摘要目的：探讨基于互联网数字技术失眠认知行为治疗（digital delivery of cognitive behavioral therapy for insomnia, dCBT-I）失眠症患者的疗效。方法纳入符合DSM-5失眠症诊断标准的患者148例，利用随机数字表法分为试验组（74例）和对照组（74例）。试验组给予dCBT-I干预,对照组给予个体、面对面CBT-I干预。采用匹兹堡睡眠质量指数（Pittsburgh Sleep Quality Index, PSQI）及各因子分、患者健康问卷（Patient Health Questionnaire-9,PHQ-9）、广泛性焦虑障碍量表（Generalized Anxiety Disorder-7，GAD-7）于基线和第2、4、6、8周末分别对2组患者进行评估，采用重复测量方差分析比较2组患者不同时点量表评分的变化。结果（1）2组患者治疗8周末较基线PSQI、PHQ-9、GAD-7总分显著下降（F=3.08、1.62、8.49，均P<0.05）；（2）与基线相比，试验组第2、4、6、8周末入睡时间、睡眠效率因子分显著下降（F=25.08、34.59，均P<0.05）；第6、8周末总睡眠时间、催眠药使用频率、日间功能障碍因子分显著下降（F=18.04、6.81、16.72，均P<0.05）；第8周末主观睡眠质量、睡眠障碍因子分显著下降（F=4.86、3.71，均P<0.05）。（3）对照组PSQI的主观睡眠质量因子分基线与8周末差值显著高于试验组[（1.3±1.1）分比（0.5±1.4）分；t=-4.18，P<0.05]；试验组催眠药物使用频率、日间功能障碍因子分基线与8周末差值显著高于对照组（t=2.05、2.69，均P<0.05）。结论个体与dCBT-I对失眠症患者均有效，尤其在缩短入睡时间、提高睡眠效率方面起效早，后者在减少催眠药使用频率和改善日间功能障碍方面优于前者。

abstractsObjective To investigate the efficacy of internet-based digital delivery of cognitive behavioral therapy for patients with insomnia (dCBT-I). Methods 148 patients who met the DSM-Ⅴcriteria for insomnia disorder were randomized into dCBT-I group (n=74) who received the CBT on line, and the control group (n=74) who received CBT face to face. Pittsburgh Sleep Quality Index (PSQI), Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were evaluated in both groups at baseline, weeks 2, 4, 6 and 8. Differences between two groups were compared by repeated ANOVA. Results (1) Compared with the baseline, the total scores of PSQI, PHQ-9 and GAD-7 in both groups significantly decreased at week 8 (F=3.08,1.62,8.49; all P<0.05). (2) Compared with the baseline, Sleep Onset Latency (SOL) and Sleep Efficiency (SE) in PSQI in dCBT-I group significantly decreased at week 2, 4, 6 and 8 (F=25.08, 34.59;both P<0.05);the Total Sleep Time (TST), used sleep medication (USM) and daytime dysfunction (DF) in PSQI significantly decreased at week 6 and 8 (F=18.04, 6.81,16.72;both P<0.05);the Subjective Sleep Quality (SQ) and Sleep Disturbance (SD) in PSQI significantly decreased at week 8 (F=4.86, 3.71; both P<0.05). (3) After 8 weeks of treatment, individual treatment in control group was superior to dCBT-I group for improvement of SQ component (t=-4.18, P<0.05), however dCBT-I group was superior to control group for improvement of USM and DF components (t=2.05, 2.69; both P<0.05). Conclusions Both individual treatment and dCBT-I are effective to shorten the sleep onset latency and&nbsp;improve the sleep efficiency in patients with insomnia. dCBT-I is superior to individual face to face CBT treatment in reducing the use of sleep medication and improving daytime function.