A Comparative Study Of Computerized Cognitive Behavioral Therapy For Insomnia On Sleep Structure And Cognitive Function In Patients With Non-organic Insomnia

ObjectiveTo investigate the differences between subjective and objective sleep structuremeasures in non-organic insomnia patients and to explore the relationship between sleep structure with cognitive function.To compare the influence of sleep structure and cognitive function what using CCBT-I,BZDs,or non-BZDs to treat non-organic insomnia patients.MethodUsing a randomized controlled trial design,patients enrolled in the study were divided into BZDsand non-BZDs and CCBT-I groups 1:1:1 ratio.Using Pittsburgh Sleep Index Scale(PSQI),Insomnia Severity Index(ISI),Sleep Belief Attitude Scale(DBAS-16)to assess the subjective sleep.Using Hamilton Depression Scale(HAMD-17),Hamilton Anxiety Scale(HAMA)to assess anxiety and depression.Using CPC to assess objective sleep outcome.Using Wisconsin card sorting test and Stroop color word test to assess cognitive function.The missing rate is chosen as an indicator of the feasibility of the assessment.Using the above scales to assessment at baseline and Week 4,8 Week 12,and 24 Week after treatment follow-up.All data were statistically analyzed using SPSS 23.0.p<0.05 was considered statistically significant.The statistical methods mainly involved in this study were paired samples t-tests,ANVOA,repeated measures analysis of variance and Wilcoxon rank sum test.Results1.A total of 56 patients with non-organic insomnia were enrolled.The differences in sleep latency and total sleep duration between PSQI and CPC were significant(t=-4.139,p<0.01;t=8.317,p<0.01).Depression and anxiety in patients with non-organic insomnia were significantly associated with subjective and objective sleep reports.The itme-4 of HAMD-17 was significantly associated with PSQI score(r=0.49,p<0.001).The total score of HAMD-17 was significantly correlated with CPC measured wake-up time(r=0.35,p<0.05);total sleep time measured by CPC significantly associated with the itme-8 of HAMA(r=0.29,p<0.05).Cognitive function test results were related to insomnia:the sleep time measured by CPC was significantly correlated with the WCST correct rate and the number of false responses(r=0.32,p<0.05;r=-0.32,p<0.05);2.Patients were randomly assigned to three treatment groups after enrollment.There were 15 patients in the BZDs group,20 in the non-BZDs group,and 21 in the CCBT-I group.There were no significant differences in the basic demographic data between three groups.3.The differences in4 weeks treatment and he baseline of PSQI score were significantly(t=8.12,p<0.001).The mean of PSQI scores were decreased after 4 weeks treatment,but there was no significant difference between there groups(p>0.05).The results of repeated measures analysis of variance showed that the ISI were only statistically different in the time main effect(p<0.05),that is,regardless of the factors of the treatment group,the patients were relieved of the insomnia symptoms.Paired sample t-test showed that the scores of HAMD-17 were decreased after 4 weeks of treatment(t=3.56,p<0.01);the scores of HAMA were decreased,but the difference was not significant(p>0.05).4.After 8-12 weeks of treatment,there still were significant differences in subjective and objective feedback on total sleep time and sleep latency(p<0.001).After 8-12 weeks of treatment,the WCST test showed a significant reduction in errors(p<0.001)and a significant reduction in total time(p<0.001).The Stroop color test showed increased significantly incorrect numbers(p<0.05)and decreased significantly in errors(p<0.05).ConclusionThe non-organic insomnia patient's subjective report on sleep is inconsistent with the objective monitoring results.Whether before or during treatment,the non-organic insomnia patients are prone to subjectively exaggerated symptoms of insomnia.Non-organic insomnia patients are often accompanied by certain depression and anxiety,these emotions are closely related to their symptoms of insomnia.As the insomnia symptoms improve,the anxiety and depression also improve significantly.Insomnia may affect the cognitive function of patients that as the insomnia symptoms relieved,cognitive impairment of patients also can be effectively alleviated.Whether CCBT-I or medication,they can relieve symptoms of insomnia.That is to say,the CCBT-I used in this study has good application value,and can be further verified and promoted in the future.