失眠筛查：一项观察性研究，调查头痛中心就诊患者的睡眠障碍、头痛特征和精神症状。

Screening for Insomnia: An Observational Study Examining Sleep Disturbances, Headache Characteristics, and Psychiatric Symptoms in Patients Visiting a Headache Center.

机构信息

Neurology Department, New York Presbyterian Hospital, Columbia, New York.

Neurology Department, Yeshiva University Ferkauf Graduate School of Psychology, Albert Einstein College of Medicine, New York, New York.

出版信息

Pain Med. 2018 May 1;19(5):1067-1076. doi: 10.1093/pm/pnx161.

DOI:10.1093/pm/pnx161

PMID:29016937

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6279263/

Abstract

OBJECTIVE

Effective treatments for insomnia exist, but few physicians treating headaches have routine methods for screening for insomnia. We sought to 1) describe the migraine characteristics and comorbid conditions that can affect sleep and 2) assess their relationships with positive screens on the Insomnia Severity Index (ISI).

METHODS

This is a retrospective cross-sectional study of the migraine and sleep characteristics of new patients in our headache center (August 15, 2015-October 28, 2015) who were suspected of having migraines based on the new patient intake questionnaire. The questionnaire included the ISI, questions about headache characteristics, and screens for psychiatric comorbidities. Two tailed t tests and analysis of variance evaluated relationships between headache characteristics, comorbidities, and ISI score.

RESULTS

A total of 61 new patients were suspected to have migraines. The mean number of headache days per month was 11.6. Only 41% of patients reported sleeping seven or more hours; 49.2% had an ISI of 15 or higher (positive screen). Regarding the insomnia scores, there were no differences between moderate and severe headache pain, between episodic and chronic headaches, and between the associated symptoms (nausea/vomiting, photophobia, phonophobia; P > 0.05). Musculoskeletal pain (18.7 vs 13.8, P = 0.027), depression (rho = 0.610), and general anxiety (rho = 0.436) were associated with higher ISI scores.

CONCLUSIONS

Nearly half of the patients with suspected migraines in a headache center screened positive for insomnia, independent of whether they had episodic or chronic headaches. This would generate a substantial number of cognitive behavioral therapy for insomnia (CBT-I) referrals. Given the strong association between comorbid musculoskeletal pain, depression, anxiety, and insomnia, we suggest prioritizing CBT-I referral for those patients regardless of their headache frequency.

摘要

目的

尽管存在有效的失眠治疗方法，但很少有治疗头痛的医生有常规的失眠筛查方法。我们旨在：1）描述影响睡眠的偏头痛特征和合并症；2）评估它们与失眠严重程度指数（ISI）阳性筛查的关系。

方法

这是对我们头痛中心（2015 年 8 月 15 日至 2015 年 10 月 28 日）新患者的偏头痛和睡眠特征的回顾性横断面研究，这些患者根据新患者入院问卷怀疑患有偏头痛。该问卷包括 ISI、头痛特征问题以及精神共病筛查。采用双尾 t 检验和方差分析评估头痛特征、合并症和 ISI 评分之间的关系。

结果

共有 61 名新患者疑似偏头痛。每月头痛天数的平均值为 11.6。只有 41%的患者报告睡眠时间为 7 小时或以上；49.2%的患者 ISI 为 15 或更高（阳性筛查）。关于失眠评分，中度和重度头痛疼痛之间、发作性和慢性头痛之间以及相关症状（恶心/呕吐、畏光、恐声）之间没有差异（P>0.05）。肌肉骨骼疼痛（18.7 比 13.8，P=0.027）、抑郁（rho=0.610）和一般焦虑（rho=0.436）与较高的 ISI 评分相关。