Vgontzas Alexandros N, Fernandez-Mendoza Julio
Sleep Research & Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA.
Sleep Med Clin. 2013 Sep 1;8(3):309-322. doi: 10.1016/j.jsmc.2013.04.009.
The diagnosis of insomnia is based solely on subjective complaints. This has contributed to the low reliability and validity of the current nosology of insomnia as well as to its lack of firm association with clinically relevant outcomes such as cardiometabolic and neurocognitive morbidity. We review evidence that insomnia with objective short sleep duration is associated with physiological hyperarousal, higher risk for hypertension, diabetes, neurocognitive impairment, and mortality as well as with a persistent course. It also appears that objective short sleep duration in poor sleepers is a biological marker of genetic predisposition to chronic insomnia. In contrast, insomnia with objective normal sleep duration is associated with cognitive-emotional and cortical arousal and sleep misperception but not with signs of physiological hyperarousal or medical complications. Thus, short sleep duration in insomnia may be a reliable marker of the biological severity and medical impact of the disorder. We propose that (a) objective measures of sleep be included in the diagnosis of insomnia and its subtypes, (b) objective measures of sleep obtained in the home environment of the patient would become part of the routine assessment and diagnosis of insomnia in a clinician's office setting, and (c) insomnia with short sleep duration may respond better to biological treatments, whereas insomnia with normal sleep duration may respond primarily to psychological therapies.
失眠的诊断完全基于主观主诉。这导致了当前失眠疾病分类学的低可靠性和有效性，以及它与诸如心血管代谢和神经认知疾病等临床相关结局缺乏紧密关联。我们回顾了相关证据，即客观睡眠时间短的失眠与生理过度觉醒、高血压、糖尿病、神经认知障碍和死亡风险增加以及病程持续有关。睡眠不佳者的客观睡眠时间短似乎也是慢性失眠遗传易感性的生物学标志物。相比之下，客观睡眠时间正常的失眠与认知 - 情感及皮层觉醒和睡眠误判有关，但与生理过度觉醒迹象或医学并发症无关。因此，失眠中的短睡眠时间可能是该疾病生物学严重程度和医学影响的可靠标志物。我们建议：（a）将客观睡眠测量纳入失眠及其亚型的诊断中；（b）在患者家庭环境中获得的客观睡眠测量结果应成为临床医生办公室环境中失眠常规评估和诊断的一部分；（c）睡眠时间短的失眠可能对生物治疗反应更好，而睡眠时间正常的失眠可能主要对心理治疗有反应。
