Cognitive–Behavioral Therapy for Insomnia in Knee Osteoarthritis: A Randomized, Double‐Blind, Active Placebo–Controlled Clinical Trial

作者：Michael T. Smith, Patrick H. Finan, Luis F. Buenaver, Mercedes Robinson, Uzma Jalal Haque, Angela M. Quain, Erin McInrue, Dingfen Han, Jeannie Leoutsakis, Jennifer A. Haythornthwaite · 发表于：Arthritis & Rheumatology · 年份：2015 · DOI：10.1002/art.39048 · 被引用次数：163 · 研究领域：Sleep and related disorders、Sleep and Wakefulness Research、Obstructive Sleep Apnea Research

OBJECTIVE: Insomnia is prevalent among patients with knee osteoarthritis (OA). Research indicates that sleep disruption may amplify clinical pain by altering central pain modulation, suggesting that treatment of insomnia may improve pain. The aims of this study were to evaluate the efficacy of cognitive-behavioral therapy for insomnia (CBT-I) in patients with knee OA, to determine whether improvements in sleep predict reduced pain, and to determine whether alterations in pain modulation mediate improvements in clinical pain. METHODS: We conducted a randomized, double-blind, active placebo-controlled clinical trial of CBT-I in 100 patients with knee OA and insomnia (mean ± SD age 59.4 ± 9.5 years). Patients were randomized (1:1) to receive either 8 sessions of CBT-I or behavioral desensitization (placebo). We conducted in-home polysomnography (PSG), diary assessment, and sensory tests of pain modulation at baseline, posttreatment, 3 months, and 6 months. RESULTS: Intent-to-treat analyses demonstrated substantial improvement in sleep in both groups of patients. Patients in the CBT-I group had significantly greater reductions in wake after sleep onset (WASO), as measured by patient diary and PSG. Patients in both groups reported significant and comparable reductions in pain over 6 months, with one-third reporting a 30% reduction in pain severity. Baseline-to-posttreatment reductions in WASO as measured by diary and PSG predicted subsequent decreases in clinical pain. This effect...