Palagini Laura, Piarulli A, Menicucci D, Cheli E, Lai E, Bergamasco M, Mauri M, Kyle S D, Espie C A, Gemignani A
Department of Clinical and Experimental Medicine, Psychiatric Unit, University of Pisa, Italy.
PERCRO Lab, Scuola Superiore Sant'Anna, Pisa, Italy.
Sleep Med. 2014 Aug;15(8):918-22. doi: 10.1016/j.sleep.2014.03.017. Epub 2014 May 9.
To identify whether metacognitive aspects are a specific mental pattern of primary insomnia (PI) or an aspecific correlate of sleep alterations.
Sleep quality (Pittsburgh Sleep Quality Index: PSQI), anxiety (Self-rating Anxiety State: SAS), depression (Beck Depression Inventory: BDI) and metacognition (Metacognitions Questionnaire - Insomnia: MCQ-I) were evaluated in 24 PI patients, 13 snorers and 17 healthy controls. Rank-transformed PSQI, BDI, SAS and MCQ-I scores were submitted to one-way analysis of variance with group as a between-factor. PSQI was submitted to three-way analysis of covariance (ANCOVA) with MCQ-I, BDI or SAS as covariate and group as a between-factor. Post-hoc analyses were conducted using pairwise comparisons with Sidak correction.
As expected, PSQI scores significantly differentiated the three groups, one from another: PI had highest scores followed by snorers and healthy controls. PI subjects had MCQ-I scores significantly higher than those of snorers and healthy controls; no difference between the latter groups was found. The ANCOVA on PSQI with MCQ-I as a covariate abolished the difference in sleep quality between PI and snorers, whereas covarying for BDI or SAS left the differences in sleep quality between the groups unchanged.
These preliminary results lead to two main conclusions: (i) metacognitive aspects are more prominent in PI when compared to snorers and healthy controls; (ii) MCQI shows higher sensitivity in defining PI patients, with respect to PSQI. If these findings are confirmed and expanded by further studies, the development of a specific metacognitive model of primary insomnia may be warranted.
确定元认知方面是原发性失眠（PI）的一种特定心理模式，还是睡眠改变的一种非特定相关因素。
对24例PI患者、13例打鼾者和17名健康对照者进行睡眠质量（匹兹堡睡眠质量指数：PSQI）、焦虑（自评焦虑量表：SAS）、抑郁（贝克抑郁量表：BDI）和元认知（失眠元认知问卷：MCQ-I）评估。将经秩转换的PSQI、BDI、SAS和MCQ-I分数进行以组为组间因素的单因素方差分析。将PSQI进行以MCQ-I、BDI或SAS为协变量且以组为组间因素的三因素协方差分析（ANCOVA）。采用经Sidak校正的两两比较进行事后分析。
正如预期的那样，PSQI分数显著区分了三组：PI组得分最高，其次是打鼾者组和健康对照组。PI组受试者的MCQ-I分数显著高于打鼾者组和健康对照组；后两组之间未发现差异。以MCQ-I为协变量对PSQI进行的ANCOVA消除了PI组和打鼾者组之间睡眠质量的差异，而以BDI或SAS为协变量时，各组之间睡眠质量的差异保持不变。
这些初步结果得出两个主要结论：（i）与打鼾者和健康对照组相比，元认知方面在PI中更为突出；（ii）就定义PI患者而言，MCQI比PSQI具有更高的敏感性。如果这些发现通过进一步研究得到证实和扩展，那么原发性失眠特定元认知模型的开发可能是必要的。
