Daley M, Morin C M, LeBlanc M, Grégoire J P, Savard J, Baillargeon L
Ecole de Psychologie, Université Laval, Quebec, Canada G1K 0A6.
Sleep Med. 2009 Apr;10(4):427-38. doi: 10.1016/j.sleep.2008.04.005. Epub 2008 Aug 26.
To document and provide a micro analysis of the relationship between insomnia and health problems, health-care use, absenteeism, productivity and accidents.
A population-based sample of 953 French-speaking adults from Québec, Canada. Participants were categorized as having insomnia syndrome (SYND) or insomnia symptoms (SYMPT) or as good sleepers (GS). They completed questionnaires on sleep, health, use of health-care services and products, accidents, work absences and reduced work productivity. Data were also obtained from the Québec-government-administered health insurance board on selected variables (e.g., consultations with health-care professionals, diagnoses).
There were significantly more individuals in the SYND group relative to the GS group reporting at least one chronic health problem (83% vs. 53%; OR: 2.78) and who had consulted a health-care professional in the past year (81% vs. 60%; OR: 2.8). There were also higher proportions of individuals in the SYND group than in the GS group who had used prescription medications (57% vs. 30.7%; OR: 2.8), most notably to treat insomnia, mood and anxiety disorders, or who had used over-the-counter products (75.6% vs. 62.0%; OR: 1.8) and alcohol as a sleep aid (17.8% vs. 3.9%; OR: 4.6). In terms of daytime function, 25.0% of the SYND had been absent from work relative to 17.1% of GS (OR: 1.7), 40.6% reported having experienced reduced productivity compared to 12.3% of GS (OR: 4.8) and non-motor-vehicle accidents occurred at higher rates in the SYND group (12.5% vs. 6.4% for GS; OR: 2.4). No differences were found for hospitalisations or motor-vehicle accidents. Most of the associations remained significant even after controlling for psychiatric comorbidity. Rates for the SYMPT group were situated between SYND and GS on all major dependent variables. Furthermore, insomnia and fatigue were perceived as contributing significantly to accidents, absences and decreased work productivity, regardless of insomnia status.
This study indicates that insomnia is associated with significant morbidity in terms of health problems and health-care utilization, work absenteeism and reduced productivity, and risk of non-motor-vehicle accidents. Future studies should evaluate whether treating insomnia can reverse this morbidity.
记录并对失眠与健康问题、医疗保健利用、旷工、工作效率及事故之间的关系进行微观分析。
来自加拿大魁北克省的953名讲法语成年人的基于人群的样本。参与者被分为患有失眠综合征（SYND）或失眠症状（SYMPT）或睡眠良好者（GS）。他们完成了关于睡眠、健康、医疗保健服务和产品使用、事故、旷工及工作效率降低的问卷。还从魁北克省政府管理的健康保险委员会获取了关于选定变量（如与医疗保健专业人员的会诊、诊断）的数据。
与GS组相比，SYND组中报告至少一种慢性健康问题的个体显著更多（83%对53%；比值比：2.78），且在过去一年中咨询过医疗保健专业人员的个体也显著更多（81%对60%；比值比：2.8）。SYND组中使用处方药的个体比例也高于GS组（57%对30.7%；比值比：2.8），最显著的是用于治疗失眠、情绪和焦虑障碍，或使用非处方产品的个体比例（75.6%对62.0%；比值比：1.8）以及将酒精作为助眠剂的个体比例（17.8%对3.9%；比值比：4.6）。在日间功能方面，SYND组中有25.0%的人旷工，而GS组为17.1%（比值比：1.7），4从魁北克省政府管理的健康保险委员会获取了关于选定变量（如与医疗保健专业人员的会诊、诊断）的数据。
与GS组相比，SYND组中报告至少一种慢性健康问题的个体显著更多（83%对53%；比值比：2.78），且在过去一年中咨询过医疗保健专业人员的个体也显著更多（81%对60%；比值比：2.8）。SYND组中使用处方药的个体比例也高于GS组（57%对30.7%；比值比：2.8），最显著的是用于治疗失眠、情绪和焦虑障碍，或使用非处方产品的个体比例（75.6%对62.0%；比值比：1.8）以及将酒精作为助眠剂的个体比例（17.8%对3.9%；比值比：4.6）。在日间功能方面，SYND组中有25.0%的人旷工，而GS组为17.1%（比值比：1.7），40.6%的人报告工作效率降低，而GS组为12.3%（比值比：4.8），并且SYND组中非机动车事故发生率更高（SYND组为12.5%，GS组为6.4%；比值比：2.4）。在住院或机动车事故方面未发现差异。即使在控制了精神共病之后，大多数关联仍然显著。在所有主要因变量上，SYMPT组的发生率介于SYND组和GS组之间。此外，无论失眠状态如何，失眠和疲劳都被认为是事故、旷工和工作效率降低的重要原因。
本研究表明，失眠在健康问题、医疗保健利用、旷工、工作效率降低以及非机动车事故风险方面与显著的发病率相关。未来的研究应评估治疗失眠是否能逆转这种发病率。 0.6%的人报告工作效率降低，而GS组为12.3%（比值比：4.8），并且SYND组中非机动车事故发生率更高（SYND组为12.5%，GS组为6.4%；比值比：2.4）。在住院或机动车事故方面未发现差异。即使在控制了精神共病之后，大多数关联仍然显著。在所有主要因变量上，SYMPT组的发生率介于SYND组和GS组之间。此外，无论失眠状态如何，失眠和疲劳都被认为是事故、旷工和工作效率降低的重要原因。
本研究表明，失眠在健康问题、医疗保健利用、旷工、工作效率降低以及非机动车事故风险方面与显著的发病率相关。未来的研究应评估治疗失眠是否能逆转这种发病率。
