Katz D A, McHorney C A
Department of Medicine, University of Wisconsin, Madison, USA.
Arch Intern Med. 1998 May 25;158(10):1099-107. doi: 10.1001/archinte.158.10.1099.
Patients with chronic insomnia are more likely to develop affective disorders, cardiac morbidity, and other adverse health outcomes, yet many clinicians tend to trivialize the complaint of insomnia or to attribute it only to psychiatric causes.
To estimate the prevalence and longitudinal course of insomnia in patients with documented chronic medical illness and/or depression and to quantify the associations between specific chronic conditions and insomnia.
The presence of mild or severe insomnia was based on responses to a sleep questionnaire completed by 3445 patients with at least 1 of 5 physician-identified chronic conditions (hypertension, diabetes, congestive heart failure, myocardial infarction, or depression) at baseline; a subsample of 1814 patients completed follow-up questionnaires at 2 years. Using multivariate techniques, we evaluated the relationship between chronic conditions, patient-reported comorbidities, and insomnia (complaints of initiating and maintaining sleep), adjusting for sociodemographics and health habits.
Sixteen percent of study patients had severe and 34% had mild insomnia at baseline. At 2-year follow-up, 59% (95% confidence interval, 55%-63%) of patients with mild insomnia and 83% (95% confidence interval, 78%-88%) of patients with severe insomnia at baseline still had sleep problems. Odds ratios corresponding to mild and severe insomnia for key risk factors were as follows: current depressive disorder, 2.6 and 8.2; subthreshold depression, 2.2 and 3.4; congestive heart failure, 1.6 and 2.5; obstructive airway disease, 1.6 and 1.5; back problems, 1.4 and 1.5; hip impairment, 2.2 and 2.7; and prostate problems, 1.6 and 1.4. The majority of insomnia-comorbidity associations observed at baseline persisted at 2-year follow-up.
Patients with insomnia require follow-up, as the majority continue to be bothered by difficulty initiating and maintaining sleep. In addition to detecting affective disorders in patients with insomnia, clinicians should focus on medical conditions that disturb sleep, especially cardiopulmonary disease, painful musculoskeletal conditions, and prostate problems.
慢性失眠患者更易患情感障碍、心脏疾病及其他不良健康后果，但许多临床医生往往轻视失眠主诉或仅将其归因于精神原因。
评估患有确诊慢性疾病和/或抑郁症患者的失眠患病率及病程，并量化特定慢性病与失眠之间的关联。
根据3445例在基线时患有5种医生确诊慢性病（高血压、糖尿病、充血性心力衰竭、心肌梗死或抑郁症）中至少1种疾病的患者完成的睡眠问卷回答情况，判断是否存在轻度或重度失眠；1814例患者的子样本在2年时完成了随访问卷。我们使用多变量技术，评估慢性病、患者报告的合并症与失眠（入睡和维持睡眠困难的主诉）之间的关系，并对社会人口统计学和健康习惯进行了校正。
16%的研究患者在基线时有重度失眠，34%有轻度失眠。在2年随访时，基线时患有轻度失眠的患者中有59%（95%置信区间，55%-63%）、患有重度失眠的患者中有83%（95%置信区间，78%-88%）仍有睡眠问题。关键危险因素对应轻度和重度失眠的比值比分别如下：当前抑郁症，2.6和8.2；阈下抑郁，2.2和3.4；充血性心力衰竭，1.6和2.5；阻塞性气道疾病，1.6和1.5；背部问题，1.4和1.5；髋部损伤，2.2和2.7；前列腺问题，1.6和1.4。在基线时观察到的大多数失眠与合并症的关联在2年随访时仍然存在。
失眠患者需要随访，因为大多数患者仍受入睡和维持睡眠困难困扰。除了在失眠患者中检测情感障碍外，临床医生还应关注干扰睡眠的躯体疾病，尤其是心肺疾病、疼痛性肌肉骨骼疾病和前列腺问题。
