边缘型人格障碍失眠的临床预测因素：一项多导睡眠图和主观检查
Clinical predictors of insomnia in borderline personality disorder: a polysomnographic and subjective examination.
作者信息
Mendoza Alvarez Mariana, Verbraecken Johan, Claes Laurence, Vandekerckhove Marie, De Picker Livia
机构信息
Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Universiteitsplein 1, Campus Drie Eiken, Wilrijk, 2610, Belgium.
Scientific Initiative of Neuropsychiatric and Psychopharmacological Studies (SINAPS), University Psychiatric Hospital Campus Duffel (UPCD), Rooienberg 19, Duffel, 2570, Belgium.
出版信息
Borderline Personal Disord Emot Dysregul. 2025 Apr 3;12(1):11. doi: 10.1186/s40479-024-00277-w.
BACKGROUND
Sleep disturbances are common in patients with borderline personality disorder (BPD) and are associated with a poor prognosis and symptom severity. Research findings on sleep abnormalities in individuals with BPD have been inconsistent, with limited evidence linking subjective and objective measures.
METHODS
We compared 44 women with BPD with 41 healthy controls. We examined differences (using ANCOVAs and ordinal logistic regression) and associations (using correlations) between objective sleep assessment (polysomnography) and subjective measures (Consensus Sleep Diary, Insomnia Severity Index, Pittsburgh Sleep Quality Index). We explored predictors of insomnia in BPD patients, including BPD severity, symptomatology, comorbid conditions, and medication use, via standard least squares regressions and ANOVAs.
RESULTS
A total of 22% of patients with BPD had clinically significant insomnia (cut-off ≥ 15), 85% reported mild (subthreshold) insomnia (cut-off > 10) (Insomnia Severity Index; ISI), and 94% reported sleep quality disturbances (PSQI > 5). Compared with those in HC, PSG results in individuals with BPD revealed a longer duration in bed, longer sleep period, REM latency, wake after sleep onset latency, Stage N1 sleep duration, shorter N2 sleep duration, and, with age, more arousals and awakenings. The correlations between objective and subjective sleep measures were weak in both groups. In patients with BPD, a greater degree of insomnia predicted a reduction in total sleep time and increased awakenings and arousals on PSG. Clinical BPD severity, emotional reactivity and dysregulation, depression symptoms, posttraumatic stress symptoms, alexithymia, and presleep arousal were associated with greater insomnia in BPD patients.
CONCLUSIONS
Our study confirmed high rates of insomnia and sleep disturbances in individuals with BPD, which contrasted with relatively minor PSG alterations. Clinical BPD severity and symptomatology are associated with sleep abnormalities in individuals with BPD. Insomnia is a neglected yet important characteristic of the BPD phenotype, warranting more attention in future research and clinical guidelines.
背景
边缘型人格障碍（BPD）患者中睡眠障碍很常见，且与预后不良和症状严重程度相关。关于BPD个体睡眠异常的研究结果并不一致，主观和客观测量之间的关联证据有限。
方法
我们将44名患有BPD的女性与41名健康对照者进行了比较。我们研究了客观睡眠评估（多导睡眠图）与主观测量（共识睡眠日记、失眠严重程度指数、匹兹堡睡眠质量指数）之间的差异（使用协方差分析和有序逻辑回归）和关联（使用相关性分析）。我们通过标准最小二乘法回归和方差分析，探讨了BPD患者失眠的预测因素，包括BPD严重程度、症状学、共病情况和药物使用情况。
结果
共有22%的BPD患者存在临床上显著的失眠（临界值≥15），85%的患者报告有轻度（阈下）失眠（临界值>10）（失眠严重程度指数；ISI），94%的患者报告有睡眠质量障碍（PSQI>5）。与健康对照者相比，BPD个体的多导睡眠图结果显示卧床时间更长、睡眠时间更长、快速眼动潜伏期、睡眠开始后觉醒潜伏期、N1期睡眠时间更长、N2期睡眠时间更短，并且随着年龄增长，觉醒和唤醒次数更多。两组中客观和主观睡眠测量之间的相关性都很弱。在BPD患者中，失眠程度越高，预测总睡眠时间减少，多导睡眠图上的觉醒和唤醒次数增加。临床BPD严重程度、情绪反应性和失调、抑郁症状、创伤后应激症状、述情障碍和睡前觉醒与BPD患者更严重的失眠相关。
结论
我们的研究证实BPD个体中失眠和睡眠障碍的发生率很高，这与相对较小的多导睡眠图改变形成对比。临床BPD严重程度和症状学与BPD个体的睡眠异常相关。失眠是BPD表型中一个被忽视但重要的特征，在未来的研究和临床指南中值得更多关注。
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