Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Social Foundation Bamberg, Teaching Hospital of the University of Erlangen, Bamberg, Germany.
Biol Psychiatry. 2011 Dec 1;70(11):1063-73. doi: 10.1016/j.biopsych.2011.08.010. Epub 2011 Oct 1.
Insomnia is highly prevalent and impairing but also highly comorbid with other chronic physical/mental disorders. Population-based research has yet to differentiate the role impairments uniquely associated with insomnia per se from those due to comorbidity.
A representative sample of 6791 adult subscribers to a large national US commercial health plan was surveyed by telephone about sleep and health. Twenty-one conditions previously found to be comorbid with insomnia were assessed with medical/pharmacy claims data and validated self-report scales. The Brief Insomnia Questionnaire, a fully structured, clinically validated scale, generated insomnia diagnoses according to inclusion criteria of DSM-IV-TR, ICD-10, and Research Diagnostic Criteria/International Classification of Sleep Disorders: Diagnostic and Coding Manual, Second Edition. The World Health Organization Disability Assessment Schedule-II assessed number of days in the past 30 when health problems prevented respondents from conducting their usual daily activities. Regression analyses estimated associations of insomnia with days-out-of-role controlling comorbidity.
Insomnia was significantly associated with days-out-of-role (.90 days/month) in a gross model. The association was reduced when controls were introduced for comorbidity (.42 days/month). This net association did not vary with number or type of comorbid conditions but was confined to respondents 35+ years of age. Insomnia was one of the most important conditions studied not only at the individual level, where it was associated with among the largest mean days-out-of-role, but also at the aggregate level, where it was associated with 13.6% of all days-out-of-role.
Insomnia has a strong net association with days-out-of-role that does not vary as a function of comorbidity.
失眠的发病率高且对患者有损害，但也与其他慢性身体/精神疾病高度共病。基于人群的研究尚未区分与失眠本身相关的损害与由共病引起的损害。
通过电话对一家大型美国商业健康计划的 6791 名成年订户进行了一项代表性调查，以了解睡眠和健康情况。使用医疗/药房索赔数据和经过验证的自我报告量表评估了 21 种先前发现与失眠共病的疾病。简短失眠问卷是一种完全结构化的、经过临床验证的量表，根据 DSM-IV-TR、ICD-10 和研究诊断标准/国际睡眠障碍分类：诊断和编码手册，第二版的纳入标准生成失眠诊断。世界卫生组织残疾评估表-第二版评估了过去 30 天中因健康问题而无法进行日常活动的天数。回归分析估计了失眠与控制共病的角色缺失天数之间的关联。
在总模型中，失眠与角色缺失天数显著相关（每月 0.90 天）。当引入共病控制时，这种关联会减少（每月 0.42 天）。这种净关联与共病数量或类型无关，但仅限于 35 岁以上的受访者。失眠是研究中最重要的疾病之一，不仅在个体水平上与最大的平均角色缺失天数相关，而且在总体水平上与所有角色缺失天数的 13.6%相关。
失眠与角色缺失天数之间存在强烈的净关联，与共病无关。
