Study On The Efficacy And Influencing Factors Of Digital Supportive Of Brief Behavioral Therapy For Patients With Medically Intractable Insomnia

Objective: In recent years,the incidence of insomnia has been increasing year by year.Although cognitive behavioral therapy is the first-line treatment for insomnia,drug therapy is still the main treatment for insomnia in China.This study evaluate the efficacy of brief behavioral therapy for patients with medically intractable Insomnia,whether it can improve the sleep quality and daytime functions,relieve depression and anxiety,and reduce the use of sedatives and hypnotics.Methods: Eighty-two patients who had been taking benzodiazepines /nonbenzodiazepines for more than one month and did not see significant improvement in their insomnia symptoms were recruited.82 patients with medically intractable Insomnia were randomly assigned to receive either brief behavioral therapy for insomnia(BBTI,n=40)or digital supportive of brief behavioral therapy for insomnia(d BBTI,n=42).All patients underwent semi-structured interviews at pretreatment to collect basic information and fill in sleep diaries for two weeks.The primary outcome in the sleep diary was the sleep onset latency(SOL),number of awaking(NOA),wake time after sleep onset(WASO),total sleep onset(TST),time in bed(TIB),sleep efficiency(SE)and types and dosages of drugs currently being used.All patients filled in the insomnia severity Index scale(ISI),Pittsburgh sleep qualityindex(PSQI),dysfunctional beliefs and attitudes about sleep scale-16(DBAS-16),selfrating depression scale(SDS),self-rating anxiety Scale(SAS),the Epworth sleeping scale(ESS).A 4-week course of BBTI treatment was followed by reference to the BBTI treatment manual.In the treatment process,digital support was added to patients in the d BBTI group,which mainly included sending sleep diary regularly through an online platform every day,and simple feedback from the therapist on the filling status and content of the sleep diary.No digital support was added to patients in the BBTI group.The sleep diary and the above scales were filled in again post-treatment and 3 months post-treatment.The doses of benzodiazepines/non-benzodiazepines for all patients were converted to oral doses of approximately equivalent diazepam.Results: There were 15 patients who did not complete 4 weeks of BBTI treatment.31 patients in the BBTI group and 36 patients in the d BBTI group were included in the final data analysis.The repeated-measures analysis of variance showed significant time effects between pretreatment and 4 weeks posttreatment in the scale ratings of TIB(F=227.635),SOL(F=42.776),NOA(F=17.242),WASO(F=19.679),SE(F=81.041),ISI(F=145.331),SDS(F=22.318),SAS(F=41.689),DBAS(F=34.164),PSQI(F=145.654),drug dose(F=13.145)(P<0.05)and no significant time effects between pretreatment and 4 weeks posttreatment in the scale ratings of TST(F=3.736,P=0.058)and ESS(F=0.018,P=0.743)in both groups.The group effects between the two groups of the scale ratings of TIB(F=1.702),TST(F=0.088),SOL(F=0.967),NOA(F=2.248),WASO(F=1.337),SE(F=0.110),ISI(F=0.025),SDS(F=0.166),SAS(F=0.078),DBAS(F=0.694),PSQI(F=1.149),ESS(F=3.101),drug dose(F=0.079)was not significant(P>0.05).The group×time interaction effects of the scale ratings of SE(F=4.094,P=0.047)was significant,in this post hoc analysis,the BBTI group had lower sleep efficiency than the d BBTI group and the difference was statistically significant(F=4.727,p=0.033),and TIB(F=2.281),TST(F=0.034),SOL(F=0.004),NOA(F=0.229),WASO(F=1.766),ISI(F=2.381),SDS(F=0.229),SAS(F=0.509)、DBAS(F=0.635),PSQI(F=2.852),ESS(F=0.018),drug dose(F=0.263)was notsignificant(P>0.05).A total of 50 patients completed a three-month follow-up after the end of treatment,and 17 patients were lost to follow-up.Finally,23 patients in the BBTI group and 27 patients in the d BBTI group were included for data analysis.The repeated-measures analysis of variance showed significant time effects between pretreatment and 3 months posttreatment in the scale ratings of TIB(F=20.882),TST(F=4.546),SOL(F=21.099),NOA(F=17.897),WASO(F=17.357),SE(F=33.536),ISI(F=114.368),SDS(F=35.781),SAS(F=41.262),DBAS(F=35.110),PSQI(F=110.838),drug dose(F=79.524)(P<0.05)and no significant time effects between pretreatment and 4 weeks posttreatment in the scale ratings of ESS(F=0.251,P=0.619)in both groups.The group effects between the two groups of the scale ratings of TIB(F=0.469),TST(F=0.208),SOL(F=0.2160),NOA(F=1.239),WASO(F=0.505),SE(F=0.320),ISI(F=0.055),SDS(F=0.669),SAS(F=0.968),DBAS(F=1.250),PSQI(F=0.284),ESS(F=2.808),drug dose(F=0.568)was not significant(P>0.05).The group×time interaction effects of the scale ratings of TIB(F=0.656),TST(F=0.369),SOL(F=0.012),NOA(F=1.711),WASO(F=1.095),SE(F=1.991),ISI(F=1.605),SDS(F=0.374),SAS(F=1.464)、DBAS(F=1.614),PSQI(F=2.386),ESS(F=1.671),drug dose(F=0.034)was not significant(P>0.05).Conclusions: 1.BBTI is a simple and efficacious intervention for chronic insomnia in adults.2.BBTI can help reduce the use of benzodiazepine/non-benzodiazepine sedatives and hypnotics for long-term use.3.Adding Digital Supportive to BBTI significantly improved sleep efficiency at four weeks post-treatment and help enhance the therapeutic effect of BBTI.