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Efficacy of dexmedetomidine with cognitive behavioral therapy for treating chronic insomnia related to conditioned arousal: a randomized controlled trial

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Abstract

To investigate the synergistic effect of dexmedetomidine and cognitive behavioral therapy (CBT) on chronic insomnia. Forty-six chronic insomnia patients were selected and randomly assigned to the CBT group (CBT-I) or the CBT combined with dexmedetomidine (CBT-I + DEX) group. The sleep indexes and polysomnographic parameters were assessed before treatment, 4 weeks after treatment, and 8 weeks after treatment. The daily sleep conditions were recorded during the entire treatment course. Eight patients in the CBT-I group quit treatment, with a success rate of 65.2 %, and two patients in the CBT-I + DEX group quit treatment, with a success rate of 91.3 %, revealing a significant difference between the two groups (P < 0.05). At 4 and 8 weeks after treatment, the soma-arousal level was significantly decreased in the CBT-I + DEX group compared with the CBT-I group (P < 0.01), but no significant difference in the cognitive arousal. Polysomnographic monitoring results show that the sleep time at non-REM stage 3 (N3) and the total sleep time in the CBT-I + DEX group was longer than the CBT-I group after 4 weeks of treatment (P < 0.05). The number of awakenings, sleep latency, REM sleep latency and sleep efficiency were significantly improved in both groups at the end of treatment (P < 0.05), but the total sleep time was not obviously increased in both groups. Dexmedetomidine hydrochloride-induced sleep effectively reduced the patients’ arousal level, prolonged deep sleep, reduced the degree of daytime sleepiness, and improved the success rate of CBT.

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Abbreviations

CBT:

Cognitive behavioral therapy

DEX:

Dexmedetomidine

DIS:

Dexmedetomidine induced sleep

SCT:

Stimulus control therapy

CR:

Cognitive restructuring

RT:

Relaxation training

SHE:

Sleep hygiene education

SD:

Sleep diary

ISI:

Insomnia Severity Index

PSAS:

Pre-Sleep Arousal Scale

HAS:

The Hyperarousal Scale

PSQI:

The Pittsburgh Sleep Quality Index

ESS:

The Epworth Sleepiness Scale

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Acknowledgments

The study was supported by the funding of new technology research about regulating center nerve hyperarousal state and correcting accumulated sleep debt (No. 12BJZ51).

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Authors and Affiliations

  1. Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China

    Xunjun Li, Xiaojiang Jiang, Yazhen Liu, Ying Lang, Yuanyuan Ye, Ling Lin, Juan Liu & Yuanfeng Zhang

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  1. Xunjun Li
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Correspondence to Xiaojiang Jiang.

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Li, X., Jiang, X., Liu, Y. et al. Efficacy of dexmedetomidine with cognitive behavioral therapy for treating chronic insomnia related to conditioned arousal: a randomized controlled trial. Sleep Biol. Rhythms 14, 75–85 (2016). https://doi.org/10.1007/s41105-015-0025-7

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  • DOI: https://doi.org/10.1007/s41105-015-0025-7

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