Foley D J, Monjan A, Simonsick E M, Wallace R B, Blazer D G
Epidemiology, Demography, and Biometry Program, National Institute on Aging, Bethesda, MD 20892-9205, USA.
Sleep. 1999 May 1;22 Suppl 2:S366-72.
To determine incidence and remission rates of insomnia in older adults and associated risk factors. Three-year longitudinal study, 1982-198--East Boston, MA; New Haven, CT; Iowa and Washington counties, IA. Participants were 6,899 men and women aged 65 years and older. Self-reported difficulty falling asleep or early morning arousal (insomnia), along with physician diagnosis of heart disease, stroke, cancer, diabetes, or hip-fracture, self-report of physical disability, depressive symptomatology, perceived health status, and use of medications ascertained at both baseline and three-year follow-up. Nearly 15% of the 4,956 participants without symptoms of insomnia at baseline reported chronic difficulty falling asleep or early morning arousal at follow-up, suggesting an annual incidence rate of approximately 5%. Incident insomnia was associated with depressed mood, respiratory symptoms, fair to poor perceived health, and physical disability. In multivariate analyses, these risk factors explained the higher incidence of insomnia among those with medical conditions such as heart disease, stroke, and diabetes. Other factors associated with an increased risk of insomnia included use of prescribed sedatives, and widowhood. Only 7% of the incident cases of insomnia occurred in the absence of associated risk factors. Of the nearly 2,000 survivors with chronic insomnia at baseline, almost half no longer reported symptoms upon follow-up and were more likely to report improved self-perceived health compared to those who continued to report symptoms. Chronic disease, depressed mood, physical disability, poor perceived health, widowhood, and use of sedatives are associated with development and remission of insomnia symptoms. Because the vast majority of incident cases of insomnia were among persons with one or more of these risk factors, these data do not support a model of incident insomnia caused by the aging process per se.
确定老年人失眠的发病率和缓解率以及相关风险因素。1982 - 198 -年在马萨诸塞州东波士顿、康涅狄格州纽黑文、爱荷华州爱荷华县和华盛顿县进行了为期三年的纵向研究。参与者为6899名65岁及以上的男性和女性。在基线和三年随访时确定自我报告的入睡困难或早醒（失眠）情况，以及医生诊断的心脏病、中风、癌症、糖尿病或髋部骨折情况、身体残疾的自我报告、抑郁症状、感知健康状况和药物使用情况。在基线时无失眠症状的4956名参与者中，近15%在随访时报告有慢性入睡困难或早醒情况，提示年发病率约为5%。新发失眠与情绪低落、呼吸道症状、健康状况一般至较差以及身体残疾有关。在多变量分析中，这些风险因素解释了患有心脏病、中风和糖尿病等疾病的人群中失眠发病率较高的原因。与失眠风险增加相关的其他因素包括使用处方镇静剂和丧偶。仅有7%的新发失眠病例发生在无相关风险因素的情况下。在基线时患有慢性失眠的近2000名幸存者中，几乎一半在随访时不再报告有症状，并且与继续报告有症状的人相比，更有可能报告自我感知健康状况有所改善。慢性病、情绪低落、身体残疾、健康状况较差、丧偶和使用镇静剂与失眠症状的发生和缓解有关。由于绝大多数新发失眠病例发生在有一个或多个这些风险因素的人群中，这些数据不支持由衰老过程本身导致新发失眠的模型。
