Pillai Vivek, Roth Thomas, Drake Christopher L
Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, MI.
Sleep. 2015 Jan 1;38(1):127-38. doi: 10.5665/sleep.4338.
We examined the 1-y stability of four insomnia symptom profiles: sleep onset insomnia; sleep maintenance insomnia; combined onset and maintenance insomnia; and neither criterion (i.e., insomnia cases that do not meet quantitative thresholds for onset or maintenance problems). Insomnia cases that exhibited the same symptom profile over a 1-y period were considered to be phenotypes, and were compared in terms of clinical and demographic characteristics.
Longitudinal.
Urban, community-based.
Nine hundred fifty-four adults with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition based current insomnia (46.6 ± 12.6 y; 69.4% female).
None.
At baseline, participants were divided into four symptom profile groups based on quantitative criteria. Follow-up assessment 1 y later revealed that approximately 60% of participants retained the same symptom profile, and were hence judged to be phenotypes. Stability varied significantly by phenotype, such that sleep onset insomnia (SOI) was the least stable (42%), whereas combined insomnia (CI) was the most stable (69%). Baseline symptom groups (cross-sectionally defined) differed significantly across various clinical indices, including daytime impairment, depression, and anxiety. Importantly, however, a comparison of stable phenotypes (longitudinally defined) did not reveal any differences in impairment or comorbid psychopathology. Another interesting finding was that whereas all other insomnia phenotypes showed evidence of an elevated wake drive both at night and during the day, the 'neither criterion' phenotype did not; this latter phenotype exhibited significantly higher daytime sleepiness despite subthreshold onset and maintenance difficulties.
By adopting a stringent, stability-based definition, this study offers timely and important data on the longitudinal trajectory of specific insomnia phenotypes. With the exception of daytime sleepiness, few clinical differences are apparent across stable phenotypes.
我们研究了四种失眠症状类型的1年稳定性：入睡困难型失眠；睡眠维持困难型失眠；入睡和维持均困难型失眠；以及不符合任何标准（即不符合入睡或维持问题定量阈值的失眠病例）。在1年期间表现出相同症状类型的失眠病例被视为表型，并就临床和人口统计学特征进行比较。
纵向研究。
城市社区。
954名符合《精神疾病诊断与统计手册》第五版当前失眠诊断标准的成年人（46.6±12.6岁；69.4%为女性）。
无。
在基线时，根据定量标准将参与者分为四个症状类型组。1年后的随访评估显示，约60%的参与者保持相同的症状类型，因此被判定为表型。稳定性因表型而异，入睡困难型失眠（SOI）最不稳定（42%），而混合型失眠（CI）最稳定（69%）。基线症状组（横断面定义）在各种临床指标上存在显著差异，包括日间功能损害、抑郁和焦虑。然而，重要的是，对稳定表型（纵向定义）的比较未发现损害或共病精神病理学方面的任何差异。另一个有趣的发现是，尽管所有其他失眠表型在夜间和白天均表现出觉醒驱动力升高的迹象，但“不符合任何标准”表型却没有；尽管该表型在入睡和维持睡眠方面存在亚阈值困难，但白天嗜睡程度却显著更高。
通过采用严格的、基于稳定性的定义，本研究提供了关于特定失眠表型纵向轨迹的及时且重要的数据。除白天嗜睡外，稳定表型之间几乎没有明显的临床差异。
