Department of Neuroscience and Behavioral Disorders, Duke-NUS Medical School, Singapore (Poon, Lee); and Ng Teng Fong General Hospital, Singapore (Quek).
J Neuropsychiatry Clin Neurosci. 2021 Summer;33(3):194-200. doi: 10.1176/appi.neuropsych.20080206. Epub 2021 May 14.
Insomnia is the most common sleep disorder in the adult population. However, the definition of insomnia disorder has varied across major classification systems and changed over time. In the present study, the investigators traced the evolution of insomnia disorder across classification systems, contemplated the empirical basis for its current definitions, and surveyed ongoing research efforts that may clarify insomnia nosology in the future. Three major classification systems for insomnia are the International Classification of Sleep Disorders, the International Classification of Diseases, and DSM. Despite their divergent origins, these classification systems have converged to nearly identical contemporary insomnia definitions. Over time, the emphasis in classification approaches has shifted from symptomatology to etiology to treatment implications. Additionally, the historical multitude of insomnia subtypes has gradually consolidated into a few core diagnoses, reflecting inadequate evidence with which to support subtyping. Current insomnia definitions include frequency and duration criteria to operationalize these diagnoses, while the diagnostic criterion of nonrestorative sleep has been eliminated (with some controversy). In ongoing research efforts, the quest for insomnia biomarkers has not thus far yielded clinically deployable breakthroughs. Data-driven insomnia subtyping suggests a promising new approach in deriving empirically based subtypes; conversely, the transdiagnostic perspective proposes the elimination of categorical distinctions in favor of finding common processes underlying all psychiatric disorders. The continual evolution of insomnia nosology highlights that much remains to be learned about these conditions; all current diagnostic classification systems are best regarded as "works in progress." Nevertheless, refinement and convergence of classification approaches is essential to standardizing insomnia research, diagnosis, and treatment.
失眠是成年人中最常见的睡眠障碍。然而，失眠障碍的定义在主要分类系统中有所不同，并且随着时间的推移而发生了变化。在本研究中，研究人员追踪了失眠障碍在分类系统中的演变，思考了其当前定义的经验基础，并调查了正在进行的研究工作，这些工作可能会在未来阐明失眠的分类学。失眠的三个主要分类系统是国际睡眠障碍分类、国际疾病分类和 DSM。尽管它们的起源不同，但这些分类系统已经趋同于几乎相同的当代失眠定义。随着时间的推移，分类方法的重点从症状学转移到病因学再到治疗意义。此外，历史上众多的失眠亚型逐渐合并为少数核心诊断，反映了支持亚型分类的证据不足。当前的失眠定义包括频率和持续时间标准来实现这些诊断，而恢复性睡眠的诊断标准已被删除（存在一些争议）。在正在进行的研究工作中，对失眠生物标志物的探索迄今为止尚未取得可临床应用的突破。基于数据的失眠亚型分类提示了一种有前途的新方法，可以从经验上得出基于亚型的分类；相反，跨诊断观点建议消除分类学区别，转而寻找所有精神障碍的共同潜在过程。失眠分类学的不断演变表明，我们仍有许多关于这些疾病的知识需要了解；所有当前的诊断分类系统最好被视为“正在进行中的工作”。然而，分类方法的细化和趋同对于标准化失眠研究、诊断和治疗至关重要。
