Abstract：
Rapid eye movement sleep fragmentation is hypothesised to be a reliable feature of insomnia, which may contribute to emotion dysregulation. Sleep restriction therapy, an effective intervention for insomnia, has the potential to reduce rapid eye movement sleep fragmentation through its manipulation of basic sleep-wake processes. We performed secondary data analysis of a randomised controlled trial to examine whether sleep restriction therapy reduces rapid eye movement sleep fragmentation in comparison to a matched control arm. Participants (n = 56; 39 female, mean age = 40.78 ± 9.08 years) were randomly allocated to 4 weeks of sleep restriction therapy or 4 weeks of time in bed regularisation. Ambulatory polysomnographic recordings were performed at baseline, week 1 and week 4. Arousals during rapid eye movement and non-rapid eye movement sleep were scored blind to group allocation. The following rapid eye movement sleep fragmentation index was the primary outcome: index 1 = (rapid eye movement arousals + rapid eye movement awakenings + non-rapid eye movement intrusions)/rapid eye movement duration in hours. Secondary outcomes were two further indices of rapid eye movement sleep fragmentation: index 2 = (rapid eye movement arousals + rapid eye movement awakenings)/rapid eye movement duration in hours; and index 3 = rapid eye movement arousals/rapid eye movement duration in hours. A non-rapid eye movement fragmentation index was also calculated (non-rapid eye movement arousals/non-rapid eye movement duration in hours). Linear-mixed models were fitted to assess between-group differences. There was no significant group difference for the primary rapid eye movement fragmentation index at week 1 (p = 0.097, d = -0.31) or week 4 (p = 0.741, d = -0.06). There was some indication that secondary indices of rapid eye movement fragmentation decreased more in the sleep restriction therapy group relative to control at week 1 (index 2: p = 0.023, d = -0.46; index 3: p = 0.051, d = -0.39), but not at week 4 (d ≤ 0.13). No group effects were found for arousals during non-rapid eye movement sleep. We did not find clear evidence that sleep restriction therapy modifies rapid eye movement sleep fragmentation. Small-to-medium effect sizes in the hypothesised direction, across several indices of rapid eye movement fragmentation during early treatment, demand further investigation in future studies.
摘要：
快速眼动睡眠碎片被认为是失眠的可靠特征，这可能会导致情绪失调。睡眠限制治疗,对失眠的有效干预，通过操纵基本的睡眠-觉醒过程，有可能减少快速眼动睡眠碎片。我们对一项随机对照试验进行了二次数据分析，以检查与匹配的对照臂相比，睡眠限制治疗是否可以减少快速眼动睡眠碎片。参与者(n=56；39名女性，平均年龄=40.78±9.08岁）被随机分配到4周的睡眠限制治疗或4周的卧床时间。在基线时进行动态多导睡眠图记录，第1周和第4周。在快速眼动和非快速眼动睡眠期间的清醒被评分为小组分配盲。以下快速眼动睡眠碎片指数是主要结果:指数1=(快速眼动觉醒+快速眼动觉醒+非快速眼动侵入)/快速眼动持续时间(小时)。次要结果是快速眼动睡眠碎片的另外两个指标:指数2=(快速眼动唤醒+快速眼动唤醒)/快速眼动持续时间(小时);指数3=快速眼动唤醒/快速眼动持续时间(小时)。还计算了非快速眼动碎片指数(非快速眼动唤醒/非快速眼动持续时间,以小时为单位)。拟合线性混合模型以评估组间差异。在第1周（p=0.097，d=-0.31）或第4周（p=0.741，d=-0.06）的主要快速眼动碎片指数没有显着差异。有迹象表明，在第1周，相对于对照组，睡眠限制治疗组的快速眼动碎片的次要指数下降更多（指数2：p=0.023，d=-0.46；指数3：p=0.051，d=-0.39），但不是在第4周（d≤0.13）。在非快速眼动睡眠期间，未发现觉醒的群体效应。我们没有找到明确的证据表明睡眠限制疗法可以改善快速眼动睡眠碎片。假设方向上的中小效应大小，在早期治疗期间，快速眼动破碎的几个指标，需要在未来的研究中进一步调查。
