Belleville Geneviève, Foldes-Busque Guillaume, Poitras Julien, Chauny Jean-Marc, Diodati Jean G, Fleet Richard, Marchand André
School of Psychology, Université Laval, Québec, Canada (GB, G F-B).
School of Psychology, Université Laval, Québec, Canada (GB, G F-B); The University-Affiliated Hospital of Lévis, Québec, Canada (G F-B, JP, RF).
Psychosomatics. 2014 Sep-Oct;55(5):458-68. doi: 10.1016/j.psym.2013.12.004. Epub 2013 Dec 8.
The current study was designed (1) to assess insomnia symptoms and sleep-related beliefs in a population of patients presenting in emergency department with unexplained chest pain (UCP) and (2) to examine the associations between insomnia and pain.
This is a report of secondary data from a cross-sectional study performed in the emergency department of 2 academic hospitals. Patients with UCP seen in an emergency department were assessed using sleep questionnaires and the Anxiety Disorders Interview Schedule for Diagnostic and Statistical Manual of Mental Disorders, fourth edition.
Nearly every second patient with UCP (44%) seen in an emergency department suffered from clinically significant insomnia symptoms. Most patients with an anxiety or a mood disorder had insomnia, but a minority of patients with insomnia had an anxiety or a mood disorder. Insomniacs with an anxiety disorder were similar to insomniacs without comorbid anxiety for sleep-related beliefs and depressive symptoms, and both groups of insomniacs reported more depressive symptoms and faulty beliefs than both groups of good sleepers, i.e., either with or without an anxiety disorder. Results from regression analyses revealed that insomnia was associated with pain on univariate regression analysis and accounted for 1.3% of the variance in both pain intensity and interference. However, this association was rendered nonsignificant when additional variables were added to the model.
Insomnia symptoms are an important, but often disregarded, feature present in a significant proportion of patients with UCP. As insomnia showed stronger associations with pain than anxiety or depression, it may represent an important factor contributing to the development and recurrence of UCP.
本研究旨在（1）评估因不明原因胸痛（UCP）就诊于急诊科的患者群体中的失眠症状及与睡眠相关的信念，以及（2）研究失眠与疼痛之间的关联。
这是一份来自于在两家学术医院急诊科进行的横断面研究的二次数据报告。使用睡眠问卷和《精神障碍诊断与统计手册》第四版的焦虑症访谈量表对在急诊科就诊的UCP患者进行评估。
在急诊科就诊的UCP患者中，几乎每两名患者中就有一名（44%）患有具有临床意义的失眠症状。大多数患有焦虑症或情绪障碍的患者存在失眠，但少数失眠患者患有焦虑症或情绪障碍。患有焦虑症的失眠患者与无共病焦虑的失眠患者在与睡眠相关的信念和抑郁症状方面相似，且两组失眠患者均比两组睡眠良好者（无论有无焦虑症）报告了更多的抑郁症状和错误信念。回归分析结果显示，在单变量回归分析中失眠与疼痛相关，且在疼痛强度和干扰方面分别占变异的1.3%。然而，当向模型中添加其他变量时，这种关联变得不显著。
失眠症状是UCP患者中很大一部分人群存在的一个重要但常被忽视的特征。由于失眠与疼痛的关联比焦虑或抑郁更强，它可能是导致UCP发生和复发的一个重要因素。
