Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR.
J Clin Psychiatry. 2010 Nov;71(11):1440-6. doi: 10.4088/JCP.09m05661gry.
Nocturnal sleep disturbances, including insomnia and recurrent nightmares, represent common distressing sleep complaints that might have important prognostic and therapeutic implications in psychiatric patients. The present study aimed at investigating nocturnal sleep disturbances in relation to the risk of suicide attempts in a consecutive cohort of psychiatric outpatients.
Participants attending a psychiatric outpatient clinic in Hong Kong were recruited into the study with a detailed sleep questionnaire assessment. The questionnaire was distributed between May and June 2006. Relevant clinical information, with a comprehensive clinical history of patients since their attendance at psychiatric services and 1 year after completion of their questionnaires, was reviewed.
The final study population consisted of 1,231 psychiatric outpatients with a mean age of 42.5 years (SD = 11.3; range, 18-65). Both frequent insomnia and recurrent nightmares were significantly and independently associated with an increased incidence of suicide attempts 1 year after questionnaire assessment (insomnia: OR = 6.96; 95% CI, 1.21-39.97; recurrent nightmares: OR = 8.17; 95% CI, 1.06-63.13) and an increase in lifetime prevalence of suicide attempts (insomnia: OR = 1.55; 95% CI, 1.06-2.25; recurrent nightmares: OR = 2.43; 95% CI, 1.51-3.91). Comorbid insomnia and nightmares had increased odds of lifetime prevalence (OR = 2.43; 95% CI, 1.53-3.85) and 1-year incidence of suicidal risk (OR = 17.08; 95% CI, 2.64-110.40). Antidepressants, particularly selective serotonin reuptake inhibitors (OR = 1.52; 95% CI, 1.02-2.25), serotonin-norepinephrine reuptake inhibitors (OR = 2.10; 95% CI, 1.15-3.83), heterocyclics (OR = 2.78; 95% CI, 1.21-6.42), and non-benzodiazepine hypnotics (OR = 1.54; 95% CI, 1.02-2.33) were independently associated with recurrent nightmares after adjustment for confounding variables.
Nocturnal sleep disturbances, particularly frequent insomnia and recurrent nightmares, were independently associated with enhanced suicidal risk among psychiatric patients. Future studies are warranted to investigate the underlying pathophysiologic mechanism and interventional responses.
夜间睡眠障碍，包括失眠和反复做噩梦，是常见的令人痛苦的睡眠问题，这可能对精神科患者的预后和治疗有重要意义。本研究旨在调查连续精神科门诊患者中与自杀企图风险相关的夜间睡眠障碍。
研究对象为在香港精神科门诊就诊的患者，通过详细的睡眠问卷进行评估。问卷于 2006 年 5 月至 6 月间发放。回顾了相关临床信息，包括患者自就诊以来的全面临床病史和完成问卷后的 1 年。
最终研究人群包括 1231 名精神科门诊患者，平均年龄为 42.5 岁（SD=11.3；范围，18-65）。频繁失眠和反复做噩梦均与 1 年后自杀企图发生率增加显著相关（失眠：OR=6.96；95%CI，1.21-39.97；反复做噩梦：OR=8.17；95%CI，1.06-63.13），与终生自杀企图发生率增加相关（失眠：OR=1.55；95%CI，1.06-2.25；反复做噩梦：OR=2.43；95%CI，1.51-3.91）。同时存在失眠和噩梦的患者，其终生患病率（OR=2.43；95%CI，1.53-3.85）和 1 年自杀风险发生率（OR=17.08；95%CI，2.64-110.40）均有所增加。抗抑郁药，特别是选择性 5-羟色胺再摄取抑制剂（OR=1.52；95%CI，1.02-2.25）、5-羟色胺-去甲肾上腺素再摄取抑制剂（OR=2.10；95%CI，1.15-3.83）、杂环类（OR=2.78；95%CI，1.21-6.42）和非苯二氮䓬类催眠药（OR=1.54；95%CI，1.02-2.33）与调整混杂因素后反复做噩梦独立相关。
夜间睡眠障碍，特别是频繁失眠和反复做噩梦，与精神科患者自杀风险增加独立相关。需要进一步研究以探讨潜在的病理生理机制和干预反应。
