Kalmbach David A, Buysse Daniel J, Cheng Philip, Roth Thomas, Yang Alexander, Drake Christopher L
Thomas Roth Sleep Disorders & Research Center, Division of Sleep Medicine, Henry Ford Health System, Detroit, MI, 48202, USA.
Center for Sleep and Circadian Science, Departments of Psychiatry and Clinical and Translational Science, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA.
Sleep Med. 2020 Jul;71:151-160. doi: 10.1016/j.sleep.2019.11.1184. Epub 2019 Nov 14.
Cognitive arousal is central to models of sleep disturbance and insomnia, but findings remain mixed regarding whether cognitive arousal is associated with objective sleep disturbance and physiologic hyperarousal. This study explored associations of objective nocturnal wakefulness and indicators of physiologic hyperarousal with cognitive arousal in healthy sleepers and individuals with insomnia.
In sum, 52 adults (51.9% women; 18 with insomnia disorder, 34 healthy sleepers) underwent two overnight polysomnography (PSG) studies (adaptation + baseline nights) and a multiple sleep latency test (MSLT). Baseline depression was assessed and presleep cognitive arousal and somatic arousal were recorded for each night. Multivariate regression was used to evaluate associations of PSG sleep parameters with insomnia, cognitive arousal, and somatic arousal.
Analyses showed that high levels of nocturnal cognitive arousal were associated with prolonged sleep latency, lower sleep efficiency, and shorter total sleep time by PSG on both nights. An association between nocturnal cognitive arousal and wake after sleep onset was observed on night one only. Moreover, greater nocturnal cognitive arousal was associated with greater likelihood of obtaining short sleep and with longer MSLT sleep latencies. Insomnia diagnosis, depression, and somatic arousal were not associated with PSG sleep parameters or MSLT latency.
Heightened cognitive arousal at night is linked to objective sleep disturbances and indicators of physiologic hyperarousal at night and during the day. For patients with insomnia, cognitive arousal may contribute to the 24-hr physiologic hyperarousal. Cognitive arousal may be a critical therapeutic target for severe or treatment-resistant sleep disturbance.
认知唤醒是睡眠障碍和失眠模型的核心，但关于认知唤醒是否与客观睡眠障碍和生理过度唤醒相关的研究结果仍不一致。本研究探讨了健康睡眠者和失眠个体中客观夜间觉醒及生理过度唤醒指标与认知唤醒之间的关联。
总计52名成年人（51.9%为女性；18名患有失眠症，34名健康睡眠者）接受了两项夜间多导睡眠图（PSG）研究（适应性+基线夜）和一项多次睡眠潜伏期测试（MSLT）。评估了基线抑郁情况，并记录了每晚睡前的认知唤醒和躯体唤醒情况。采用多元回归分析来评估PSG睡眠参数与失眠、认知唤醒和躯体唤醒之间的关联。
分析表明，高水平的夜间认知唤醒与两晚PSG记录的较长睡眠潜伏期、较低睡眠效率和较短总睡眠时间相关。仅在第一晚观察到夜间认知唤醒与睡眠起始后觉醒之间存在关联。此外，较高的夜间认知唤醒与获得短睡眠的可能性增加以及MSLT睡眠潜伏期延长相关。失眠诊断、抑郁和躯体唤醒与PSG睡眠参数或MSLT潜伏期无关。
夜间认知唤醒增强与夜间及白天的客观睡眠障碍和生理过度唤醒指标相关。对于失眠患者，认知唤醒可能导致24小时生理过度唤醒。认知唤醒可能是严重或难治性睡眠障碍的关键治疗靶点。
