Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden; Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, Madrid, Spain.
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
J Affect Disord. 2020 Apr 1;266:413-416. doi: 10.1016/j.jad.2020.01.122. Epub 2020 Jan 22.
The association between specific psychiatric disorders and insomnia is well established, but the prevalence of insomnia in obsessive-compulsive disorder (OCD) is unknown. This population-based study examined the prevalence of insomnia in patients with OCD compared to unaffected individuals from the general population and to their unaffected full siblings, and evaluated the contribution of psychiatric comorbidities to this association.
Individuals diagnosed with OCD (31,856) were identified from a cohort of 13,017,902 individuals living in Sweden anytime during 1973 and 2013. Logistic regression analyses were used to investigate the odds of insomnia in individuals with OCD, compared to the general population and their unaffected full siblings. Sensitivity analyses were performed in subgroups from which all individuals with comorbid psychiatric conditions were excluded, one at a time.
Individuals with OCD had almost 7-fold increased odds of receiving an insomnia diagnosis or being dispensed a drug with specific indication for insomnia, compared to unaffected individuals from the general population (42.2% vs. 11.0%, respectively; OR=6.92 [95% CI, 6.76-7.08]). Familiar factors shared with siblings and comorbid conditions did not fully explain this association, but when individuals with comorbid depression and anxiety disorders were excluded, the odds of insomnia were significantly reduced (OR=4.97 [95% CI, 4.81-5.14] and OR=4.51 [95% CI, 4.33-4.69], respectively).
Due to the intrinsic coverage issues of the registers, results may not be generalizable to milder forms of the disorder and to individuals who do not seek help.
Insomnia should be systematically evaluated and managed in individuals with OCD, particularly in those with comorbid anxiety and depression.
特定精神障碍与失眠之间存在关联已得到充分证实，但强迫症（OCD）患者失眠的患病率尚不清楚。本基于人群的研究旨在调查与未受影响的普通人群个体及未受影响的同卵双胞胎相比，OCD 患者中失眠的患病率，并评估精神共病对这种关联的影响。
从居住在瑞典的 13017902 个人中，任何时间在 1973 年至 2013 年间被诊断为 OCD（31856 人）的个体被确定为研究对象。采用逻辑回归分析比较 OCD 患者与普通人群及未受影响的同卵双胞胎发生失眠的可能性。逐一排除所有患有共病精神疾病的个体后，在亚组中进行敏感性分析。
与普通人群未受影响的个体相比，OCD 患者接受失眠诊断或开具特定失眠药物的可能性几乎增加了 7 倍（分别为 42.2%和 11.0%；OR=6.92[95%CI，6.76-7.08]）。与同卵双胞胎共有的遗传因素和共病情况并不能完全解释这种关联，但当排除共患抑郁和焦虑障碍的个体后，失眠的可能性显著降低（OR=4.97[95%CI，4.81-5.14]和 OR=4.51[95%CI，4.33-4.69]）。
由于登记册本身的覆盖范围问题，结果可能无法推广到疾病的较轻形式和未寻求帮助的个体。
OCD 患者应系统地评估和管理失眠，特别是那些伴有焦虑和抑郁共病的患者。
