目的 探讨失眠认知行为治疗(cognitive behavioral therapy for insomnia,CBT-I)对不同程度失眠障碍合并抑郁、焦虑患者的疗效。方法 2020年7月至2023年1月，采用便利抽样法选取上海市精神卫生中心126例失眠障碍伴抑郁、焦虑症状的患者，分为中度失眠组和重度失眠组，两组均接受8周的CBT-I治疗。分别在基线、2周、4周及8周时，使用匹兹堡睡眠指数量表(Pittsburgh sleep quality index，PSQI)、汉密尔顿抑郁量表(17-item Hamilton depression scale,HAMD-17)、汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)以及睡眠信念和态度量表（dysfunctional beliefs and attitudes about sleep scale,DBAS-16）等进行评估。结果 治疗后，中度组和重度组患者的PSQI[5.00(4.00,8.00) vs. 7.48(7.00,10.25)]分、HAMD-17[6.00(2.00,6.44) vs. 6.44(5.00,8.00)]分、HAMA[5.10(2.00,5.20) vs.5.20(3.00,7.25）]分；两组治疗效果差异无统计学意义（P=0.216）。中度组所有指标在2周末均明显改善（均P＜0.05）；重度组DBAS-16后果因子和药物因子在4周末明显改善（均P＜0.05），且睡眠潜伏期和生活质量存在波动现象。 结论 CBT-I对失眠、抑郁和焦虑均有显著疗效，但不同失眠严重程度患者的失眠改善幅度存在差异。

Objective To explore the efficacy of cognitive-behavioral therapy for insomnia (CBT-I) in different levels of insomnia accompanied with depression and anxiety.Methods From July 2020 to January 2023,126 insomnia patients accompanied with depression and anxiety symptoms participated the study at the Shanghai Mental Health Center,and were divided into a moderate insomnia group and a severe insomnia group.Both groups received 8 weeks of CBT-I treatment and were evaluated by the Pittsburgh Sleep Index (PSQI),Hamilton Depression Scale (HAMD-17), Hamilton Anxiety Scale (HAMA)and Sleep Belief and Attitude Scale (DBAS-16) at baseline,2 weeks,4 weeks,and 8 weeks.Results After treatment,moderate and severe groups scored PSQI [5.00(4.00,8.00) vs. 7.48(7.00,10.25)],HAMD-17 [6.00(2.00,6.44) vs. 6.44(5.00,8.00)],HAMA [5.10(2.00,5.20) vs.5.20(3.00,7.25）];there was no significant difference in the treatment effect between the two groups (P=0.216). All indicators in the moderate group showed significant improvement at the end of 2 weeks (all P＜ 0.05); in the severe group, the consequence factor and medication factor of DBAS-16 showed significant improvement at the end of 4 weeks (all P＜0.05),and sleep latency and quality of life exhibited fluctuating phenomena.Conclusions CBT-I demonstrates significant efficacy in improving insomnia,depression,and anxiety.The extent of improvement varies among patients with different levels of insomnia.

R473.74

国家重点研发计划（2022YFC2503902）；上海市科委科技创新行动计划（20Y11906600）；上海市申康发展中心重大临床研究项目-青年项目（SHDC2020CR4074）