cognitive behavioral therapy for insomnia enhances depression outcome in patients with comorbid major depressive disorder and insomnia", Sleep, 31, pp.489~495 (2008)
  39. Geyer JD, "Sleep education for paradoxical insomnia", Behav Sleep Med, 96, pp.266~272 (2011)

관련 논문AI추천

이 간행물의 다른 논문 (6건)