ISI-3：一种简短失眠筛查工具的评估
ISI-3: evaluation of a brief screening tool for insomnia.
作者信息
Thakral Manu, Von Korff Michael, McCurry Susan M, Morin Charles M, Vitiello Michael V
机构信息
College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA; Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle, WA, USA.
Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
出版信息
Sleep Med. 2021 Jun;82:104-109. doi: 10.1016/j.sleep.2020.08.027. Epub 2020 Aug 27.
STUDY OBJECTIVES
We evaluated the performance of the Insomnia Severity Index-3 (ISI-3) as a short screening tool to identify clinically significant insomnia derived from the 7-item ISI in an older primary care population.
METHODS
We used results from two surveys including the 7-item ISI: Sample 1 (n = 3197) and Sample 2 (n = 247) individuals aged ≥60 years with a diagnosis of osteoarthritis from electronic health records. The 7 items were: difficulty falling asleep, difficulty staying asleep, waking too early, sleep satisfaction, sleep interference with daytime functioning, noticeability of sleep problems by others, and worry about sleep. The ISI-3 included items with highest item-total correlations to the 7-item ISI from Sample 1. A 7-item ISI score ≥15 was defined as clinically significant insomnia and served as the primary criterion for the ISI-3. We derived operating characteristics to determine the diagnostic accuracy and cut-points to maximize sensitivity and specificity for both samples.
RESULTS
The items with the highest item-total correlations were: sleep dissatisfaction, sleep interference with daily functioning, and worry about sleep problems (r = 0.78-0.81); while difficulty falling asleep, difficulty staying asleep, waking too early and noticeability of sleep problems by others showed lower correlations (r = 0.60-0.74). The ISI-3 achieved high discriminant validity in identifying insomnia (AUC = 0.97-0.98). An ISI-3 score of ≥7 maximized sensitivity (0.94-0.97) and specificity (0.88-0.91) with kappa = 0.68-0.71, 89.1-91.5% agreement.
CONCLUSIONS
The ISI-3 can effectively screen for insomnia to trigger a more thorough diagnostic evaluation including the 7-item ISI for research or clinical purposes. Future validation studies are needed in other community and clinical populations.
CLINICAL TRIAL
This manuscript describes secondary analyses of data two National Institutes on Aging-funded clinical trials (ClinicalTrials.gov identifier: NCT01142349, NCT02946957).
研究目的
我们评估了失眠严重程度指数-3（ISI-3）作为一种简短筛查工具的性能，以识别老年初级保健人群中源自7项失眠严重程度指数（ISI）的具有临床意义的失眠。
方法
我们使用了两项包含7项ISI的调查结果：样本1（n = 3197）和样本2（n = 247），这些个体年龄≥60岁，通过电子健康记录诊断为骨关节炎。这7项分别是：入睡困难、睡眠维持困难、早醒、睡眠满意度、睡眠对日间功能的干扰、他人对睡眠问题的察觉以及对睡眠的担忧。ISI-3包括与样本1中7项ISI的项目总分相关性最高的项目。7项ISI评分≥15被定义为具有临床意义的失眠，并作为ISI-3的主要标准。我们得出操作特征以确定两个样本的诊断准确性和切点，以最大化敏感性和特异性。
结果
项目总分相关性最高的项目是：睡眠不满意、睡眠对日常功能的干扰以及对睡眠问题的担忧（r = 0.78 - 0.81）；而入睡困难、睡眠维持困难、早醒以及他人对睡眠问题的察觉显示出较低的相关性（r = 0.60 - 0.74）。ISI-3在识别失眠方面具有较高的判别效度（AUC = 0.97 - 0.98）。ISI-3评分≥7可最大化敏感性（0.94 - 0.97）和特异性（0.88 - 0.91），kappa值为0.68 - 0.71，一致性为89.1 - 91.5%。
结论
ISI-3可有效筛查失眠，以便为研究或临床目的触发更全面的诊断评估，包括7项ISI。未来需要在其他社区和临床人群中进行验证研究。
临床试验
本手稿描述了两项由美国国立衰老研究所资助的临床试验数据的二次分析（ClinicalTrials.gov标识符：NCT01142349，NCT02946957）。
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