Clinical features of anxiety and insomnia during pregnancy and the therapeutic effect of cognitive behavior therapy for insomnia

doi:10.3877/cma.j.issn.2095-655X.2019.03.008

Abstract

Abstract:

Objective

To explore the clinical features of anxiety and insomnia during pregnancy and the therapeutic effects of cognitive behavior therapy for insomnia (CBT-I).

Methods

Forty-eight pregnant patients with insomnia and anxiety recruited from psychological clinic of Chongqing Women and Children Hospital from March to June 2018 were randomly divided into experimental group and control group. Experimental group received a 6-week-setting CBT-I therapy and control group was underwent health education at the same time. Assessment of Self-rating Anxiety Scale (SAS) and Pittsburg Sleep Quality Index (PSQI) were taken before intervention, 6 weeks after intervention, and 4 weeks after the end of intervention, and Cardiorespiratory Coupled Sleep Quality Assessment System (CPC) was used to measure sleep onset latency (SOL), time in bed (TIB), total sleep time (TST) and sleep efficiency (SE) at the same time points.

Results

Thirty-six (75.00%) pregnant women with insomnia and anxiety had a first pregnancy, 44 (91.67%) patients had bachelor′s degree or higher and 39 (81.25%) patients were still working. As for level of anxiety, 2 (4.17%) patients were mild anxiety, 36 (75.00%) patients were moderate anxiety and 10 (20.83%) patients were severe anxiety. SAS score after intervention in experimental group [(50.13±7.73)points] showed lower than that in control group [(60.25±8.69)points, t=-4.27, P<0.05)]. There was no significant difference between the two groups [(57.92±12.22)points, (61.38±5.11)points, t=-1.28, P>0.05)] 4 weeks after the end of intervention. PSQI score in experimental group after intervention [(10.50±2.34)points] showed lower than that in control group [(15.52±2.50)points, t=-6.68, P<0.05)]. PSQI score in experimental group 4 weeks after the end of intervention [(11.63±3.00)points] was also lower than that in control group [(14.83±2.99)points, t=-3.71, P<0.05)]. CPC showed that SOL in experimental group after intervention and 4 weeks after the end of intervention [(29.54±8.67)min, (28.88±9.18)min)] were both lower than those in control group [(54.58±16.20)min, (55.67±18.39)min, t=-6.68, -6.36, all P<0.05)] and TST[(347.50±38.12)min, (325.87±58.18)min] were both higher than those in control group[(230.25±68.75)min, (257.41±77.85)min, t=7.31, 3.45, all P<0.05)].

Conclusions

Pregnant women with insomnia and anxiety are mainly for the first time pregnant, bachelor degree or higher, and still working, mostly moderate anxiety. CBT-I can improve anxiety and sleep quality in pregnant patients with insomnia and anxiety, while its long-term therapeutic effect was not satisfying.

Key words: Sleep initiation and maintenance disorders, Pregnant women, Anxiety, Cognitive behavioral therapy for insomnia

Rong Han, Yuan Zhao, Chenggang Jiang. Clinical features of anxiety and insomnia during pregnancy and the therapeutic effect of cognitive behavior therapy for insomnia[J]. Chinese Journal of Diagnostics(Electronic Edition), 2019, 07(03): 173-178.

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项目		CBT-I组(n＝24)	常规健康教育组(n＝24)	统计值	P值
年龄(岁，±s)		29.67±6.10	27.35±3.99	t＝1.49	0.142
受教育程度(例，%)		?	?	χ²＝1.13	0.570
?	中学	6(25.00)	6(25.00)	?	?
?	本科	15(62.50)	17(70.83)	?	?
?	本科以上	3(12.50)	1(4.17)	?	?
孕次(例，%)		?	?	χ²＝1.78	0.182
?	1次	16(66.67)	20(83.33)	?	?
?	≥2次	8(33.33)	4(16.67)	?	?
就业情况(例，%)		?	?	χ²＝0.78	0.376
?	就业	13(54.17)	16(66.67)	?	?
?	未就业	11(45.83)	8(33.33)	?	?
焦虑程度(例，%)		?	?	χ²＝3.71	0.156
?	轻度焦虑	2(8.33)	0(0.00)	?	?
?	中度焦虑	19(79.17)	17(70.83)	?	?
?	重度焦虑	3(12.50)	7(29.17)	?	?

项目		CBT-I组(n＝24)	常规健康教育组(n＝24)	统计值	P值
年龄(岁，±s)		29.67±6.10	27.35±3.99	t＝1.49	0.142
受教育程度(例，%)		?	?	χ²＝1.13	0.570
?	中学	6(25.00)	6(25.00)	?	?
?	本科	15(62.50)	17(70.83)	?	?
?	本科以上	3(12.50)	1(4.17)	?	?
孕次(例，%)		?	?	χ²＝1.78	0.182
?	1次	16(66.67)	20(83.33)	?	?
?	≥2次	8(33.33)	4(16.67)	?	?
就业情况(例，%)		?	?	χ²＝0.78	0.376
?	就业	13(54.17)	16(66.67)	?	?
?	未就业	11(45.83)	8(33.33)	?	?
焦虑程度(例，%)		?	?	χ²＝3.71	0.156
?	轻度焦虑	2(8.33)	0(0.00)	?	?
?	中度焦虑	19(79.17)	17(70.83)	?	?
?	重度焦虑	3(12.50)	7(29.17)	?	?

组别	例数	干预前	干预6周后	干预结束4周后
CBT-I组	24	67.08±4.49	50.13±7.73	57.92±12.22
常规健康教育组	24	69.00±3.40	60.25±8.69	61.38±5.11
t值	?	－1.67	－4.27	－1.28
P值	?	0.102	0.000	0.208

组别	例数	干预前	干预6周后	干预结束4周后
CBT-I组	24	67.08±4.49	50.13±7.73	57.92±12.22
常规健康教育组	24	69.00±3.40	60.25±8.69	61.38±5.11
t值	?	－1.67	－4.27	－1.28
P值	?	0.102	0.000	0.208

组别	例数	干预前	干预6周后	干预结束4周后
CBT-I组	24	15.75±1.92	10.50±2.34	11.63±3.00
常规健康教育组	24	16.04±1.85	15.52±2.50	14.83±2.99
t值	?	－5.36	－6.68	－3.71
P值	?	0.595	0.000	0.001

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