Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Novi, MI, USA.
Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.
Sleep Med. 2019 Mar;55:40-47. doi: 10.1016/j.sleep.2018.12.001. Epub 2018 Dec 14.
While anxiety rates are alarmingly high in short sleeping insomniacs, the relationship between insomnia and anxiety symptoms has not been extensively studied, especially in comparison to the relationship between insomnia and depressive symptoms. Using residency training as a naturalistic stress exposure, we prospectively assessed the role of sleep disturbance and duration on anxiety-risk in response to stress.
Web-based survey data from 1336 first-year training physicians (interns) prior to and then quarterly across medical internship. Using mixed effects modeling, we examined how pre-internship sleep disturbance and internship sleep duration predicted symptoms of anxiety, using an established tool for quantifying symptom severity in generalized anxiety disorder (GAD).
Pre-internship poor sleepers are at more than twice the odds of having short sleep (≤6 h) during internship as good sleepers (OR = 2.38, 95% CI = 1.61, 3.57). Poor sleepers were also at twice the odds for screening positive for probable GAD diagnosis (OR = 2.08, 95% CI = 1.26, 3.45). Notably, sleep onset insomnia strongly predicted anxiety development under stress (OR = 3.55, 95% CI = 1.49, 8.45). During internship, short sleep associated with concurrent anxiety symptoms (b = -0.26, 95% CI = -0.38, -0.14) and predicted future anxiety symptoms even more strongly (b = -0.39, 95% CI = -0.76, -0.03).
Poor sleepers, particularly those with sleep onset insomnia symptoms, are vulnerable to short sleep and GAD anxiety and worry during chronic stress.
尽管短期睡眠失眠症患者的焦虑率高得惊人，但失眠与焦虑症状之间的关系尚未得到广泛研究，尤其是与失眠与抑郁症状之间的关系相比。利用住院医师培训作为自然应激暴露，我们前瞻性评估了睡眠障碍和持续时间对应激反应中焦虑风险的作用。
在医学实习之前和之后的每个季度，通过网络调查收集了 1336 名一年级培训医师（实习医生）的数据。使用混合效应模型，我们使用一种用于量化广泛性焦虑障碍（GAD）症状严重程度的既定工具，检查了实习前睡眠障碍和实习期间睡眠时间如何预测焦虑症状。
与睡眠良好者相比，实习前睡眠不佳者在实习期间发生短睡眠（≤6 小时）的可能性是其两倍以上（OR=2.38，95%CI=1.61，3.57）。睡眠潜伏期失眠者也有两倍的可能性被筛查出患有 GAD 诊断（OR=2.08，95%CI=1.26，3.45）。值得注意的是，睡眠起始性失眠强烈预测了应激下焦虑的发展（OR=3.55，95%CI=1.49，8.45）。在实习期间，短睡眠与同时存在的焦虑症状相关（b=-0.26，95%CI=-0.38，-0.14），并且更强烈地预测了未来的焦虑症状（b=-0.39，95%CI=-0.76，-0.03）。
睡眠不佳者，尤其是有睡眠起始性失眠症状者，在慢性应激期间易发生短睡眠和 GAD 焦虑和担忧。
