Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, Michigan.
Department of Psychological Sciences, Kent State University, Kent, Ohio.
J Sleep Res. 2018 Dec;27(6):e12710. doi: 10.1111/jsr.12710. Epub 2018 May 24.
Sleep reactivity is the trait-like degree to which stress exposure disrupts sleep, resulting in difficulty falling and staying asleep. Individuals with highly reactive sleep systems experience drastic deterioration of sleep when stressed, whereas those with low sleep reactivity proceed largely unperturbed during stress. Research shows that genetics, familial history of insomnia, female gender and environmental stress influence how the sleep system responds to stress. Further work has identified neurobiological underpinnings for sleep reactivity involving disrupted cortical networks and dysregulation in the autonomic nervous system and hypothalamic-pituitary-adrenal axis. Sleep reactivity is most pathologically and clinically pertinent when in excess, such that high sleep reactivity predicts risk for future insomnia disorder, with early evidence suggesting high sleep reactivity corresponds to severe insomnia phenotypes (sleep onset insomnia and short sleep insomnia). High sleep reactivity is also linked to risk of shift-work disorder, depression and anxiety. Importantly, stress-related worry and rumination may exploit sensitive sleep systems, thereby augmenting the pathogenicity of sleep reactivity. With the development of cost-effective assessment of sleep reactivity, we can now identify individuals at risk of future insomnia, shift-work disorder and mental illness, thus identifying a target population for preventive intervention. Given that insomniacs with high sleep reactivity tend to present with severe insomnia phenotypes, patient sleep reactivity may inform triaging to different levels of treatment. Future research on sleep reactivity is needed to clarify its neurobiology, characterize its long-term prospective associations with insomnia and shift-work disorder phenotypes, and establish its prognostic value for mental illness and other non-sleep disorders.
睡眠反应性是指压力暴露对睡眠的干扰程度，表现为入睡和保持睡眠困难。睡眠反应性高的个体在受到压力时睡眠会急剧恶化，而睡眠反应性低的个体在受到压力时则基本不受影响。研究表明，遗传、失眠家族史、女性性别和环境压力会影响睡眠系统对压力的反应。进一步的研究还确定了睡眠反应性的神经生物学基础，涉及皮质网络的破坏以及自主神经系统和下丘脑-垂体-肾上腺轴的失调。当睡眠反应性过高时，它在病理学和临床上最为相关，例如，高睡眠反应性预示着未来失眠障碍的风险，早期证据表明高睡眠反应性与严重的失眠表型（入睡困难型失眠和睡眠维持困难型失眠）相对应。睡眠反应性还与轮班工作障碍、抑郁和焦虑的风险相关。重要的是，与压力相关的担忧和沉思可能会利用敏感的睡眠系统，从而增加睡眠反应性的致病性。随着对睡眠反应性进行经济有效的评估的发展，我们现在可以识别出未来有失眠、轮班工作障碍和精神疾病风险的个体，从而确定了预防性干预的目标人群。鉴于高睡眠反应性的失眠症患者往往表现出严重的失眠表型，患者的睡眠反应性可能有助于对不同程度的治疗进行分诊。未来还需要对睡眠反应性进行研究，以阐明其神经生物学机制，描述其与失眠和轮班工作障碍表型的长期前瞻性关联，并确定其对精神疾病和其他非睡眠障碍的预后价值。
