Xue Yan, Wang Wei-Dong, Liu Yan-Jiao, Wang Jian, Walters Arthur S
Psychological and Sleep Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, 100053, Beijing, PR China.
Department of Neurology, Vanderbilt University School of Medicine, TN, 37232-2551, USA.
Sleep Med. 2025 Apr 29;132:106545. doi: 10.1016/j.sleep.2025.106545.
Generalized anxiety disorder (GAD) is a chronic and disabling mental health condition characterized by excessive, uncontrollable worry and persistent psychological and somatic tension. Affecting approximately 3-6 % of the global population, GAD significantly impairs daily functioning and often coexists with other psychiatric conditions. Among its many symptoms, sleep disturbances-particularly insomnia-are among the most frequently reported and debilitating. Individuals with GAD commonly experience difficulties with sleep initiation, maintenance, and restorative rest, making insomnia one of the most pervasive features of the disorder. Emerging research highlights a bidirectional relationship between GAD and insomnia: while anxiety contributes to cognitive and physiological arousal that interferes with sleep, insomnia in turn exacerbates emotional dysregulation, amplifies worry, and may even precede the development of anxiety disorders. Neurobiological and neuroimaging studies support this reciprocal link, showing shared dysfunctions such as heightened hypothalamic-pituitary-adrenal (HPA) axis activity, increased amygdala reactivity, reduced prefrontal cortical control, and GABAergic deficits. These overlapping mechanisms underscore a common pathophysiological substrate that reinforces both conditions. Recognizing and addressing this interplay is critical, as untreated insomnia may perpetuate or intensify GAD symptoms. Notably, cognitive behavioral therapy for insomnia (CBT-I) has been effective in improving sleep and reducing anxiety severity-even without directly targeting anxiety-supporting a shift toward integrating sleep-focused interventions in the treatment of GAD. This review aimed to elucidate clinical and neurobiological evidence on the bidirectional link between insomnia and GAD, emphasizing shared mechanisms and treatment implications.
广泛性焦虑障碍（GAD）是一种慢性致残性心理健康状况，其特征为过度且无法控制的担忧以及持续的心理和躯体紧张。GAD影响着全球约3%-6%的人口，严重损害日常功能，且常与其他精神疾病共存。在其众多症状中，睡眠障碍——尤其是失眠——是最常被报告且最具致残性的症状之一。患有GAD的个体通常在入睡、维持睡眠和获得恢复性休息方面存在困难，这使得失眠成为该障碍最普遍的特征之一。新出现的研究突出了GAD与失眠之间的双向关系：焦虑会导致干扰睡眠的认知和生理唤醒，而失眠反过来又会加剧情绪失调、放大担忧，甚至可能先于焦虑症的发生。神经生物学和神经影像学研究支持这种相互联系，显示出共同的功能障碍，如下丘脑-垂体-肾上腺（HPA）轴活动增强、杏仁核反应性增加、前额叶皮质控制减弱以及γ-氨基丁酸（GABA）能缺陷。这些重叠的机制强调了一种共同的病理生理基础，强化了这两种状况。认识并解决这种相互作用至关重要，因为未经治疗的失眠可能会使GAD症状持续或加重。值得注意的是，失眠的认知行为疗法（CBT-I）在改善睡眠和减轻焦虑严重程度方面已显示出效果——即使没有直接针对焦虑——这支持了在GAD治疗中转向整合以睡眠为重点的干预措施。本综述旨在阐明关于失眠与GAD之间双向联系的临床和神经生物学证据，强调共同机制和治疗意义。
