Castillo Jelina, Goparaju Balaji, Bianchi Matt T
Neurology Department, Sleep Division, Massachusetts General Hospital, Boston, MA, United States.
Neurology Department, Sleep Division, Massachusetts General Hospital, Boston, MA, United States; Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States.
J Psychosom Res. 2014 May;76(5):361-7. doi: 10.1016/j.jpsychores.2014.03.001. Epub 2014 Mar 22.
Insomnia is commonly co-morbid with obstructive sleep apnea. Among patients reporting insomnia symptoms, sleep misperception occurs when self-reported sleep duration under-estimates objective measures. Misperception represents a clinical challenge since insomnia management is based entirely on patient self-report. We tested the hypothesis that misperception occurring in sleep apnea patients would improve with subsequent treatment.
We compared subjective sleep-wake reports with objective sleep in adults with obstructive sleep apnea (n=405) in two nights of polysomnography (diagnostic and treatment) within a median interval of 92 days.
Sleep latency was generally over-estimated, while wake after sleep onset and number of awakenings were under-estimated. None of these estimations differed between diagnostic and treatment polysomnograms. We observed a large spectrum of total sleep time misperception values during the diagnostic polysomnogram, with one third of the cohort under-estimating their total sleep time by at least 60 min. Of those with >60 minute misperception, we observed improved total sleep time perception during treatment polysomnography. Improved perception correlated with improvements in self-reported sleep quality and response confidence. We found no polysomnogram or demographic predictors of total sleep time misperception for the diagnostic polysomnogram, nor did we find objective correlates of improved perception during titration.
Our results suggest that misperception may improve with treatment of obstructive sleep apnea in patients who also exhibit misperception. Within subject changes in misperception are consistent with misperception being, at least to some extent, a state characteristic, which has implications for management of patients with comorbid insomnia and sleep apnea.
失眠常与阻塞性睡眠呼吸暂停并存。在报告有失眠症状的患者中，当自我报告的睡眠时间低于客观测量值时，就会出现睡眠感知错误。由于失眠的管理完全基于患者的自我报告，因此感知错误是一项临床挑战。我们检验了这样一个假设，即睡眠呼吸暂停患者中出现的感知错误会随着后续治疗而改善。
我们在平均间隔92天的两次多导睡眠图检查（诊断性和治疗性）的两个晚上，比较了405名阻塞性睡眠呼吸暂停成年患者的主观睡眠-觉醒报告和客观睡眠情况。
睡眠潜伏期通常被高估，而睡眠开始后的觉醒时间和觉醒次数被低估。这些估计值在诊断性和治疗性多导睡眠图之间没有差异。在诊断性多导睡眠图期间，我们观察到总睡眠时间感知错误值的范围很广，三分之一的队列将其总睡眠时间低估了至少60分钟。在那些有超过60分钟感知错误的患者中，我们在治疗性多导睡眠图期间观察到总睡眠时间感知有所改善。感知的改善与自我报告的睡眠质量和反应信心的改善相关。我们没有发现诊断性多导睡眠图总睡眠时间感知错误的多导睡眠图或人口统计学预测因素，在滴定过程中也没有发现感知改善的客观相关因素。
我们的结果表明，对于同时存在感知错误的阻塞性睡眠呼吸暂停患者，随着治疗的进行，感知错误可能会改善。个体内部感知错误的变化与感知错误至少在一定程度上是一种状态特征相一致，这对合并失眠和睡眠呼吸暂停的患者的管理具有重要意义。
