Department of Behavioural Medicine, University of Oslo, Oslo, Norway.
Priory Hospital Altrincham, Cheshire, United Kingdom.
J Clin Sleep Med. 2022 Mar 1;18(3):779-787. doi: 10.5664/jcsm.9712.
Insomnia is highly prevalent and associated with anxiety and depression in patients with coronary heart disease patients. The development of effective psychological interventions is needed. Worry and rumination are potential risk factors for the maintenance of insomnia, anxiety, and depression that may be modified by psychological treatment grounded in the Self-Regulatory Executive Function model. However, the relationships between worry, rumination, anxiety and depression, and insomnia are not known. Therefore, we investigated these relationships both cross-sectionally and longitudinally among patients with coronary heart disease.
A cross-sectional study consecutively included 1,082 patients in 2014-2015, and 686 were followed up after mean of 4.7 years. Data were gathered from hospital records and self-report questionnaires comprising assessment of worry (Penn State Worry Questionnaire), rumination (Ruminative Responses Scale), anxiety and depression (Hospital Anxiety and Depression Scale), and insomnia (Bergen Insomnia Scale).
Insomnia correlated moderately with all other psychological variables ( 0.18-0.50, all values < .001). After adjustments for anxiety and depression, odds ratios for insomnia at baseline were 1.27 (95% confidence interval 1.08-1.50) and 1.60 (95% confidence interval 1.31-1.94) per 10 points increase of worry and rumination, respectively. Corresponding odds ratios for insomnia at follow-up were 1.28 (95% confidence interval 1.05-1.55) and 1.38 (95% confidence interval 1.09-1.75). Depression was no longer significantly associated with insomnia after adjustments for worry and rumination, but anxiety remained significant.
Worry and rumination predicted insomnia both cross-sectionally and prospectively, even after controlling for anxiety and depression, although anxiety remained significant. Future studies may test psychological interventions targeting these factors in patients with coronary heart disease and insomnia.
Frøjd LA, Papageorgiou C, Munkhaugen J, et al. Worry and rumination predict insomnia in patients with coronary heart disease: a cross-sectional study with long-term follow-up. . 2022;18(3):779-787.
失眠在冠心病患者中非常普遍，且与焦虑和抑郁有关。需要开发有效的心理干预措施。担忧和反刍可能是失眠、焦虑和抑郁维持的潜在风险因素，而基于自我调节执行功能模型的心理治疗可能会改变这些因素。然而，担忧、反刍、焦虑和抑郁与失眠之间的关系尚不清楚。因此，我们在冠心病患者中进行了横断面和纵向研究，以调查这些关系。
一项横断面研究于 2014 年至 2015 年连续纳入 1082 例患者，其中 686 例在平均 4.7 年后进行了随访。数据来自医院记录和自我报告问卷，包括对担忧（宾夕法尼亚州担忧问卷）、反刍（反刍反应量表）、焦虑和抑郁（医院焦虑和抑郁量表）以及失眠（卑尔根失眠量表）的评估。
失眠与所有其他心理变量中度相关（0.18-0.50，所有 值均<.001）。在校正焦虑和抑郁后，基线时担忧和反刍每增加 10 分，失眠的比值比分别为 1.27（95%置信区间 1.08-1.50）和 1.60（95%置信区间 1.31-1.94）。随访时失眠的相应比值比分别为 1.28（95%置信区间 1.05-1.55）和 1.38（95%置信区间 1.09-1.75）。在校正担忧和反刍后，抑郁与失眠不再显著相关，但焦虑仍然显著。
担忧和反刍不仅在横断面，而且在前瞻性研究中都预测了失眠，即使在控制了焦虑和抑郁之后，尽管焦虑仍然显著。未来的研究可能会测试针对冠心病和失眠患者这些因素的心理干预措施。
Frøjd LA, Papageorgiou C, Munkhaugen J, et al. Worry and rumination predict insomnia in patients with coronary heart disease: a cross-sectional study with long-term follow-up.. 2022;18(3):779-787.
