【医脉通】2020+AASM临床实践指南:成人慢性失眠症患者的行为和心理治疗.pdf
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1、 Behavioral and psychological treatments for chronic insomnia disorder in adults:an American Academy of Sleep Medicine clinical practice guideline Jack D.Edinger,PhD1;J.Todd Arnedt,PhD2;Suzanne M.Bertisch,MD,MPH3;Colleen E.Carney,PhD 4;John J.Harrington,MD5;Kenneth L.Lichstein,PhD6;Michael J.Sateia,
2、MD,FAASM7;Wendy M.Troxel,PhD8;Eric S.Zhou,PhD9;Uzma Kazmi,MPH10;Jonathan L.Heald,MA10;Jennifer L.Martin,PhD11,12 1National Jewish Health,Denver,CO 2University of Michigan,Ann Arbor,MI 3Brigham and Womens Hospital,Harvard Medical School,Boston,MA 4Ryerson University,Toronto,CA 5University of Nebraska
3、 Medical Center,Omaha,NE 6University of Alabama,Tuscaloosa,AL 7Geisel School of Medicine at Dartmouth,Hanover,NH 8RAND Corporation,Pittsburgh,PA 9Harvard Medical School,Dana-Farber Cancer Institute,Boston Childrens Hospital,Boston,MA 10American Academy of Sleep Medicine,Darien,IL 11David Geffen Scho
4、ol of Medicine at the University of California Los Angeles,Los Angeles,CA 12VA Greater Los Angeles Healthcare System,Geriatric Research,Education and Clinical Center,Los Angeles,CA Address correspondence to:Jack D.Edinger,PhD,National Jewish Health,1400 Jackson St,Denver,CO 80206;Email:EdingerJNJHea
5、lth.org ManuscriptDownloaded from jcsm.aasm.org by 36.112.171.122 on November 11,2020.For personal use only.No other uses without permission.Copyright 2020 American Academy of Sleep Medicine.All rights reserved.ABSTRACT Introduction:This guideline establishes clinical practice recommendations for th
6、e use of behavioral and psychological treatments for chronic insomnia disorder in adults.Methods:The American Academy of Sleep Medicine(AASM)commissioned a task force of experts in sleep medicine to develop recommendations and assign strengths based on a systematic review of the literature and an as
7、sessment of the evidence using Grading of Recommendations Assessment,Development and Evaluation(GRADE)methodology.The task force evaluated a summary of the relevant literature and the quality of evidence,the balance of clinically relevant benefits and harms,patient values and preferences,and resourc
8、e use considerations that underpin the recommendations.The AASM Board of Directors approved the final recommendations.Recommendations:The following recommendations are intended as a guide for clinicians in choosing a specific behavioral and psychological therapy for the treatment of chronic insomnia
9、 disorder in adult patients.Each recommendation statement is assigned a strength(“strong”or“conditional”).A“strong”recommendation(ie,“We recommend”)is one that clinicians should follow under most circumstances.A“conditional”recommendation is one that requires that the clinician use clinical knowledg
10、e and experience,and to strongly consider the patients values and preferences to determine the best course of action.1.We recommend that clinicians use multi-component cognitive behavioral therapy for insomnia for the treatment of chronic insomnia disorder in adults.(STRONG)2.We suggest that clinici
11、ans use multi-component brief therapies for insomnia for the treatment of chronic insomnia disorder in adults.(CONDITIONAL)3.We suggest that clinicians use stimulus control as a single-component therapy for the treatment of chronic insomnia disorder in adults.(CONDITIONAL)4.We suggest that clinician
12、s use sleep restriction therapy as a single-component therapy for the treatment of chronic insomnia disorder in adults.(CONDITIONAL)5.We suggest that clinicians use relaxation therapy as a single-component therapy for the treatment of chronic insomnia disorder in adults.(CONDITIONAL)6.We suggest tha
13、t clinicians not use sleep hygiene as a single-component therapy for the treatment of chronic insomnia disorder in adults.(CONDITIONAL)Downloaded from jcsm.aasm.org by 36.112.171.122 on November 11,2020.For personal use only.No other uses without permission.Copyright 2020 American Academy of Sleep M
14、edicine.All rights reserved.INTRODUCTION Chronic insomnia disorder is a common sleep disorder that leads to impairment in health and functioning 1,2.This clinical practice guideline is intended to update the previously published American Academy of Sleep Medicine(AASM)guidelines on the psychological
15、 and behavioral treatments of insomnia.3 This guideline,in conjunction with the accompanying systematic review(SR)4,provides a comprehensive update of the available evidence and a synthesis of clinical practice recommendations for the psychological and behavioral treatments of chronic insomnia disor
16、der.It is intended to optimize patient-centered care by providing actionable recommendations for the use of specific behavioral and psychological treatments in adults with chronic insomnia disorder.Separate clinical practice guidelines for pharmacologic treatment of chronic insomnia disorder are ava
17、ilable.5 The treatment of chronic insomnia disorder should be based on a diagnosis established using ICSD-3 or DSM-5 criteria,6,7 and a comprehensive clinical history.Historically,in some settings patients have been offered only sleep hygiene as treatment for their chronic insomnia disorder;however,
18、standard of care should be to provide one of the recommended interventions discussed within the guideline to patients with chronic insomnia disorder,taking into consideration the accessibility and resource requirements when deciding on the most appropriate treatment for a given patient.Follow-up car
19、e to evaluate symptoms at the conclusion of treatment is indicated,and residual sleep-related symptoms should be evaluated and addressed.METHODS The AASM commissioned a task force(TF)of sleep medicine clinicians with expertise in chronic insomnia disorder.The TF was required to disclose all potentia
20、l conflicts of interest(COI),per the AASMs COI policy,prior to being appointed to the TF and throughout the research and writing of the guideline and SR documents.In accordance with the AASMs conflicts of interest policy,individuals were not appointed to the TF if they reported a professional or fin
21、ancial conflict that might diminish the integrity,credibility or ethical standards of the guideline.Individuals reporting professional or financial conflicts that represented potential bias but did not prohibit participation in the development of the guideline,were required to recuse themselves from
22、 discussion or writing responsibilities related to the conflicts.All relevant conflicts of interest reported by the TF are listed in the Disclosures section.The TF conducted a SR of the published scientific literature,4 to answer two Patient,Intervention,Comparison,and Outcomes(PICO)questions relate
23、d to the behavioral and psychological treatments for insomnia in adults.The review focused exclusively on efficacy of behavioral and psychological interventions of chronic insomnia disorder in adults,with and without comorbid conditions(Table 1),compared to control or minimal intervention(PICO 1).Th
24、e review also compared the effectiveness of different intervention delivery methods(eg,individual,group,telehealth,internet-based programs,telephone;PICO 2).The SR focused on the following critical patient-oriented,clinically relevant outcomes:patient reported sleep quality,sleep latency,wake after
25、sleep onset and remission and responder rates.The TF considered remission and responder rates as the most influential critical outcomes for evaluating the quality of evidence.The review did not conduct comparisons of different interventions or combinations of pharmacotherapy with behavioral and psyc
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- 医脉通 aasm 临床 实践 指南 成人 慢性 失眠症 患者 行为 行动 以及 心理治疗
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