A Study Of Brief Cognitive Behavioral Therapy In Patients With Insomnia After Ischemic Stroke

ObjectiveStroke is a common neurological disease,and insomnia is one of the common symptoms of stroke and a difficult task in nursing care.In this study,a survey was conducted using relevant scales to describe the current situation and influencing factors of insomnia patients after ischemic stroke,based on which a brief cognitive-behavioral therapy intervention program was constructed;the brief cognitive-behavioral therapy was applied to intervene in insomnia patients after ischemic stroke,and its efficacy was observed.This study provides a reference for the improvement of ischemic post-stroke insomnia patients in the future.Methods1.Investigation of the current situation of insomnia in patients with ischemic stroke and analysis of the factors affecting itA convenience sampling method was used to select 201 ischemic stroke patients who were admitted to the neurology ward of Jiangsu Subei People’s Hospital from July to September 2021 as the study population.The patients’ insomnia symptoms were assessed using the Pittsburgh Sleep Quality Index(PSQI),their fatigue level was assessed using the Fatigue Severity Scale(FSS),and their fatigue level was assessed using the Zung Self-rating anxiety scale(SAS)and the Zung Self-rating depression scale(SDS).The self-rating anxiety scale(SAS)and the self-rating depression scale(SDS)were used to assess patients’ anxiety and depression,and the Barthel index(BI)was used to assess patients’ self-care ability in daily life.The collected questionnaires were compiled and entered into the data,and the data were analyzed using SPSS23.0 after the database was established.Count data were statistically described by frequency,percentage,or percentages;measurement data were expressed as mean ± standard deviation(x±s);the effect of patients’ general clinical data on insomnia was tested by independent samples t-test and one-way ANOVA;the correlation between patients’ PSQI scores and FSS,SAS,SDS,and BI scores were analyzed by Pearson correlation.Multiple linear regression was used to analyze the factors influencing insomnia in patients after ischemic stroke.2.An intervention study of brief cognitive behavioral therapy in patients with insomnia after ischemic stroke2.1 Construction of the intervention protocol.A preliminary brief cognitive-behavioral therapy intervention protocol was developed through literature review and expert group discussion,and then six cases of post-ischemic stroke insomnia patients were selected for pre-experimentation,according to which the results were further refined to form the final draft of the brief cognitive-behavioral therapy intervention protocol.2.2 Intervention phase.Patients with insomnia after an ischemic stroke who were admitted to the neurology ward of Jiangsu Subei People’s Hospital from December 2021 to June 2022 were collected.One hundred cases were selected for the study according to the inclusion and exclusion criteria and were divided into 50 cases each in the control group and the observation group according to the random number table method.The control group adopted conventional care methods;the observation group used brief cognitive behavioral therapy for intervention based on the intervention methods of the control group.PSQI with FSS,SAS,SDS,and BI were used to assess insomnia symptoms,fatigue,anxiety-depression level,and self-care ability in the control and observation groups before the intervention and at 3 months of the intervention.Descriptive statistics,chi-square test,t-test for two independent samples,and t-test for paired samples were used for statistical analysis.Results1.Investigation of the current situation of insomnia in patients with ischemic stroke and analysis of the factors affecting itIn this study,210 questionnaires were distributed,9 invalid questionnaires were excluded,and 201 questionnaires were returned,with a valid return rate of 95.71%.201 ischemic stroke patients had Pittsburgh Sleep Quality Index scores ranging from 1 to 20,with a mean value of(9.26±4.82),and the scores for each dimension were:sleep quality(1.52±0.87),time to fall asleep(1.39± 1.10),sleep duration(1.33±0.94),sleep efficiency(1.33±0.92),sleep disturbance(1.77±0.68),hypnotic medication(0.31 ±0.87),and daytime function(1.64 ± 0.96),where 60.20%of the patients had insomnia.The results of correlation analysis showed that patients’ PSQI scores were positively correlated with FSS scores(r=0.787,P<0.001),SAS scores(r=0.806,P<0.001),and SDS scores(r=0.808,P<0.001);and negatively correlated with BI scores(r=-0.495,P<0.001).Multiple linear regression analysis showed that previous history,stroke site,fatigue,anxiety and depression,and ability to take care of oneself were influential factors in patients with ischemic stroke,explaining 78.8%of the variance in insomnia in patients with ischemic stroke.2.An intervention study of brief cognitive behavioral therapy in patients with insomnia after ischemic strokeA total of 100 study cases were included in this study,with a sample attrition of 7 cases,and 93 cases were finally completed,including 47 cases in the control group and 46 cases in the observation group.There was no statistically significant difference between the general clinical information of patients in both groups before the intervention(P>0.05).①Patients’insomnia symptoms:before the intervention,the PSQI scores of the control group and the observation group were(12.21±2.26)and(12.78±2.51),respectively,and there was no statistical difference between the scores of the two groups(P>0.05);at 3 months of the intervention,the PSQI scores of the control group and the observation group were(11.72±2.32)and(5.70±2.29),respectively,compared with the control group,the difference was statistically significant(P<0.001).At 3 months of intervention,the PSQI scores of both groups were lower than the pre-intervention level in the group,among which,there was a statistically significant difference in the observation group(P<0.001),while there was no statistically significant difference in the control group(P>0.05).②The patients’ fatigue level:before the intervention,the FSS scores were(5.43±0.54)and(5.50±0.66)in the control group and the observation group,respectively,with no statistical difference between the two groups(P>0.05);at 3 months of the intervention,the FSS scores were(5.26±0.71)and(3.96±0.82)in the control group and the observation group,respectively,with the difference compared to the control group statistically significant(P<0.001).At 3 months of intervention,the FSS scores of both groups were lower than the pre-intervention level in the group,among which,there was a statistically significant difference in the observation group(P<0.001),while there was no statistically significant difference in the control group(P>0.05).③ Patients’ anxiety level:before the intervention,the SAS scores were(56.70±3.29)and(57.34±3.00)in the control and observation groups,respectively,with no statistical difference between the two groups(P>0.05);at 3 months of the intervention,the SAS scores were(56.16±3.47)and(47.39±3.38)in the control and observation groups,respectively,compared with the control group,with a statistically significant difference(P<0.001).At 3 months of intervention,the SAS scores of both groups were lower than the pre-intervention level in the group,among which,there was a statistically significant difference in the observation group(P<0.001),while there was no statistically significant difference in the control group(P>0.05).④ Depression level of patients:before the intervention,the SDS scores of the control and observation groups were(60.43±3.73)and(60.94±3.35),respectively,with no statistically significant difference between the two groups(P>0.05);at 3 months of the intervention,the SDS scores of the control and observation groups were(59.57±4.44)and(49.74±3,53),respectively,compared with the control group,with a statistically significant difference(P<0.001).At 3 months of intervention,the SDS scores of both groups were lower than the pre-intervention level,with a statistically significant difference in the observation group(P<0.001)and no statistically significant difference in the control group(P>0.05).⑤ Patients’ self-care ability:before the intervention,the BI scores of the control group and the observation group were(69.89± 15.20)and(67.17±17.50),respectively,with no statistical difference between the two groups(P>0.05);at 3 months of the intervention,the BI scores of the control group and the observation group were(70.85±15.08)and(84.78±13.50),respectively,compared with the control group,with a statistically significant difference(P<0.001).At 3 months of intervention,the BI scores of both groups were higher than the pre-intervention level in the group,among which,there was a statistically significant difference in the observation group(P<0.001),while there was no statistically significant difference in the control group(P>0.05).Conclusion1.The incidence of insomnia in post-ischemic stroke patients is high and requires urgent attention and improvement.Factors affecting insomnia after ischemic stroke include history,stroke site,fatigue,anxiety,depression,and ability to take care of oneself.2.Brief cognitive behavioral therapy can improve insomnia,fatigue,anxiety,and depression in patients with ischemic stroke,and improve patients’ ability to take care of themselves,which has certain clinical significance.