背景:先前的研究表明,简短的认知行为预防失眠计划可以降低高危青少年患失眠的风险71%。这项研究旨在评估高危青少年亚组对失眠预防的不同反应。
方法:将有失眠家族史和阈下失眠症状的青少年随机分配到为期4周的失眠预防计划或非活动对照组。在基线时进行评估,1周,干预后6个月和12个月。基线睡眠,白天,和情绪概况通过使用潜在类别分析(LCA)来确定不同的亚组。分析是根据意向治疗方法进行的。
结果:LCA确定了三个亚组:(a)仅失眠症状,(b)失眠症状,白天嗜睡和轻度焦虑,和(c)失眠症状伴有白天嗜睡,轻度焦虑,和抑郁症。与对照组相比,第3亚组接受干预的青少年在12个月随访期间失眠障碍的发生率显着降低(风险比[HR]=0.37;95%置信区间[CI]:0.13-0.99;p=.049),第2亚组(HR=0.14;95%CI:0.02-1.08;p=.059)。此外,在第2和第3亚组中接受干预的青少年日间过度嗜睡的风险降低(第2亚组:调整后OR[AdjOR]=0.45,95%CI:0.23-0.87;第3亚组:调整后OR=0.32,95%CI:0.13-0.76)和可能的焦虑(第2亚组:调整后OR=0.47,95%CI:0.27-0.82;第3亚组:随访-
结论:有失眠风险的青少年可以根据其心理状况分为不同的亚组,这与对失眠预防计划的不同反应有关。这些发现表明,需要进一步对有风险的青少年进行表型分析和分组,以制定个性化的失眠预防方法。
BACKGROUND: Previous study has shown that a brief cognitive-behavioral prevention insomnia program could reduce 71% risk of developing insomnia among at-risk adolescents. This study aimed to evaluate the differential response to insomnia prevention in subgroups of at-risk adolescents.
METHODS: Adolescents with a family history of insomnia and subthreshold insomnia symptoms were randomly assigned to a 4-week insomnia prevention program or nonactive control group. Assessments were conducted at baseline, 1 week, and 6- and 12-month after the intervention. Baseline sleep, daytime, and mood profiles were used to determine different subgroups by using latent class analysis (LCA). Analyses were conducted based on the intention-to-treat approach.
RESULTS: LCA identified three subgroups: (a) insomnia symptoms only, (b) insomnia symptoms with daytime sleepiness and mild anxiety, and (c) insomnia symptoms with daytime sleepiness, mild anxiety, and depression. The incidence rate of insomnia disorder over the 12-month follow-up was significantly reduced for adolescents receiving intervention in subgroup 3 compared with the controls (hazard ratio [HR] = 0.37; 95% confidence interval [CI]: 0.13-0.99; p = .049) and marginally for subgroup 2 (HR = 0.14; 95% CI: 0.02-1.08; p = .059). In addition, adolescents who received intervention in subgroups 2 and 3 had a reduced risk of excessive daytime sleepiness (subgroup 2: adjusted OR [AdjOR] = 0.45, 95% CI: 0.23-0.87; subgroup 3: AdjOR = 0.32, 95% CI: 0.13-0.76) and possible anxiety (subgroup 2: AdjOR = 0.47, 95% CI: 0.27-0.82; subgroup 3: AdjOR = 0.33, 95% CI: 0.14-0.78) compared with the controls over the 12-month follow-up.
CONCLUSIONS: Adolescents at risk for insomnia can be classified into different subgroups according to their psychological profiles, which were associated with differential responses to the insomnia prevention program. These findings indicate the need for further phenotyping and subgrouping at-risk adolescents to develop personalized insomnia prevention.