Kalmbach David A, Pillai Vivek, Arnedt J Todd, Anderson Jason R, Drake Christopher L
Sleep and Circadian Research Laboratory, Departments of Psychiatry and Neurology, University of Michigan Medical School, Ann Arbor, MI 48109, USA.
Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, MI 48202, USA.
Sleep Med. 2016 May;21:63-9. doi: 10.1016/j.sleep.2016.02.005. Epub 2016 Feb 26.
To test for sensitization of the sleep system in response to insomnia development and major life stress. In addition, to evaluate the impact on depression and anxiety associated with sleep system sensitization.
A longitudinal study with three annual assessments. The community-based sample included 262 adults with no history of insomnia or depression who developed insomnia one year after baseline (67.6% female; 44.0 ± 13.4 yr). Measures included the Ford Insomnia Response to Stress Test to assess sleep reactivity, Quick Inventory of Depressive Symptomatology, and Beck Anxiety Inventory. Insomnia classification was based on DSM-IV criteria. Sleep system sensitization was operationally defined as significant increases in sleep reactivity.
Sensitization of the sleep system was observed from baseline to insomnia onset at 1-yr follow-up among insomniacs with low premorbid vulnerability (p < 0.001), resulting in 68.3% of these individuals re-classified as highly sleep reactive. Major life stress was associated with greater sleep system sensitization (p = 0.02). Results showed that sleep reactivity at 2-yr follow-up remained elevated among those with low premorbid vulnerability, even after insomnia remission (p < 0.01). Finally, analyses revealed that increases in sleep reactivity predicted greater depression (p < 0.001) and anxiety (p < 0.001) at insomnia onset. The impact of sensitization on depression was stable at 2-yr follow-up (p = 0.01).
Evidence supports sensitization of the sleep system as a consequence of insomnia development and major life stress among individuals with low premorbid sleep reactivity. Sleep system sensitization may serve as a mechanism by which insomnia is perpetuated. Harmful effects of the sensitization process may increase risk for insomnia-related depression and anxiety.
测试睡眠系统对失眠发展和重大生活压力的反应敏感性。此外，评估睡眠系统敏感化对抑郁和焦虑的影响。
一项进行三次年度评估的纵向研究。基于社区的样本包括262名无失眠或抑郁病史的成年人，他们在基线后一年出现失眠（女性占67.6%；年龄44.0±13.4岁）。测量指标包括用于评估睡眠反应性的福特失眠应激反应测试、抑郁症状快速清单和贝克焦虑量表。失眠分类基于《精神疾病诊断与统计手册》第四版标准。睡眠系统敏感化在操作上被定义为睡眠反应性显著增加。
在病前易感性较低的失眠患者中，从基线到1年随访失眠发作时观察到睡眠系统敏感化（p<0.001），导致这些个体中有68.3%被重新分类为高睡眠反应性。重大生活压力与更高的睡眠系统敏感化相关（p=0.02）。结果显示，即使在失眠缓解后，病前易感性较低的患者在2年随访时的睡眠反应性仍保持升高（p<0.01）。最后，分析表明，睡眠反应性增加预示着失眠发作时抑郁（p<0.001）和焦虑（p<0.001）程度更高。敏感化对抑郁的影响在2年随访时保持稳定（p=0.01）。
有证据支持在病前睡眠反应性较低的个体中，失眠发展和重大生活压力会导致睡眠系统敏感化。睡眠系统敏感化可能是失眠持续存在的一种机制。敏感化过程的有害影响可能会增加与失眠相关的抑郁和焦虑风险。
