Randomized controlled trial of cognitive behavioral therapy for perinatal insomnia: postpartum outcomes

被引:1
|
作者
Manber, Rachel [1 ]
Bei, Bei [2 ]
Suh, Sooyeon [1 ,3 ,6 ]
Simpson, Norah [1 ]
Rangel, Elizabeth [1 ]
Sit, Anita [4 ]
Lyell, Deirdre J. [5 ]
机构
[1] Stanford Univ, Sch Med, Dept Psychiat & Behav Sci, Stanford, CA USA
[2] Monash Univ, Turner Inst Brain & Mental Hlth, Sch Psychol Sci, Clayton, Vic 3800, Australia
[3] Sungshin Womens Univ, Dept Psychol, Seoul, South Korea
[4] Santa Clara Valley Med Ctr, Gen Gynecol & Obstet Div, San Jose, CA USA
[5] Stanford Univ, Sch Med, Dept Obstet & Gynecol, Stanford, CA USA
[6] Sungshin Univ, Dept Psychol, Seongbuk Gu Bomunr Ro 34 da Gil 2, Seoul 02844, South Korea
来源
JOURNAL OF CLINICAL SLEEP MEDICINE | 2023年 / 19卷 / 08期
基金
美国国家卫生研究院;
关键词
insomnia; pregnancy; postpartum; CBTI; SEVERITY INDEX; SLEEP; DEPRESSION; DISTURBANCES; MOOD;
D O I
10.5664/jcsm.10572
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Study Objectives: This study aimed to assess the effectiveness of cognitive behavioral therapy for insomnia (CBTI) during the postpartum period as part of a larger randomized controlled trial of CBTI on perinatal insomnia.Methods: A total of 179 women of 18-30 gestational weeks with insomnia disorder were randomly assigned to CBTI or an active control (CTRL) therapy. Participants were assessed between 18 and 32 weeks of pregnancy at baseline, after the intervention during pregnancy, and at 8,18, and 30 weeks postpartum. The primary outcomes were Insomnia Severity Index (ISI) scores and total awake time, defined as minutes awake during the sleep opportunity period, assessed with actigraphy and sleep diaries. Included in the analyses were women who provided data for at least 1 of 3 postpartum assessments (68 in CBTI; 61 in CTRL).Results: Piecewise mixed-effects models revealed a main effect reflecting reduction in ISI scores from 8-18 weeks postpartum (P = .036) and a nonsignificant increase from 18-30 weeks; significant effects for group allocation were present only in week 30 (P = .042). CTRL participants reported significantly longer time awake, excluding time spent caring for the infant, at each postpartum assessment; time awake at night caring for the infant did not differ between groups. There was no significant group difference in the postpartum trajectory of actigraphy-measured total awake time, the two diary measures of time awake (P values > .05). CBTI participants with at least 50% reduction in ISI during pregnancy had consistently stable ISI scores (mean < 6) during the postpartum period; those in the CTRL group had variable ISI scores over time with large individual differences.Conclusions: For women with insomnia disorder during pregnancy, CBTI initiated during pregnancy conferred postpartum benefits in terms of wakefulness after sleep onset (excluding time spent caring for the infant) and insomnia severity, though the latter emerged only later in the postpartum period. These findings underscore the importance of treating insomnia during pregnancy, a conclusion that is further supported by our finding that pregnant women who responded to insomnia treatment during pregnancy experienced better sleep in the postpartum period.
引用
收藏
页码:1411 / 1419
页数:9
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