Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK; Universite de Paris, Paris, France; Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Research and Development, St. Olavs University Hospital, Trondheim, Norway; Department of Mental Health Care, St. Olavs University Hospital, Trondheim, Norway.
Sleep Med Rev. 2021 Jun;57:101429. doi: 10.1016/j.smrv.2021.101429. Epub 2021 Jan 19.
Despite several high-quality reviews of insomnia and incidence of mental disorders, prospective longitudinal relationships between a wider range of sleep disturbances and first onset of a depressive, bipolar, or psychotic disorders during the peak age range for onset of these conditions has not been addressed. Database searches were undertaken to identify publications on insomnia, but also on other sleep problems such as hypersomnia, short sleep duration, self-identified and/or generic 'sleep problems' and circadian sleep-wake cycle dysrhythmias. We discovered 36 studies that were eligible for systematic review and from these publications, we identified 25 unique datasets that were suitable for meta-analysis (Number>45,000; age ∼17). Individuals with a history of any type of sleep disturbance (however defined) had an increased odds of developing a mood or psychotic disorder in adolescence or early adulthood (Odds ratio [OR]:1.88; 95% Confidence Intervals:1.67, 2.25) with similar odds for onset of bipolar disorders (OR:1.72) or depressive disorders (OR:1.62). The magnitude of associations differed according to type of exposure and was greatest for sleep disturbances that met established diagnostic criteria for a sleep disorder (OR: 2.53). However, studies that examined observer or self-rated symptoms, also reported a significant association between hypersomnia symptoms and the onset of a major mental disorder (OR:1.39). Overall study quality was moderate with evidence of publication bias and meta-regression identified confounders such as year of publication. We conclude that evidence indicates that subjective, observer and objective studies demonstrate a modest but significant increase in the likelihood of first onset of mood and psychotic disorders in adolescence and early adulthood in individuals with broadly defined sleep disturbances. Although findings support proposals for interventions for sleep problems in youth, we suggest a need for greater consensus on screening strategies and for more longitudinal, prospective studies of circadian sleep-wake cycle dysrhythmias in youth.
尽管有几项关于失眠和精神障碍发病率的高质量综述，但在这些疾病发病高峰期，更广泛的睡眠障碍与首次抑郁、双相或精神病性障碍发作之间的前瞻性纵向关系尚未得到解决。我们进行了数据库检索，以确定关于失眠的出版物，但也包括其他睡眠问题的出版物，如嗜睡症、睡眠时间短、自我识别和/或通用的“睡眠问题”以及昼夜睡眠-觉醒周期节律紊乱。我们发现了 36 项符合系统评价标准的研究，并从这些出版物中确定了 25 项适合荟萃分析的独特数据集（数量>45000；年龄约 17 岁）。有任何类型睡眠障碍（无论如何定义）病史的个体在青少年或成年早期发生情绪或精神病性障碍的几率增加（优势比[OR]：1.88；95%置信区间：1.67，2.25），双相障碍（OR：1.72）或抑郁障碍（OR：1.62）的发病几率也相似。关联的大小因暴露类型而异，与符合睡眠障碍既定诊断标准的睡眠障碍（OR：2.53）最为显著。然而，那些检查观察者或自我评定症状的研究也报告了嗜睡症状与主要精神障碍发病之间存在显著关联（OR：1.39）。总体研究质量为中等，存在发表偏倚的证据，荟萃回归确定了混杂因素，如发表年份。我们的结论是，有证据表明，主观、观察者和客观研究表明，在广泛定义的睡眠障碍个体中，青少年和成年早期首次出现情绪和精神病性障碍的可能性适度但显著增加。尽管这些发现支持了针对青少年睡眠问题的干预措施的建议，但我们建议需要就筛查策略达成更大共识，并对青少年昼夜睡眠-觉醒周期节律紊乱进行更多的纵向前瞻性研究。
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