Netherlands Institute for Neuroscience, Department of Sleep and Cognition, Amsterdam, the Netherlands.
Department of Methodology and Statistics, Utrecht University, the Netherlands.
J Psychiatr Res. 2024 Nov;179:279-285. doi: 10.1016/j.jpsychires.2024.09.032. Epub 2024 Sep 24.
Hyperarousal is a key symptom of anxiety, stress-related disorders, and insomnia. However, it has been conceptualized in many different ways, ranging from various physiological markers (e.g. cortisol levels, high-frequency EEG activity) to personality traits, or state assessments of subjective anxiety and tension. This approach resulted in partly inconsistent evidence, complicating unified interpretations. Crucially, no previous studies addressed the likely variability of hyperarousal within and across days, nor the relationship of such variability in hyperarousal with the night-by-night variability in sleep quality characteristic of insomnia. Here, we present a novel data-driven approach to understanding dynamics of state hyperarousal in insomnia. Using ecological momentary assessment, we tracked fluctuations in a wide range of emotions across 9 days in 169 people with insomnia disorders and 38 controls without sleep problems. Exploratory factor analysis identified a hyperarousal factor, comprised of items describing tension and distress. People with insomnia scored significantly higher on this factor than controls at all timepoints. In both groups, the hyperarousal factor score peaked in the morning and waned throughout the day, pointing to a potential contributing role of sleep or other circadian processes. Importantly, the overnight increase in hyperarousal was stronger in people with in insomnia than in controls. Subsequent adaptive LASSO regression analysis revealed a stronger overnight increase in hyperarousal across nights of worse subjective sleep quality. These findings demonstrate the relationship between subjective sleep quality and overnight modulations of hyperarousal. Disorders in which hyperarousal is a predominant complaint might therefore benefit from interventions focused on improving sleep quality.
过度兴奋是焦虑、与压力相关的障碍和失眠的一个关键症状。然而，它已经以许多不同的方式被概念化，从各种生理标志物（例如皮质醇水平、高频 EEG 活动）到人格特质，或主观焦虑和紧张的状态评估。这种方法导致了部分不一致的证据，使统一解释变得复杂。至关重要的是，以前没有研究解决过度兴奋在日内和日间的变化，也没有解决这种过度兴奋的变化与失眠特征的每晚睡眠质量变化之间的关系。在这里，我们提出了一种新的基于数据的方法来理解失眠症中状态过度兴奋的动态。使用生态瞬时评估，我们在 9 天内跟踪了 169 名失眠症患者和 38 名无睡眠问题的对照组的广泛情绪波动。探索性因素分析确定了一个过度兴奋因素，由描述紧张和痛苦的项目组成。与对照组相比，失眠症患者在所有时间点的得分都显著更高。在两组中，过度兴奋因素得分在早上最高，并在一天中逐渐下降，表明睡眠或其他昼夜节律过程可能起到了一定的作用。重要的是，与对照组相比，失眠症患者的过度兴奋在夜间的增加更为强烈。随后的自适应 LASSO 回归分析显示，在主观睡眠质量较差的夜间，过度兴奋的夜间增加更为明显。这些发现表明了主观睡眠质量与夜间过度兴奋调节之间的关系。因此，以改善睡眠质量为重点的干预措施可能会使以过度兴奋为主要抱怨的障碍受益。
