Adelaide Institute for Sleep Health, A Flinders Centre of Research Excellence, Flinders University of South Australia, Australia.
Adelaide Institute for Sleep Health, A Flinders Centre of Research Excellence, Flinders University of South Australia, Australia; School of Psychology, Flinders University of South Australia, Australia.
Sleep Med Rev. 2019 Feb;43:71-83. doi: 10.1016/j.smrv.2018.10.004. Epub 2018 Nov 11.
The purpose of this review was to evaluate the strength of evidence for a relationship between risk of mortality and frequent and ongoing insomnia using a meta-analytic strategy. Seventeen studies, including a total of 36,938,981 individuals followed up for a mean of 11.6 y, reporting the investigation of the association between mortality and frequent (≥3 nights/wk), ongoing (≥1 mo) insomnia were identified. There was no difference in the odds of mortality for those individuals with symptoms of insomnia when compared to those without symptoms (OR = 1.06, 95%CI = 0.61-1.84, p = .84). This finding was echoed in the assessment of the rate of mortality in those with and without symptoms of insomnia using the outcomes of multivariate models, with the most complete adjustment for potential confounders, as reported by the individual studies included in this meta-analysis (HR = 1.07, 95%CI = .96-.1.19, p = .22). Additional analyses revealed a tendency for an increased risk of mortality associated with hypnotic use. The current evidence reinforces the use of cognitive therapy, within a CBTi framework, as a frontline non-pharmacological treatment for insomnia to reassure patients their longevity will not be impacted as a consequence of suffering from insomnia.
本次综述的目的是采用荟萃分析策略评估频繁且持续失眠与死亡率之间的关系的证据强度。共确定了 17 项研究，包括总共 36938981 名随访时间平均为 11.6 年的个体，这些研究报告了死亡率与频繁（≥每周 3 晚）、持续（≥1 个月）失眠之间的关联的调查。与无失眠症状的个体相比，有失眠症状的个体的死亡率并无差异（OR=1.06，95%CI=0.61-1.84，p=0.84）。这一发现与使用荟萃分析中纳入的研究报告的多变量模型的结局评估有失眠和无失眠症状的个体的死亡率一致，对潜在混杂因素进行了最完整的调整（HR=1.07，95%CI=0.96-1.19，p=0.22）。进一步的分析显示，催眠药物的使用与死亡率增加的风险相关。目前的证据支持将认知疗法（CBTi 框架内）作为失眠的一线非药物治疗方法，以消除患者对失眠会影响寿命的担忧。
