Sleep Research & Treatment center, Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA, USA.
Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
Sleep Health. 2022 Aug;8(4):391-397. doi: 10.1016/j.sleh.2022.05.004. Epub 2022 Jun 19.
To assess the association of insomnia phenotypes, being insomnia with short sleep duration (ISSD) and insomnia with normal sleep duration (INSD), with suicidality in a randomly selected population-based sample.
Data were analyzed from the Penn State Adult Cohort. Participants (N = 1741, 52.5 years, 57.4% female) were randomly recruited from the general population between January 1990 through March 1999 and mortality data were available through December 2018. Insomnia symptoms were defined as self-reports of moderate-to-severe difficulties initiating or maintaining sleep, early morning awakening and non-restorative sleep, or having chronic insomnia (n = 719). Short sleep duration was defined as <6 hours of in-lab polysomnography-measured sleep duration (n = 879). Suicidality (SAI; n = 102) was ascertained by a lifetime history of suicidal ideation (SI; n = 84), suicide attempts (SA; n = 48) or death by suicide (DBS; n = 10).
Compared to normal sleepers who slept ≥6 hours, participants with ISSD and INSD were associated with 1.72-fold and 2.22-fold increased odds of SAI, respectively; these associations were significant for SI, with 2.09-fold and 2.24-fold increased odds, respectively, but not for SA, after adjusting for physical and mental health comorbidities. ISSD and INSD differed in SAI age of onset and hospitalizations after SA.
The results of this cohort study suggest that both INSD and ISSD phenotypes are associated with increased suicidal ideation, while the INSD phenotype has an earlier age of onset and is more likely to experience hospitalizations after attempting suicide. These results highlight the importance of targeting insomnia symptoms to help prevent suicide.
评估失眠表型（即失眠伴短睡眠时间[ISSD]和失眠伴正常睡眠时间[INSD]）与随机抽取的基于人群样本中自杀行为的相关性。
数据来自宾夕法尼亚州立成人队列。参与者（N=1741 人，52.5 岁，57.4%为女性）于 1990 年 1 月至 1999 年 3 月期间从一般人群中随机招募，并于 2018 年 12 月前获得了死亡率数据。失眠症状定义为自报告的中度至重度入睡困难或难以维持睡眠、早醒和睡眠质量差，或患有慢性失眠症（n=719）。短睡眠时间定义为实验室多导睡眠图测量的睡眠时间<6 小时（n=879）。自杀意念（SI；n=84）、自杀企图（SA；n=48）或自杀死亡（DBS；n=10）的终生史确定了自杀意念（SAI；n=102）。
与睡眠≥6 小时的正常睡眠者相比，ISSD 和 INSD 患者的 SAI 风险分别增加了 1.72 倍和 2.22 倍；调整了身体和心理健康合并症后，这些关联在 SI 中具有显著意义，风险分别增加了 2.09 倍和 2.24 倍，但在 SA 中没有增加。ISSD 和 INSD 在自杀意念发病年龄和自杀未遂后的住院治疗方面存在差异。
这项队列研究的结果表明，INSD 和 ISSD 表型均与自杀意念增加相关，而 INSD 表型的发病年龄更早，自杀未遂后更有可能住院治疗。这些结果强调了针对失眠症状进行治疗以预防自杀的重要性。
