Morlock Robert J, Tan Maudrene, Mitchell David Y
Pfizer Inc., Worldwide Development, Ann Arbor, Michigan 48105, USA.
Clin Ther. 2006 Jul;28(7):1044-53. doi: 10.1016/j.clinthera.2006.07.008.
The aims of this work were to characterize ambulatory patients in the United States presenting with primary or secondary insomnia complaints and resultant diagnoses, and to describe the characteristics of patients treated with medications commonly used for sleep complaints.
Data from the National Ambulatory Medical Care Survey for the years 1997 through 2002 were analyzed. Data were stratified by patient characteristics, physician specialty, resulting diagnosis, and medications prescribed or provided. The unit of analysis was the individual patient visit; statistical comparisons were made using the chi(2) test for categorical variables and the Rao-Scott design-adjusted chi(2) test for comparisons of patient age groups. P<0.05 was the criterion for statistical significance. Cells containing < 30 observations were not included in the statistical analysis.
The data included 147,945 patient visit records; rates of physician response to the survey ranged from 62.9% in 1999 to 70.4% in 2002. Based on this sample, it was projected that 30 million office visits involved insomnia complaints over the 6-year period from 1997 to 2002 throughout the United States. With a total of 4.9 billion physician visits projected for that time period, 0.6% of visits were insomnia related. Women were 1.5 times more likely to have insomnia-related visits (P<0.001). Overall, the greatest proportion of insomnia patients of both sexes was between the ages of 18 and 64 years (P<0.001). Sleep difficulties were most frequently attributed to organic disorders, depression and/or anxiety, and primary insomnia (55.8%, 27.3%, and 9.8%, respectively; P<0.001). The most frequently prescribed or recommended medications were zaleplon/zolpidem and trazodone (28.5% and 32.0%, respectively; P<0.001). Zaleplon and zolpidem were most frequently used for patients with organic diagnoses and those aged < or =65 years (33.2% and 29.8%; P<0.001).
Demographics of patients with insomnia and their diagnoses from 1999 to 2002 remained stable, but the use of medications changed predictably as newer agents became available.
本研究旨在描述美国门诊中出现原发性或继发性失眠主诉及相应诊断结果的患者特征，并阐述使用常用于治疗睡眠问题的药物进行治疗的患者特征。
分析了1997年至2002年美国门诊医疗护理调查的数据。数据按患者特征、医生专业、诊断结果以及所开或所提供的药物进行分层。分析单位为个体患者就诊情况；采用卡方检验对分类变量进行统计比较，并采用Rao-Scott设计调整的卡方检验对患者年龄组进行比较。P<0.05为统计学显著性标准。包含少于30次观察结果的单元格未纳入统计分析。
数据包括147,945条患者就诊记录；医生对调查的回复率从1999年的62.9%到2002年的70.4%不等。基于该样本，预计在1997年至2002年的6年期间，全美国有3000万次门诊涉及失眠主诉。该时间段预计总门诊量为49亿次，其中0.6%与失眠相关。女性出现与失眠相关门诊的可能性是男性的1.5倍（P<0.001）。总体而言，两性中失眠患者比例最高的年龄段为18至64岁（P<0.001）。睡眠困难最常归因于器质性疾病、抑郁和/或焦虑以及原发性失眠（分别为55.8%、27.3%和9.8%；P<0.001）。最常开具或推荐的药物是扎来普隆/唑吡坦和曲唑酮（分别为28.5%和32.0%；P<0.001）。扎来普隆和唑吡坦最常用于患有器质性疾病诊断的患者以及年龄小于或等于65岁的患者（33.2%和29.8%；P<0.001）。
1999年至2002年失眠患者的人口统计学特征及其诊断结果保持稳定，但随着新药物的出现，药物使用情况发生了可预测的变化。
