Parthasarathy Sairam, Vasquez Monica M, Halonen Marilyn, Bootzin Richard, Quan Stuart F, Martinez Fernando D, Guerra Stefano
Department of Medicine, University of Arizona, Tucson; Arizona Respiratory Center, University of Arizona, Tucson.
Arizona Respiratory Center, University of Arizona, Tucson.
Am J Med. 2015 Mar;128(3):268-75.e2. doi: 10.1016/j.amjmed.2014.10.015. Epub 2014 Oct 16.
Insomnia has been associated with mortality risk, but whether this association is different in subjects with persistent vs intermittent insomnia is unclear. Additionally, the role of systemic inflammation in such an association is unknown.
We used data from a community-based cohort to determine whether persistent or intermittent insomnia, defined based on persistence of symptoms over a 6-year period, was associated with death during the following 20 years of follow-up. We also determined whether changes in serum C-reactive protein (CRP) levels measured over 2 decades between study initiation and insomnia determination were different for the persistent, intermittent, and never insomnia groups. The results were adjusted for confounders such as age, sex, body mass index, smoking, physical activity, alcohol, and sedatives.
Of the 1409 adult participants, 249 (18%) had intermittent and 128 (9%) had persistent insomnia. During a 20-year follow-up period, 318 participants died (118 due to cardiopulmonary disease). In adjusted Cox proportional-hazards models, participants with persistent insomnia (adjusted hazards ratio [HR] 1.58; 95% confidence interval [CI], 1.02-2.45) but not intermittent insomnia (HR 1.22; 95% CI, 0.86-1.74) were more likely to die than participants without insomnia. Serum CRP levels were higher and increased at a steeper rate in subjects with persistent insomnia as compared with intermittent (P = .04) or never (P = .004) insomnia. Although CRP levels were themselves associated with increased mortality (adjusted HR 1.36; 95% CI, 1.01-1.82; P = .04), adjustment for CRP levels did not notably change the association between persistent insomnia and mortality.
In a population-based cohort, persistent, and not intermittent, insomnia was associated with increased risk for all-cause and cardiopulmonary mortality and was associated with a steeper increase in inflammation.
失眠与死亡风险相关，但持续性失眠与间歇性失眠患者的这种关联是否存在差异尚不清楚。此外，全身炎症在此种关联中的作用也未知。
我们使用了来自一个社区队列的数据，以确定基于6年期间症状持续性定义的持续性或间歇性失眠是否与接下来20年随访期间的死亡相关。我们还确定了在研究开始至失眠判定的20年间所测量的血清C反应蛋白（CRP）水平变化在持续性、间歇性和无失眠组之间是否不同。结果针对年龄、性别、体重指数、吸烟、身体活动、饮酒和镇静剂等混杂因素进行了调整。
在1409名成年参与者中，249人（18%）有间歇性失眠，128人（9%）有持续性失眠。在20年的随访期内，318名参与者死亡（118人死于心肺疾病）。在调整后的Cox比例风险模型中，与无失眠的参与者相比，持续性失眠参与者（调整后风险比[HR] 1.58；95%置信区间[CI]，1.02 - 2.45）而非间歇性失眠参与者（HR 1.22；95% CI，0.86 - 1.74）死亡可能性更高。与间歇性失眠（P = 0.04）或无失眠（P = 0.004）者相比，持续性失眠患者的血清CRP水平更高且升高速度更快。尽管CRP水平本身与死亡率增加相关（调整后HR 1.36；95% CI，1.01 - 1.82；P = 0.04），但对CRP水平进行调整并未显著改变持续性失眠与死亡率之间的关联。
在一个基于人群的队列中，持续性而非间歇性失眠与全因死亡率和心肺死亡率增加风险相关，且与炎症的急剧增加相关。
