Sivertsen Børge, Overland Simon, Neckelmann Dag, Glozier Nicholas, Krokstad Steinar, Pallesen Ståle, Nordhus Inger Hilde, Bjorvatn Bjørn, Mykletun Arnstein
Department of Clinical Psychology, University of Bergen, and Affective Disorder Section, Department of Psychiatry, Haukeland University Hospital, Bergen, Norway.
Am J Epidemiol. 2006 Jun 1;163(11):1018-24. doi: 10.1093/aje/kwj145. Epub 2006 Apr 12.
Chronic insomnia is common in the general population. Its effect on functioning and disability is usually attributed to an underlying condition, so the diagnosis of insomnia does not qualify for award of a disability pension in the United States or Europe. The aim of this study was to investigate whether insomnia, defined according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, contributed to long-term work disability. Using a historical cohort design, the authors gathered baseline data from a population-based Norwegian health study of 37,308 working-age people not claiming a disability pension through 1995-1997. The outcome was subsequent award of a disability pension (18-48 months after the health screening) as registered by the National Insurance Administration. Insomnia was a strong predictor of subsequent permanent work disability (adjusted odds ratio=3.90, 95% confidence interval: 3.20, 4.76). Sociodemographic and shift-work characteristics had little confounding effect (adjusted odds ratio=3.69, 95% confidence interval: 3.00, 4.53), and this association remained significant after adjustment for psychiatric and physical morbidity and for health-related behaviors (adjusted odds ratio=1.75, 95% confidence interval: 1.40, 2.20). This study suggests that insomnia should receive increased attention as a robust predictor of subsequent work disability.
慢性失眠在普通人群中很常见。其对功能和残疾的影响通常归因于潜在疾病，因此在美国或欧洲，失眠的诊断不符合领取残疾抚恤金的条件。本研究的目的是调查根据《精神疾病诊断与统计手册》第四版定义的失眠是否会导致长期工作残疾。作者采用历史队列设计，从1995 - 1997年挪威一项针对37308名未领取残疾抚恤金的工作年龄人群的基于人群的健康研究中收集基线数据。结果是国家保险管理局登记的随后领取残疾抚恤金情况（健康筛查后18 - 48个月）。失眠是随后永久性工作残疾的有力预测因素（调整后的优势比 = 3.90，95%置信区间：3.20，4.76）。社会人口统计学和轮班工作特征的混杂效应很小（调整后的优势比 = 3.69，95%置信区间：3.00，4.53），在对精神和身体疾病以及健康相关行为进行调整后，这种关联仍然显著（调整后的优势比 = 1.75，95%置信区间：1.40，2.20）。这项研究表明，失眠作为后续工作残疾的有力预测因素应受到更多关注。
