Dragioti Elena, Levin Lars-Åke, Bernfort Lars, Larsson Britt, Gerdle Björn
Pain and Rehabilitation Centre, Department of Medical and Health Sciences (IMH), Linköping University, 581 85 Linköping, Sweden.
Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, 581 85 Linköping, Sweden.
Ann Gen Psychiatry. 2017 Feb 23;16:15. doi: 10.1186/s12991-017-0137-3. eCollection 2017.
Insomnia is a major cause of concern in the elderly with and without pain. This study set out to examine the insomnia and its correlates in a large sample of community adults aged ≥65 years.
A cross-sectional postal survey was completed by 6205 older individuals (53.8% women; mean age = 76.2 years; SD = 7.5). The participants also completed the Insomnia Severity Index (ISI) and questionnaires assessing pain intensity, pain spreading, anxiety, depression, and basic demographic information. The sample was divided into three groups based on the presence and duration of pain: chronic pain (CP; = 2790), subacute pain (SP; = 510), and no pain (NP; = 2905).
A proportion of each of the groups had an ISI score of 15 or greater (i.e., clinical insomnia): CP = 24.6%; SP = 21.3%; and NP = 13.0%. The average scores of ISI differed significantly among CP, SP, and NP groups ( < 0.001). Stratified regression analyses showed that pain intensity, pain spreading, anxiety, and depression were independently related to insomnia in the CP group. Anxiety and depression were independently related to insomnia in the SP group, but only anxiety was significantly associated with insomnia in the NP group. Age and sex were not associated with insomnia.
This study confirms that insomnia is not associated with chronological aging per se within the elderly population. Although the possible associations of insomnia with pain are complex, ensuing from pain intensity, pain spreading, anxiety, and depression, our results highlighted that anxiety was more strongly associated with insomnia in all groups than the depression and pain characteristics. Therapeutic plans should consider these relations during the course of pain, and a comprehensive assessment including both pain and psychological features is essential when older people are seeking primary health care for insomnia complaints.
失眠是困扰有疼痛和无疼痛老年人的一个主要问题。本研究旨在调查65岁及以上社区成年人大样本中的失眠情况及其相关因素。
6205名老年人（53.8%为女性；平均年龄=76.2岁；标准差=7.5）完成了一项横断面邮寄调查。参与者还完成了失眠严重程度指数（ISI）以及评估疼痛强度、疼痛扩散、焦虑、抑郁和基本人口统计学信息的问卷。根据疼痛的存在和持续时间，将样本分为三组：慢性疼痛（CP；=2790）、亚急性疼痛（SP；=510）和无疼痛（NP；=2905）。
每组中都有一定比例的人ISI得分在15分及以上（即临床失眠）：CP组=24.6%；SP组=21.3%；NP组=13.0%。CP组、SP组和NP组的ISI平均得分差异显著（<0.001）。分层回归分析表明，疼痛强度、疼痛扩散、焦虑和抑郁与CP组的失眠独立相关。焦虑和抑郁与SP组的失眠独立相关，但在NP组中只有焦虑与失眠显著相关。年龄和性别与失眠无关。
本研究证实，在老年人群中，失眠本身与实际年龄无关。虽然失眠与疼痛之间可能的关联很复杂，源于疼痛强度、疼痛扩散、焦虑和抑郁，但我们的结果强调，在所有组中，焦虑与失眠的关联比抑郁和疼痛特征更强。治疗方案在疼痛过程中应考虑这些关系，当老年人因失眠主诉寻求初级医疗保健时，包括疼痛和心理特征的综合评估至关重要。
