Krakow Barry, Ulibarri Victor A, Romero Edward A
Sleep and Human Health Institute, Albuquerque, New Mexico, USA.
Prim Care Companion J Clin Psychiatry. 2010;12(4). doi: 10.4088/PCC.09m00873bro.
Some chronic insomnia patients who take nightly prescription medication achieve less than optimal results. The US Food and Drug Administration (FDA) and the American Academy of Sleep Medicine (AASM) recommend reevaluation of this type of patient to assess for potential psychiatric or medical causes to explain this "failure for insomnia to remit."
A retrospective chart review examined a consecutive series of chronic insomnia patients with persistent insomnia complaints despite current nightly use of prescription medication from May 2005 to February 2008. To assess the role of psychiatric influences on insomnia symptoms, our sample (N = 218) was divided into 2 subgroups: a group with a history of psychiatric complaints (psychiatric insomnia, n = 189) and a control group of no psychiatric complaints (insomnia, n = 29).
The average patient reported insomnia for a decade and took prescription medication for sleep for a mean of 4.5 years. Although 100% of the sample used nightly sleep drugs, only 20% believed medication was the best solution for their condition. As evaluated by self-report and polysomnography, these patients exhibited moderately severe insomnia across most measures. Only a few differences were noted between groups. Subjective perception of insomnia severity was worse in the psychiatric insomnia group, which also reported significantly more insomnia-related interference in daily functioning, symptoms of sleep maintenance insomnia, and a trend toward greater daytime fatigue. The mean Apnea-Hypopnea Index score was 19.5 events/hour, yielding an obstructive sleep apnea diagnosis in 75% of patients per conservative AASM nosology (79% in the insomnia group and 74% in the psychiatric insomnia group, P = .22).
In this treatment-seeking sample of patients regularly taking sleep medications, residual insomnia was widespread, and patients with psychiatric insomnia may have perceived their condition as more problematic than a control group of insomnia patients without mental health complaints. Both groups exhibited high rates of objectively diagnosed obstructive sleep apnea, a medical condition associated with pervasive sleep fragmentation. These findings support FDA and AASM guidelines to reassess chronic insomnia patients who manifest residual symptoms despite nightly use of prescription medication for sleep.
一些每晚服用处方药物的慢性失眠患者并未取得理想的治疗效果。美国食品药品监督管理局（FDA）和美国睡眠医学会（AASM）建议对这类患者进行重新评估，以确定是否存在潜在的精神或医学原因来解释这种“失眠未缓解”的情况。
一项回顾性病历审查研究了2005年5月至2008年2月期间连续的一系列慢性失眠患者，这些患者尽管每晚都在使用处方药物，但仍持续存在失眠症状。为了评估精神因素对失眠症状的影响，我们的样本（N = 218）被分为两个亚组：有精神疾病史的一组（精神性失眠，n = 189）和无精神疾病史的对照组（失眠，n = 29）。
平均而言，患者报告失眠长达十年，服用助眠处方药物的平均时间为4.5年。尽管100%的样本每晚都使用助眠药物，但只有20%的患者认为药物是治疗其病情的最佳方法。通过自我报告和多导睡眠图评估，这些患者在大多数指标上都表现出中度严重的失眠。两组之间仅发现了一些差异。精神性失眠组对失眠严重程度的主观感受更差，该组还报告在日常功能中与失眠相关的干扰明显更多、睡眠维持性失眠症状更多，并且有白天疲劳感更强的趋势。平均呼吸暂停低通气指数评分为每小时19.5次事件，按照AASM保守的疾病分类标准，75%的患者被诊断为阻塞性睡眠呼吸暂停（失眠组为79%，精神性失眠组为74%，P = 0.22）。
在这个定期服用助眠药物的寻求治疗的患者样本中，残留失眠情况普遍存在，并且与没有心理健康问题的失眠对照组相比，精神性失眠患者可能觉得自己的病情问题更大。两组中客观诊断为阻塞性睡眠呼吸暂停的比例都很高，这是一种与普遍存在的睡眠片段化相关的医学状况。这些发现支持了FDA和AASM的指南，即对尽管每晚使用助眠处方药物仍表现出残留症状的慢性失眠患者进行重新评估。
