Epsylon Laboratory Dynamic of Human Abilities and Health Behaviors, University of Montpellier, Montpellier, France.
Department of Neurology, Montpellier University Hospital, Montpellier, France.
Sleep. 2018 Mar 1;41(3). doi: 10.1093/sleep/zsy002.
Despite the high comorbidity of insomnia disorder (ID) with multiple sclerosis (MS), the relevance of psychological processes involved in the maintenance of insomnia is yet to be established in this neurological disorder. This study aimed to ascertain to what extent the suggested emotional, cognitive, and behavioral processes maintaining insomnia are relevant in people with insomnia and MS.
A between-subjects design was used to compare 26 patients with insomnia and MS, with 31 patients with MS only, and with 26 matched neurological disease-free individuals with insomnia. All patients participated in a standardized clinical interview and completed a battery of self-reported measures of cognitive and somatic presleep arousal experienced at bedtime, sleep- or insomnia-related unhelpful beliefs, and sleep-related safety behaviors. All patients with MS underwent a neurological examination.
ID comorbid to MS was strongly associated with increased levels of cognitive and somatic arousal, higher endorsement of dysfunctional beliefs about the consequences of insomnia on daytime functioning, and worry about insomnia and more frequent engagement in sleep-related safety behaviors. Patients with MS with ID did not differ from neurological disease-free individuals with insomnia on these measures. No link was found between MS clinical peculiarities and ID diagnosis.
ID comorbid to MS is associated with the classical psychological factors perpetuating ID in neurological disease-free individuals with insomnia. Primary care providers and neurologists should consider target-oriented therapies like cognitive behavioral therapy for chronic insomnia as a treatment approach for ID comorbid to MS.
尽管失眠障碍（ID）与多发性硬化症（MS）的共病率很高，但在这种神经系统疾病中，维持失眠的心理过程的相关性尚未确定。本研究旨在确定在患有失眠和 MS 的人群中，维持失眠的情绪、认知和行为过程在多大程度上是相关的。
采用病例对照研究设计，比较了 26 例失眠合并 MS 的患者、31 例单纯 MS 的患者和 26 例经匹配的无神经系统疾病但有失眠的患者。所有患者均接受了标准化的临床访谈，并完成了一系列自我报告的认知和躯体睡前唤醒、睡眠或失眠相关的无益信念、以及与睡眠相关的安全行为的测量。所有 MS 患者均接受了神经系统检查。
MS 合并 ID 与认知和躯体唤醒水平升高、对失眠对日间功能的影响的不良信念的高认可度、对失眠的担忧以及更频繁地进行与睡眠相关的安全行为显著相关。在这些测量指标上，患有 MS 合并 ID 的患者与无神经系统疾病但有失眠的患者没有差异。MS 临床特征与 ID 诊断之间没有关联。
MS 合并 ID 与在无神经系统疾病但有失眠的个体中维持 ID 的经典心理因素有关。初级保健提供者和神经科医生应考虑将针对慢性失眠的认知行为疗法等靶向治疗方法作为 MS 合并 ID 的治疗方法。
