The effectiveness of non-pharmacological treatment for perinatal insomnia

非药物治疗围产期失眠的有效性

• 批准号: 8522239
• 负责人: RACHEL MANBER
• 金额: $ 51.83万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-03 至 2017-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8522239
• 关键词: Acute; Adopted; Aftercare; Age; Arousal; Behavior; Biological Markers; Birth; British; Caring; Clinic; Cognition; Cognitive Therapy; Communities; Consensus; Discipline of obstetrics; Educational Intervention; Effectiveness; Family; Health; Improve Access; Individual; Infant; Intervention; Lead; Low income; Marital Relationships; Maternal Age; Maternal Health; Measures; Medical; Mental Depression; Methods; Minority; Mothers; Nurses; Oxytocin; Parent-Child Relations; Parents; Patients; Perinatal; Postpartum Period; Pregnancy; Pregnancy Outcome; Pregnant Women; Premature Birth; Primary Health Care; Psychotherapy; Public Health; Quality of life; Relative (related person); Reproductive Health; Research; Risk; Sampling; Services; Severities; Sleep; Sleeplessness; Small for Gestational Age Infant; Strategic Planning; Target Populations; Telephone; Testing; Time; Training; Transportation; Underserved Population; United States Department of Veterans Affairs; United States National Institutes of Health; Weight; Woman; active control; adverse outcome; awake; base; chronic pain; depressive symptoms; design; effective therapy; efficacy testing; evidence base; flexibility; hypnotic; improved; novel; primary outcome; programs; secondary outcome; social stigma

DESCRIPTION (provided by applicant): Consistent with the NINR strategic plan to identify strategies that will reduce the long-term adverse consequences of poor maternal and reproductive health in minorities and underserved populations, this proposal aims to evaluate a primary care based intervention for maternal insomnia disorder (MID) among economically, educationally, racially, and ethnically diverse samples of pregnant women. MID, which encompasses insomnia during pregnancy and postpartum, is associated with adverse consequences to the mother and her family. These include increased risk for preterm birth, births of infants small for gestational age, cesarean birth, poor maternal infant attachment, worsening of the marital relationship, and increased risk for perinatal depression. Cognitive Behavioral Therapy for Insomnia (CBTI) is an effective treatment for insomnia even when factors outside of an individual's control interfere with sleep. CBTI is effective for postpartum insomnia, despite sleep disruption caused by the need to attend to an infant at night. TIPS (Tips for Infant and Parent Sleep) is a two- session, nurse-administered educational intervention aimed at optimizing infant sleep. We propose to evaluate the efficacy and effectiveness of an integrated CBTI+TIPS treatment. To maximize the public health impact, improve access, and reduce treatment barriers (stigma and transportation issues), treatment will be delivered by nurses in community obstetrical clinics, where women receive care during their pregnancy until six weeks postpartum. This will be the first study to test the efficacy of CBTI for the treatment o MID. Primary outcomes, for which the study is optimally designed and sufficiently powered, are maternal sleep and infant sleep. Secondary outcomes, for which we are either unable to estimate power or expect to be under powered, are pregnancy outcomes (proportion of infants who are small for gestational age), maternal-infant attachment and its biological marker, oxytocin, and maternal wellbeing (depressive symptom severity and quality of life). The Aims of this research are to: (1) evaluate the efficacy of CBTI+TIPS in terms of a) maternal sleep during pregnancy and b) maternal and infant sleep during the postpartum; (2) evaluate the effectiveness of CBTI+TIPS on measures beyond sleep, including number of infants born small for gestational age, b) maternal-infant attachment (based on observations of a parent-child interactions with the NCAST), c) oxytocin levels, d) maternal depressive symptom severity, and (e) maternal quality of life.

描述（由申请人提供）：与NINR战略计划一致，以确定将减少少数群体和服务不足人群中不良的孕产妇和生殖健康的长期不良后果的策略，该建议旨在评估经济，教育，种族，种族，种族，种族，种族，种族和孕妇的孕妇的基于初级护理的干预措施。 Mid涵盖了怀孕和产后失眠，与母亲及其家人的不利后果有关。其中包括早产的风险增加，胎龄小的婴儿的出生，剖宫产，孕产妇的依恋差，婚姻关系恶化以及围产期抑郁症的风险增加。失眠（CBTI）的认知行为疗法也是一种有效的失眠治疗方法，即使在个人控制之外的因素会干扰睡眠。 CBTI对产后失眠有效，尽管由于需要在晚上参加婴儿而导致睡眠中断。技巧（婴儿和父母睡眠的技巧）是一项两次疗程，由护士管理的教育干预措施，旨在优化婴儿睡眠。我们建议评估综合CBTI+TIPS处理的功效和有效性。为了最大程度地发挥公共卫生的影响，改善访问权限并减少治疗障碍（污名和运输问题），护士将在社区产科诊所进行治疗，妇女在怀孕期间接受护理，直到产后六周。这将是第一项测试CBTI治疗o中的疗效的研究。该研究的主要结果是最佳设计和足够动力的，是母亲的睡眠和婴儿睡眠。次要结果是我们无法估计的能力，要么期望能够受到动力，是怀孕结果（胎龄小的婴儿的比例），孕产妇的附着及其生物学标志物，催产素和母体健康状况（抑郁症状的症状严重性和生活质量）。这项研究的目的是：（1）评估CBTI+尖端的功效，以a）怀孕期间的母亲睡眠和b）产后母亲和婴儿睡眠； （2）评估CBTI+技巧对超出睡眠的措施的有效性，包括胎龄小的婴儿人数，b）母亲依恋（基于对父母与NCAST的互动的观察），c）oxytocin含量，c）氧气症状，d）d）d）母体抑郁症状的症状，以及（e）孕产妇的孕产妇质量。