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Wei J, Song M, Mao HJ, Qi R, Yang L, Xu Y, Yan P, Hu L. Analysis of the Improvement Sequence in Insomnia Symptoms and Factors Influencing the Treatment Outcomes of Smartphone-Delivered CBT in Patients with Insomnia Disorder. Nat Sci Sleep 2024; 16:1365-1376. [PMID: 39290809 PMCID: PMC11407310 DOI: 10.2147/nss.s486288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 09/10/2024] [Indexed: 09/19/2024] Open
Abstract
Background The effectiveness of medication combined with smartphone-delivered cognitive behavioral therapy for insomnia (CBT-I) has been well verified, but there are few studies on the sequence of remission of insomnia symptoms. This study aims to understand the sequence of symptom improvement and the factors influencing the treatment effectiveness in patients with insomnia. Methods Smartphone-delivered CBT, as a form of Online CBT, allows for training through mobile devices at any time and place. We utilized the Good Sleep 365 app to conduct a survey, involving 2820 patients who met the baseline inclusion criteria. These patients were assessed using a general demographic questionnaire and the Pittsburgh Sleep Quality Index (PSQI) to evaluate general demographic information and insomnia symptoms, and subsequently underwent CBT training using the Good Sleep 365 app. A total of 1179 patients completed follow-ups at 4 weeks, 8 weeks, 16 weeks, and 24 weeks. Results At 4 weeks and 8 weeks, the descending order of the reduction rates of PSQI components (excluding component 6: use of sleeping medication) was: sleep latency, subjective sleep quality, sleep efficiency, sleep disturbance, sleep maintenance, and daytime dysfunction. At 16 weeks and 24 weeks, the descending order was subjective sleep quality, sleep latency, sleep efficiency, daytime dysfunction, sleep maintenance, and sleep disturbance. There were significant differences in the reduction rates of PSQI components (excluding component 6: use of sleeping medication) both at the same follow-up times and at different follow-up times (all P<0.05). Multivariable logistic regression analysis showed that patients older than 30 years and those with a college degree or above had better treatment outcomes, whereas those with a disease duration of more than three years had worse outcomes. Conclusion The sequence of symptom improvement in patients with insomnia changes over time, and age, educational level, and duration of disease are factors influencing treatment outcomes.
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Affiliation(s)
- Jia Wei
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310013, People's Republic of China
| | - Mingfen Song
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310013, People's Republic of China
| | - Hong Jing Mao
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310013, People's Republic of China
| | - Ruobing Qi
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310013, People's Republic of China
| | - Lili Yang
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310013, People's Republic of China
| | - You Xu
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310013, People's Republic of China
| | - Pan Yan
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310013, People's Republic of China
| | - Linlin Hu
- Sleep Medicine Center, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310013, People's Republic of China
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Liang R, Zhu W, Gao Y, Zhao C, Zhang C, Xu L, Zuo Y, Lv Y, Zhao M, Li C, Gao J, Mei J, Gong X, Zhang L, Shen S, Yang C, Ren J, Liu Y, Wang Z, Wang P, Zhou J, Wang F, Wu J, Chen J, Zhu Y, Zhang C, Dong X, Han F. Clinical features, polysomnography, and genetics association study of restless legs syndrome in clinic based Chinese patients: A multicenter observational study. Sleep Med 2024; 117:123-130. [PMID: 38531167 DOI: 10.1016/j.sleep.2024.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/15/2024] [Accepted: 03/15/2024] [Indexed: 03/28/2024]
Abstract
STUDY OBJECTIVES To systemically describe the clinical features, polysomnography (PSG) finding, laboratory tests and single-nucleotide polymorphisms (SNPs) in a clinic based Chinese primary restless legs syndrome (RLS) population. METHODS This observational study, conducted from January 2020 to October 2021 across 22 sleep labs in China, recruited 771 patients diagnosed with RLS following the 2014 RLSSG criteria. Clinical data, PSG testing, and laboratory examination and SNPs of patients with RLS were collected. A total of 32 SNPs in 24 loci were replicated using the Asian Screening Array chip, employing data from the Han Chinese Genomes Initiative as controls. RESULTS In this study with 771 RLS patients, 645 had primary RLS, and 617 has DNA available for SNP study. Among the 645 primary RLS, 59.7% were women. 33% had a family history of RLS, with stronger familial influence in early-onset cases. Clinical evaluations showed 10.4% had discomfort in body parts other than legs. PSG showed that 57.1% of RLS patients had periodic leg movement index (PLMI) of >5/h and 39.1% had PLMI >15/h, respectively; 73.8% of RLS patients had an Apnea-Hypopnea Index (AHI) > 5/h, and 45.3% had an AHI >15/h. The laboratory examinations revealed serum ferritin levels <75 ng/ml in 31.6%, and transferrin saturation (TSAT) of <45% in 88.7% of RLS patients. Seven new SNPs in 5 genes showed a significant allelic association with Chinese primary RLS, with one previously reported (BTBD9) and four new findings (TOX3, PRMT6, DCDC2C, NOS1). CONCLUSIONS Chinese RLS patients has specific characters in many aspects. A high family history with RLS not only indicates strong genetic influence, but also reminds us to consider the familial effect in the epidemiological study. Newly developed sequencing technique with large samples remains to be done.
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Affiliation(s)
- Ruiling Liang
- Division of Sleep Medicine, Peking University People's Hospital, Beijing, China
| | - Wenjun Zhu
- Division of Sleep Medicine, Peking University People's Hospital, Beijing, China
| | - Yinghui Gao
- PKU-UPenn Sleep Center, Peking University International Hospital, Beijing, China
| | - Chen Zhao
- Institute of Neurogenomics, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Chi Zhang
- Division of Sleep Medicine, Peking University People's Hospital, Beijing, China
| | - Liyue Xu
- Division of Sleep Medicine, Peking University People's Hospital, Beijing, China
| | - Yuhua Zuo
- Division of Sleep Medicine, Peking University People's Hospital, Beijing, China
| | - Yunhui Lv
- The Sleep Center, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Mingming Zhao
- Department of Sleep Medicine, People's Hospital of Guangxi Zhuang Autonomous Region, Nan Ning, China
| | - Chenyu Li
- Department of Neurology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Jie Gao
- Department of Neurology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Junhua Mei
- Department of Neurology, Wuhan First Hospital, Wuhan, China
| | - Xue Gong
- Department of Neurology, Wuhan First Hospital, Wuhan, China
| | - Lisan Zhang
- Department of Neurobiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shuxia Shen
- Department of Neurology, Yulin No.2 Hospital, Yulin, Shaanxi, China
| | - Chunbin Yang
- The Sleep Center, People's Hospital of JinChang, JinChang, Gansu, China
| | - Jilin Ren
- The Sleep Center, People's Hospital of JinChang, JinChang, Gansu, China
| | - Yan Liu
- The Sleep Center, WeiNan Central Hospital, WeiNan, Shaanxi, China
| | - Zan Wang
- The Sleep Center, Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Peipei Wang
- Sleep Medicine Department, Sanya Central Hospital, The Third People's Hospital of Hainan, China
| | - Jinxia Zhou
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Feng Wang
- The Sleep Center, General Hospital of the Yangtze River Shipping, Wuhan, Hubei, China
| | - Jun Wu
- Department of Neurology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Juan Chen
- Department of Neurology, The First Hospital of Changsha, Changsha, Hunan, China
| | - Yanmei Zhu
- Department of Neurology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Chunrong Zhang
- Department of Neurology, Qinhuangdao HaiGang Hospital, Qinhuangdao, Hebei, China
| | - Xiaosong Dong
- Division of Sleep Medicine, Peking University People's Hospital, Beijing, China
| | - Fang Han
- Division of Sleep Medicine, Peking University People's Hospital, Beijing, China.
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Wei J, Xu Y, Mao H. Mobile cognitive behavioral therapy for insomnia: analysis of factors affecting treatment prognosis. Sci Rep 2024; 14:3086. [PMID: 38321116 PMCID: PMC10847131 DOI: 10.1038/s41598-024-53119-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 01/28/2024] [Indexed: 02/08/2024] Open
Abstract
This study aims to explore the factors that affect the prognosis of patients with insomnia who are treated with mobile cognitive behavioral therapy. Patients with insomnia who visited the sleep disorders clinic were selected and completed mobile Cognitive behavioral therapy. Patients completed at least three evaluations (including baseline, monthly evaluations thereafter, and a final evaluation at the end of one year) and responded well to treatment within one year of follow-up. Insomnia, anxiety, and depression symptoms were evaluated using the Pittsburgh Sleep Quality Index (PSQI), the Generalized Anxiety Disorder 7-item (GAD-7) scale, and the 9-item Patient Health Questionnaire (PHQ-9), respectively. Treatment prognosis including relapse, recurrence, and remission group. These 339 patients were divided into three groups: 160 patients who remission, 100 patients who relapsed, and 79 patients who experienced recurrence after remission. Demographic characteristics of the 339 patients showed no significant difference in gender between the three groups (P = 0.978). However, significant differences were found in age (P = 0.006) and onset time (P = 0.000) among the three groups. The remission group had a higher average age than the recurrence group and the relapse group, and the onset time was slower than the other two groups. Multivariate logistic regression analysis showed that age and delayed onset time were protective factors for good treatment prognosis, while low educational level and high GAD-7 scores were independent risk factors for poor prognosis. There are many factors that affect the treatment prognosis of insomnia. Age, low educational level, high GAD-7 scores, and delayed onset time can be used to predict the prognosis of insomnia treatment.
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Affiliation(s)
- Jia Wei
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University, Hangzhou, China
| | - You Xu
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University, Hangzhou, China
| | - Hongjing Mao
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University, Hangzhou, China.
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Ding P, Li J, Chen H, Zhong C, Ye X, Shi H. Independent and joint effects of sleep duration and sleep quality on suboptimal self-rated health in medical students: A cross-sectional study. Front Public Health 2022; 10:957409. [PMID: 36276404 PMCID: PMC9583520 DOI: 10.3389/fpubh.2022.957409] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/20/2022] [Indexed: 01/24/2023] Open
Abstract
Objective Studies on the association between sleep behavior and health often ignored the confounding effects of biorhythm-related factors. This study aims to explore the independent and joint effects of sleep duration and sleep quality on suboptimal self-rated health (SRH) in medical students. Methods Cross-sectional study. Proportional stratified cluster sampling was used to randomly recruit students from various medical specialties at a medical university in eastern China. Our questionnaire mainly included information on basic demographic characteristics, SRH, sleep behavior, and biorhythm-related factors. The independent and joint effects of sleep duration and sleep quality on suboptimal SRH were assessed by logistic regression after controlling for potential confounders. Results Of 1,524 medical students (mean age = 19.9 years, SD = 1.2 years; 59.1% female), 652 (42.8%) had suboptimal SRH. Most medical students (51.5%) slept for 7 h/night, followed by ≥8 (29.1%) and ≤ 6 h (19.4%). After adjusting for basic demographic characteristics and biorhythm-related factors, compared with students who slept for ≥8 h/night, the adjusted ORs (95%CI) for those who slept 7 and ≤ 6 h/night were 1.36 (1.03, 1.81) and 2.28 (1.60, 3.26), respectively (P < 0.001 for trend); compared with those who had good sleep quality, the adjusted ORs (95%CI) for those who had fair and poor sleep quality were 4.12 (3.11, 5.45) and 11.60 (6.57, 20.46), respectively (P < 0.001 for trend). Further, compared with those who slept for ≥8 h/night and good sleep quality, those who slept ≤ 6 h and poor sleep quality had the highest odds of suboptimal SRH (OR 24.25, 95%CI 8.73, 67.34). Conclusions Short sleep and poor sleep quality were independently and jointly associated with higher odds of suboptimal SRH among medical students.
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Affiliation(s)
- Pan Ding
- Department of Preventive Medicine, School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Jinyong Li
- Renji College, Wenzhou Medical University, Wenzhou, China
| | - Huajian Chen
- Department of Preventive Medicine, School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Chongzhou Zhong
- Department of Preventive Medicine, School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Xiaoli Ye
- Propaganda Department, Wenzhou Medical University, Wenzhou, China,Xiaoli Ye
| | - Hongying Shi
- Department of Preventive Medicine, School of Public Health and Management, Wenzhou Medical University, Wenzhou, China,*Correspondence: Hongying Shi
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Hu N, Xu Y, Mao H. Factors influencing the efficiency of cellphone-based CBT for treating sleep disorders. Front Psychiatry 2022; 13:974888. [PMID: 36299534 PMCID: PMC9589090 DOI: 10.3389/fpsyt.2022.974888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This survey aimed to better comprehend the factors influencing patient response to insomnia treatment. METHODS We conducted an online survey. A total of 1,395 patients completed the questionnaire at baseline. Insomnia, anxiety and depressive symptoms were evaluated using the Pittsburgh Sleep Quality Index (PSQI), 7-item Generalized Anxiety Disorder assessment (GAD-7) and 9-item Patient Health Questionnaire (PHQ-9), respectively. A total of 488 patients completed at least two surveys (baseline and monthly surveys thereafter) and reported that the online CBT was effective at the 1-year follow-up. The 488 patients were divided into three groups: the rapid (treatment effective at 4 weeks), intermediate (4-16 weeks), and delayed-response group (over 16 weeks). RESULTS Analysis of the demographic characteristics of the 488 patients did not reveal significant sex differences among the three groups (P = 0.111). However, the groups significantly differed in age (P = 0.001) and education (P = 0.006). Compared to the rapid response group, the delayed-response group had a higher mean age (P < 0.01) and a slightly lower level of education. The duration of the disorder was longer in the delayed-response group. Multivariate logistic regression showed that male sex, junior high school education, and higher PSQI were independent risk factors for the delayed response to treatment. CONCLUSION Many factors affected the efficiency of insomnia treatment. Male sex, junior school education, and a high PSQI score predicted delayed response to insomnia treatment.
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Affiliation(s)
- Nannan Hu
- Affiliated Mental Health Center and Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - You Xu
- Affiliated Mental Health Center and Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hongjing Mao
- Affiliated Mental Health Center and Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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