WPA Section on Psychiatry and Sleep Wakefulness Disorders.
World Psychiatry. 2005 Oct;4(3):186-90.
Over the last years, a large body of evidence has accumulated showing that complaints of disordered sleep are quite prevalent in the community. Insomnia is by far the most common disturbance and is often associated with concurrent psychiatric illness, in particular anxiety and mood disorders. On the other hand, sleep complaints are frequently present among psychiatric patients and have been incorporated in the official diagnostic criteria for many mental disorders, such as major depression, post-traumatic stress disorder, generalized anxiety disorder and substance-related disorders. Estimates of the prevalence of sleep disorders diverge widely, because these disorders have been variously conceptualized. Currently, however, three different classifications for sleep disorders establish reliable diagnostic criteria and allow for more consistency in clinical research. In particular, the ICD-10 diagnostic criteria for insomnia helped to establish a consensus among sleep specialists by defining accurately this clinical condition, i.e. by conceptualizing it as the subjective complaint of insufficient or non-restorative sleep, which is the important feature, not the actual amount of time spent asleep. Alongside the evolution of taxonomic systems, the development of specific diagnostic tools, such as rating scales for measuring clinical manifestations of sleep disorders, has contributed significantly to the growth in the field. For instance, the risk factors responsible for the development of chronic insomnia, its consequences, and the complex relationship between insomnia and psychopathology, have been considerably clarified. In terms of the polysomnographic aberrations observed in various mental disorders, these, although proven not to be pathognomonic for any of them, have been considerably refined over the last decade, and certain general sleep patterns for some specific disorders have emerged. Finally, substantial advances have been made in the elucidation of the neuropsychobiological substrate of disturbed sleep. Thus, hyperarousal has been identified as the cardinal feature of chronic insomnia, which is associated with an around-the-clock activation of both major components of the stress system, the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system.
在过去的几年中，大量证据表明，睡眠障碍的抱怨在社区中相当普遍。到目前为止，失眠是最常见的紊乱，它通常与同时存在的精神疾病有关，特别是焦虑和情绪障碍。另一方面，睡眠抱怨经常出现在精神科患者中，并已被纳入许多精神障碍的官方诊断标准，如重度抑郁症、创伤后应激障碍、广泛性焦虑症和物质相关障碍。睡眠障碍的患病率估计差异很大，因为这些障碍的概念各不相同。目前，然而，三种不同的睡眠障碍分类建立了可靠的诊断标准，并允许在临床研究中更加一致。特别是，ICD-10 失眠诊断标准通过准确地定义这种临床状况，即把它概念化为主观的睡眠不足或非恢复性睡眠的抱怨，这是重要的特征，而不是实际睡眠时间，帮助睡眠专家建立了共识。除了分类系统的演变外，特定诊断工具的发展，如测量睡眠障碍临床表现的评分量表，也为该领域的发展做出了重大贡献。例如，慢性失眠发展的危险因素、其后果，以及失眠与精神病理学之间的复杂关系，已经得到了相当大的澄清。就各种精神障碍中观察到的多导睡眠图异常而言，尽管这些异常不能作为任何一种疾病的特异性诊断，但在过去十年中已经得到了相当大的改进，并且某些特定疾病出现了一些特定的一般睡眠模式。最后，在阐明睡眠障碍的神经心理生物学基础方面也取得了重大进展。因此，过度唤醒已被确定为慢性失眠的主要特征，它与应激系统的两个主要组成部分，即下丘脑-垂体-肾上腺轴和交感神经系统，全天激活有关。
