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您当前位置:桓兴肿瘤医院 > 桓兴医讯 > 桓兴医讯 关于认知行为疗法联合莫达非尼治疗癌症治疗后的失眠
桓兴医讯 关于认知行为疗法联合莫达非尼治疗癌症治疗后的失眠
文章来源:北京市朝阳区桓兴肿瘤医院 点击数: 发布时间:2014-12-09 09:18
《临床肿瘤杂志》2014年12月1日在线先发
关于认知行为疗法联合莫达非尼治疗癌症治疗后的失眠的随机安慰剂对照试验
目的
失眠是一种令人不安的和癌症后经常出现的后果。虽然失眠的认知行为治疗(CBT-I)在一般人群中是首选的治疗方法,但癌症患者使用CBT-I是复杂的,因为它会导致短暂但实质的白天睡眠增加。在这项研究中,我们评估CBT-I联合促醒剂莫达非尼(A)在癌症幸存者失眠治疗比单独CBT-I是否更好的结果。
患者和方法
我们报告一个包含96名癌症幸存者的随机试验(平均年龄为56岁;女性为87.5%;乳腺癌占68%)。主要分析研究是否超过一种的7周的干预条件(比如CBT-I,莫达非尼,或CBT-I联合莫达非尼),与安慰剂胶囊(P)组相比,产生了更显著的临床获益。失眠是失眠严重程度指数和由匹兹堡睡眠质量的睡眠质量评估。所有患者均接受睡眠卫生指导。
结果
控制的基线差异分析表明,CBT-I联合莫达非尼(P=0.001)和CBT-I联合安慰剂胶囊(P =.010)组比P组减少失眠的严重程度显著增大,影响大小分别为1.31和1.02。睡眠质量也类似的改善。3个月后两项指标持续获益。CBT-I加或不加莫达非尼较CBT-I联合安慰剂胶囊没有显著差异(P =.421),莫达非尼单用与安慰剂胶囊单用没有显著差异(P =.584)。
结论
CBT-I会导致失眠和睡眠质量显著和持久的的改善。莫达非尼没有显着提高CBT-I效益或独立影响失眠及睡眠质量。
北京桓兴肿瘤医院 桓兴医讯编译组 吴永勇
2014年12月9日 星期二
Published online before print December 1, 2014, doi:10.1200/JCO.2014.57.6769JCO December 1, 2014JCO.2014.57.6769
Randomized Placebo-Controlled Trial of Cognitive Behavioral Therapy and Armodafinil for Insomnia After Cancer Treatment
Purpose Insomnia is a distressing and often persisting consequence of cancer. Although cognitive behavioral therapy for insomnia (CBT-I) is the treatment of choice in the general population, the use of CBT-I in patients with cancer is complicated, because it can result in transient but substantial increases in daytime sleepiness. In this study, we evaluated whether CBT-I, in combination with the wakefulness-promoting agent armodafinil (A), results in better insomnia treatment outcomes in cancer survivors than CBT-I alone.
Patients and Methods We report on a randomized trial of 96 cancer survivors (mean age, 56 years; female, 87.5%; breast cancer, 68%). The primary analyses examined whether ≥ one of the 7-week intervention conditions (ie, CBT-I, A, or both), when compared with a placebo capsule (P) group, produced significantly greater clinical gains. Insomnia was assessed by the Insomnia Severity Index and sleep quality by the Pittsburgh Sleep Quality Inventory. All patients received sleep hygiene instructions.
Results Analyses controlling for baseline differences showed that both the CBT-I plus A (P = .001) and CBT-I plus P (P = .010) groups had significantly greater reductions in insomnia severity postintervention than the P group, with effect sizes of 1.31 and 1.02, respectively. Similar improvements were seen for sleep quality. Gains on both measures persisted 3 months later. CBT-I plus A was not significantly different from CBT-I plus P (P = .421), and A alone was not significantly different from P alone (P = .584).
Conclusion CBT-I results in significant and durable improvements in insomnia and sleep quality. A did not significantly improve the efficacy of CBT-I or independently affect insomnia or sleep quality.
http://jco.ascopubs.org/content/early/2014/12/01/JCO.2014.57.6769.abstract

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