Hatoum H T, Kania C M, Kong S X, Wong J M, Mendelson W B
G.D. Searle & Co, Skokie, Il 60077, USA.
Am J Manag Care. 1998 Jan;4(1):79-86.
The purpose of the study was to assess the prevalence of and factors associated with insomnia among enrollees of managed care organizations (MCOs). A survey was distributed either by mail or during a clinic visit to 7,500 enrollees of five MCOs in the United States. The survey included a sleep questionnaire, demographic questions, and questions about medical encounters and prescription drug use. Three levels of insomnia (none; level I--difficulty initiating or maintaining sleep; level II--insomnia with daytime dysfunction) were defined from the responses. Comorbidities were determined by proxy from prescription drug use reported by respondents. A total of 3,447 survey responses were received, yielding a response rate of 46%. Level I and level II insomnia was reported by 13.5% and 32.5% of the respondents, respectively. Level II insomnia increased with decreasing education, income, and age and was more prevalent in women and non-Caucasians. Insomnia was significantly correlated with all daytime sleepiness and most nighttime disturbances factors. Fifty-two percent of all respondents reported at least one comorbid condition. Respondents with multiple comorbidities reported level II insomnia more frequently than those with no comorbidities. Only 0.9% of clinic visitors were seeing a physician specifically for sleep problems. Of those with level I and level II insomnia, only 5.5% and 11.6%, respectively, were taking prescription medications specifically for sleep problems; 11.2% and 21.4%, respectively, were taking over-the-counter medications for sleep. Insomnia occurs in MCO enrollees at rates comparable to those found in the general population. However, few patients with insomnia are actually being treated for their condition. Proper evaluation, diagnosis, and treatment of insomnia are warranted.
该研究的目的是评估管理式医疗组织（MCO）参保者中失眠症的患病率及其相关因素。通过邮件或在诊所就诊时向美国五家MCO的7500名参保者发放了一份调查问卷。该调查问卷包括一份睡眠问卷、人口统计学问题以及有关医疗就诊和处方药使用的问题。根据回答定义了三个失眠级别（无；I级——入睡困难或维持睡眠困难；II级——伴有日间功能障碍的失眠）。通过受访者报告的处方药使用情况间接确定合并症。共收到3447份调查问卷回复，回复率为46%。分别有13.5%和32.5%的受访者报告了I级和II级失眠。II级失眠随着教育程度、收入和年龄的降低而增加，在女性和非白种人中更为普遍。失眠与所有日间嗜睡和大多数夜间干扰因素显著相关。所有受访者中有52%报告至少有一种合并症。患有多种合并症的受访者比没有合并症的受访者更频繁地报告II级失眠。只有0.9%的诊所就诊者专门为睡眠问题看医生。在患有I级和II级失眠的人中，分别只有5.5%和11.6%正在服用专门治疗睡眠问题的处方药；分别有11.2%和21.4%正在服用非处方睡眠药物。MCO参保者中失眠症的发生率与普通人群中的发生率相当。然而，实际上很少有失眠患者接受针对其病情的治疗。对失眠症进行适当的评估、诊断和治疗是必要的。
