Oh Chang-Myung, Kim Ha Yan, Na Han Kyu, Cho Kyoo Ho, Chu Min Kyung
Division of Endocrinology and Metabolism, CHA Bundang Medical Center, School of Medicine CHA University, Seongnam-si, South Korea.
Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea.
Front Neurol. 2019 Aug 13;10:849. doi: 10.3389/fneur.2019.00849. eCollection 2019.
One of the most common sleep disorders, insomnia is a significant public health concern. Several psychiatric disorders, such as anxiety disorders and depression, have shown strong relationships with insomnia. However, the clinical impact of the combination of these two conditions on insomnia severity and sleep quality remains unknown. We investigated the relationship between sleep disturbance and psychiatric comorbidities in subjects with high risk for insomnia. We analyzed data from a nation-wide cross-sectional survey of Korean adults aged 19 ~ 69 years conducted from November 2011 to January 2012. The survey was performed via face-to-face interviews using a structured questionnaire. We used the insomnia severity index (ISI) to evaluate insomnia and defined respondents with ISI scores of ≥10 were considered to be at high risk for insomnia. To diagnose anxiety and depression, we used the Goldberg anxiety scale (GAS) and Patient Health Questionnaire-9 (PHQ-9), respectively. Of the 2,762 respondents, 290 (10.5%) were classified as subjects with high risk for insomnia; anxiety [odds ratio (OR), 9.8; 95% confidence interval (CI), 7.3-13.1] and depression (OR, 19.7; 95% CI, 13.1-29.6) were more common in this population than in participants without insomnia. Of the participants with insomnia, 152 (52.4%) had neither anxiety nor depression, 63 (21.7%) only had anxiety, 21 (7.2%) only had depression, and 54 (18.6%) had both anxiety and depression. The group with both anxiety and depression was associated with worse scores on sleep-related scales than the other groups [high ISI, Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale]. The relationship between outcome measures (ISI and PSQI) and psychiatric problems was significant only when anxiety and depression were present. The PSQI has a significant mediation effect on the relationship between psychiatric comorbidities and insomnia severity. Among the respondents with insomnia, psychiatric comorbidities may have a negative impact on daytime alertness, general sleep quality, and insomnia severity, especially when the two conditions are present at the same time. Clinicians should, therefore, consider psychiatric comorbidities when treating insomnia.
失眠是最常见的睡眠障碍之一，是一个重大的公共卫生问题。几种精神疾病，如焦虑症和抑郁症，已显示出与失眠有密切关系。然而，这两种情况同时存在对失眠严重程度和睡眠质量的临床影响仍不清楚。我们调查了失眠高风险受试者中睡眠障碍与精神共病之间的关系。我们分析了2011年11月至2012年1月对19至69岁韩国成年人进行的全国性横断面调查的数据。该调查通过使用结构化问卷进行面对面访谈来进行。我们使用失眠严重程度指数（ISI）来评估失眠，并将ISI得分≥10的受访者定义为失眠高风险人群。为了诊断焦虑和抑郁，我们分别使用了戈德堡焦虑量表（GAS）和患者健康问卷-9（PHQ-9）。在2762名受访者中，290人（10.5%）被归类为失眠高风险受试者；焦虑症[优势比（OR），9.8；95%置信区间（CI），7.3 - 13.1]和抑郁症（OR，19.7；95%CI，13.1 - 29.6）在该人群中比无失眠的参与者更常见。在失眠参与者中，152人（52.4%）既没有焦虑症也没有抑郁症，63人（21.7%）仅有焦虑症，21人（7.2%）仅有抑郁症，54人（18.6%）既有焦虑症又有抑郁症。与其他组相比，既有焦虑症又有抑郁症的组在与睡眠相关量表上的得分更差[高ISI、匹兹堡睡眠质量指数（PSQI）和爱泼华嗜睡量表]。仅当存在焦虑症和抑郁症时，结局指标（ISI和PSQI）与精神问题之间的关系才显著。PSQI对精神共病与失眠严重程度之间的关系具有显著的中介作用。在失眠受访者中，精神共病可能会对日间警觉性、总体睡眠质量和失眠严重程度产生负面影响，尤其是当这两种情况同时存在时。因此，临床医生在治疗失眠时应考虑精神共病。
