Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA.
Cerner Enviza, an Oracle Company, Kansas City, Missouri, USA.
Brain Behav. 2023 Aug;13(8):e3143. doi: 10.1002/brb3.3143. Epub 2023 Jul 12.
Insomnia is prevalent in adults with major depressive disorder (MDD) and is a key diagnostic criterion of MDD; however, little is understood about the burden of insomnia symptom severity in MDD. We evaluated the relationship between insomnia symptom severity and the clinical, economic, and patient-centric burden among community-dwelling individuals with MDD.
Respondents with diagnosed depression who reported insomnia symptoms in the past 12 months (N = 4402) were identified from the 2019 United States National Health and Wellness Survey. Multivariable analyses assessed the association of Insomnia Severity Index (ISI) with health-related outcomes while controlling for sociodemographic and health characteristics. Further analyses also controlled for depression severity (9-item Patient Health Questionnaire).
Mean ISI score was 14.3 ± 5.6. Higher ISI was associated with greater depression severity (r = .51, p < .001). After adjustments, a one-standard deviation (5.6-point) increase in ISI score was significantly associated with higher depression (rate ratio [RR] = 1.36), anxiety (RR = 1.33) and daytime sleepiness (RR = 1.16) levels, more healthcare provider (RR = 1.13) and emergency room visits (RR = 1.31), hospitalizations (RR = 1.21), work productivity and activity impairment (RRs = 1.27 and 1.23, respectively), and poorer mental and physical health-related quality of life (β = -3.853 and -1.999, respectively) (p < .001). These findings remained statistically significant when controlling for concurrent depression severity.
In adults with MDD, greater insomnia symptom severity is associated with worse health-related outcomes, which suggests the importance of addressing insomnia symptoms as a clinical target for treating MDD.
失眠在患有重度抑郁症（MDD）的成年人中很常见，也是 MDD 的一个关键诊断标准；然而，对于 MDD 中失眠症状严重程度的负担知之甚少。我们评估了失眠症状严重程度与社区居住的 MDD 患者的临床、经济和以患者为中心的负担之间的关系。
从 2019 年美国国家健康和健康调查中确定了过去 12 个月报告有失眠症状的诊断为抑郁症的受访者（N=4402）。多变量分析评估了在控制社会人口统计学和健康特征的情况下，失眠严重程度指数（ISI）与健康相关结果之间的关联。进一步的分析还控制了抑郁严重程度（9 项患者健康问卷）。
平均 ISI 评分为 14.3±5.6。较高的 ISI 与更严重的抑郁程度相关（r=0.51，p<0.001）。调整后，ISI 评分增加一个标准差（5.6 分）与抑郁（比率比[RR]为 1.36）、焦虑（RR 为 1.33）和白天嗜睡（RR 为 1.16）水平升高显著相关，更多的医疗保健提供者（RR 为 1.13）和急诊室就诊（RR 为 1.31）、住院（RR 为 1.21）、工作生产力和活动障碍（RR 分别为 1.27 和 1.23），以及较差的精神和身体健康相关生活质量（β分别为-3.853 和-1.999）（p<0.001）。当控制并发抑郁严重程度时，这些发现仍然具有统计学意义。
在患有 MDD 的成年人中，失眠症状严重程度越大与健康相关结果越差相关，这表明重视失眠症状作为治疗 MDD 的临床目标的重要性。
