| Background and Objective:Insomnia,One of the most frequent sleep complaints in the sleep disorders,which is characterized by difficulty initiating and maintaining sleep and/or waking up too early.About one-third of the adult population in the world suffer from insomnia 1,persistent insomnia could result to decreasing immune function,memory decline,impairment of daytime function,and it also can lead to anxiety,depression,obesity and other adverse consequences.Hypertension,which is the most common risk factor of cardiovascular and cerebrovascular diseases,is the leading cause of death in cardiovascular and cerebrovascular diseases.It characterized with High morbidity,high disability and high mortality,and brought a huge economic burden to patients and society.Although insomnia can be a symptom or an independent disorder,it is most frequently observed as a comorbid condition with another medical condition or mental disorder.It has been found that Insomnia and hypertension are usually coexisted as comorbidity,and promote adverse effect on each other.However,individuals with comorbid insomnia usually seek treatment for the primary medical condition,few of them receiving treatment for insomnia.In fact,treating the primary medical/psychiatric disorder is not likely to be sufficient for resolving chronic insomnia that occurs in chronic medical and psychiatric diseases.Patients with comorbid insomnia should accept standard medical care for insomnia when they treating the primary medical/psychiatric disorders.Pharmacological treatment and non-pharmacologic treatment are two of the most popular treatment for insomnia,and the Pharmacological treatment has the advantages of rapid onset,good curative effect,and so on.However,the phenomenon of side effects,drug dependence,impaired cognitive function,and rebound phenomenon after drug withdrawal which was cause by Hypnotic drugs should not be ignored.Non-pharmacologic treatment mainly refers to cognitive behavioral therapy,which is an efficacious treatment for insomnia,and also can avoid the shortcomings caused by hypnotic,such as side effects and dependence.CBTI was recommended as first-line treatment of insomnia and also be recommended for the treatment of comorbid insomnia by The American Sleep Medicine Association at the same time.With the development of science and technology,and the application of network and mobile phones,various new patterns of CBTI has emerged.Remote CBTI,one of the new patterns of CBTI,not only has a good efficacy for insomnia,but also can significant improve the compliance of the patients.Hence,in this study,we determine the efficacy of the remote CBTI in improving blood pressure,in participants with hypertension comorbid insomnia.Methods:Patients were recruited from department of neurology and Endocrinology,Daping Hospital,Third Military Medical University during February 2016-October 2016.106 participants with hypertension and poor sleep quality were included in this trial,and were randomly divided into two groups,53 patients received the remote CBTI group,and 53 received the conventional hypertension treatment group.Included criteria: ? Male or female,?18 years on entry to study,?Meet the diagnostic criteria for hypertension,or have been diagnosed with high blood pressure,and the SBP readings ?160 mmHg,and DBP readings ?110 mm Hg.And will not change in antihypertensive medication in next 8 weeks.?Have a certain understanding of the test,can cooperate with the remote monitoring management.? patients Self-reported difficulty getting to sleep and/or difficulty in maintaining sleep,meet the diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders(Fifth Edition)(DSM-?)for chronic insomnia.Exclusion criteria:?have a history of severe physical disease and mental illness.?Ongoing substance or alcohol abuse.?history of sleep apnea,restless legs syndrome,other types of sleep disorders.?Once received cognitive behavioral treatment for insomnia.?Pregnancy,breast-feeding women.?ongoing involvement in night-shift work.All patients underwent semi-structured interviews before the trial,to collect the incentives,insomnia severity,psychological status and other basi c conditions,and complete the questionnaire(PSQI,ISI,BAI,BDI),measure the clinical blood pressure.We gave patients the instructing of how to fill the sleep-blood pressure diary,and the standardized cardiovascular education.We also made the appropriate CBTI scheme for the tested group.the video of sleep-hygiene education,cognitive therapy and relaxation therapy were send to patients through APP or internet.Patients and doctors communicate through mobile phones or telephone no less than 1times/week,to know the patient's sleep and situation.The communications were lasting 15 to 60 minutes each time,a total of 8 weeks.Results:1?After treatment,patients in remote CBTI group improved significantly on sleep onset latency,total sleep time at post-test,and sleep efficiency(P<0.01).The total sleep time at post-test,and sleep efficiency of the conventional hypertension treatment group were also improved(P<0.05).There was no significant improvement in sleep onset latency(P>0.05).The sleep parameters of remote CBTI group(onset latency 44.80?22.63,total sleep time at post-test 302.40?43.35,and sleep efficiency 72.24?9.07%)were improved more significantly than the conventional hypertension treatment group(onset latency 56.53?34.70,total sleep time at post-test 262.98?50.01,and sleep efficiency 58.00?11.46%)after 8 weeks of treatment(P<0.01).2?After treatment,both the Systolic blood pressure and diastolic blood pressure of the remote CBTI group were decreased significantly(P<0.01),the systolic blood pressure of the conventional hypertension treatment group was significant decreased too,however,there were no difference among the diastolic blood pressure and heart rate(P>0.05).The Systolic blood pressure of the remote CBTI group was decreased about 7.77 mmHg;the diastolic blood pressure was decreased by 3.54 mmHg.The Systolic blood pressure of the conventional hypertension treatment group was decreased about 3.00 mm Hg;the diastolic blood pressure was decreased by 1.52 mm Hg.The reductions of blood pressure in the remote CBTI group were greater than that of the conventional treatment group(P < 0.01).3?After treatment,the degree of anxiety of remote CBTI group was significantly decreased(P < 0.05).However,there was no significant difference in the degree of depression between the CBTI group and the conventional hypertension treatment group.Conclusions:1?The remote CBTI can significantly reduce the sleep onset latency,increasing total sleep time and improving sleep efficiency in the patients with hypertension comorbid insomnia,and it also can relieve the patients` anxiety at the same time.2?Improving insomnia through remote CBTI can effectively reduce the systolic blood pressure of patients with hypertensive comorbid insomnia. |
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