Haldemann R, Good M, Holsboer-Trachsler E
Rhône-Poulenc Rorer AG/SA, Thalwil.
Praxis (Bern 1994). 1996 Dec 17;85(51-52):1656-62.
The aim of the study was to assess the prevalence, severity, associated factors and diagnosis of sleep disorders in general practice. Over 700 patients were investigated with a multiple choice questionnaire in 24 general practices in Switzerland. To assess sleep disorders, criterion A for insomnia according DSM-III-R was applied. The prevalence of sleep disorders was 44%, 64% of these were classified as mild, 31% as moderate and 5% as severe. 50% of the female patients complained about insomnia compared to 36% in males. Retrospectively, 74% of the patients stated having suffered from sleep disorders for more than one year (mild 76%, moderate 69%, severe 75%). 70% of patients with mild, 42% with moderate and 30% of patients with severe insomnia didn't inform their physicians about their sleep difficulties on the occasion of an earlier consultations. Patients with moderate or severe insomnia felt moderately or markedly disabled in their quality of life (71%) and work (58%). To estimate general anxiety and depressive state, self-rating scales were used (STAI, D-S). In comparison to reference values for healthy volunteers, insomniac patients had significantly higher scores on both scales, which were associated with the severity of sleep disorders, corroborating the association of sleep disorders with anxiety disorders and depressions. The physicians diagnosed in 18% of insomniacs a psychiatric disease, in 52% a psychoreactive disorder and in 26% a somatic etiology. The study shows that sleep disorders are a frequent syndrome in general practice and often not reported to the physician; therefore, the patients should routinely be questioned about sleep problems, and associated psychiatric diseases should be considered.
本研究的目的是评估全科医疗中睡眠障碍的患病率、严重程度、相关因素及诊断情况。在瑞士的24家全科诊所,对700多名患者进行了多项选择题问卷调查。为评估睡眠障碍,采用了《精神疾病诊断与统计手册》第三版修订本(DSM-III-R)中失眠的A标准。睡眠障碍的患病率为44%,其中64%被归类为轻度,31%为中度,5%为重度。50%的女性患者抱怨失眠,而男性患者中这一比例为36%。回顾性来看,74%的患者表示患有睡眠障碍超过一年(轻度76%,中度69%,重度75%)。70%的轻度失眠患者、42%的中度失眠患者和30%的重度失眠患者在之前就诊时未告知医生他们的睡眠问题。中度或重度失眠患者在生活质量(71%)和工作(58%)方面感到中度或明显受限。为评估一般焦虑和抑郁状态,使用了自评量表(状态-特质焦虑量表、抑郁自评量表)。与健康志愿者的参考值相比,失眠患者在这两个量表上的得分显著更高,这与睡眠障碍的严重程度相关,证实了睡眠障碍与焦虑症和抑郁症之间的关联。医生诊断出18%的失眠患者患有精神疾病,52%患有心理反应性障碍,26%患有躯体病因。该研究表明,睡眠障碍在全科医疗中是一种常见综合征,且常常未告知医生;因此,应常规询问患者睡眠问题,并考虑相关的精神疾病。