中医辨证治疗亚健康失眠的临床疗效观察

目的 观察中医辨证治疗阴虚火旺和心脾两虚型亚健康失眠的临床疗效。方法 采用多中心、单盲、随机对照研究方法,将符合纳入标准的亚健康失眠受试者随机分为中医辨证汤药治疗组(A组96例)和中成药乌灵胶囊治疗对照组(B组94例)。1周为1个疗程,共4个疗程,每周复诊1次。比较各组治疗前后及2组间的匹兹堡睡眠质量量表(PSQI)评分、临床医生总体印象(CGI)评分及WHO生活质量测定量表简明版(WHOQOL-BREF)评分以评估其疗效。结果 2组治疗前后PSQI、CGI及WHOQOL-BREF评分均有改善(P＜0.01);2组间治疗各时点及停药2周后的CGI分值有统计学差异(P＜0.01);2组间治疗前后的WHOQOL-BREF评分差值,A组均高于B组,其中生存质量总分和心理领域分值的差异有统计学意义(P<0.05)。结论 基于辨证的中药汤剂干预对阴虚火旺和心脾两虚型的亚健康失眠者的失眠及生活质量均有明显改善,安全性和依从性良好,且在改善患者的总体生存质量及心理状况方面明显优于中成药乌灵胶囊组。     

加味桂枝甘草龙骨牡蛎汤治疗心胆气虚型失眠疗效观察

目的观察加味桂枝甘草龙骨牡蛎汤治疗心胆气虚型失眠的疗效。方法选取2017年10月—2019年4月闵行区中心医院收治的84例辨证符合心胆气虚型的失眠症患者作为研究对象,采用随机数字表法将其随机分为治疗组42例和对照组42例。对照组患者采用艾司唑仑片进行治疗,治疗组患者在此基础上采用加味桂枝甘草龙骨牡蛎汤进行治疗。比较两组患者治疗前后匹兹堡睡眠质量指数(PSQI)、睡眠状态自评量表(SRSS)评分、炎症因子水平以及治疗后的临床疗效。结果治疗后,治疗组心胆气虚型失眠患者PSQI各项评分及SRSS评分降低,且治疗组低于对照组,差异有统计学意义(P<0.05)。治疗组心胆气虚型失眠患者的睡眠改善总有效率88.23%优于对照组64.71%,差异有统计学意义(P<0.05)。治疗后,治疗组和对照组心胆气虚型失眠患者TNF-α和IL-6水平均显著降低,且治疗组低于对照组,差异有统计学意义(P<0.05)。结论加味桂枝甘草龙骨牡蛎汤可降低心胆气虚型失眠患者炎症反应,改善其睡眠质量,疗效确切。     

Interpersonal distress is associated with sleep and arousal in insomnia and good sleepers

Objective

The interpersonal environment is strongly linked to sleep. However, little is known about interpersonal distress and its association with sleep. We examined the associations among interpersonal distress, objective and subjective sleep in people with and without insomnia.

Methods

Participants in this cross-sectional observational study included men and women with insomnia (n = 28) and good sleeper controls (n = 38). Interpersonal distress was measured with the Inventory of Interpersonal Problems. Sleep parameters included insomnia severity, self-reported presleep arousal, and sleep quality; and polysomnographically-assessed sleep latency (SL), total sleep time (TST), wake after sleep onset (WASO), percent delta (stage 3 + 4 NREM), percent REM, and EEG beta power. Hierarchical linear regression was used to assess the relationship between distress from interpersonal problems and sleep and the extent to which relationships differed among insomnia patients and controls.

Results

More interpersonal distress was associated with more self-reported arousal and higher percentage of REM. More interpersonal distress was associated with greater insomnia severity and more cognitive presleep arousal for individuals with insomnia, but not for controls. Contrary to expectations, interpersonal distress was associated with shorter sleep latency in the insomnia group. Results were attenuated, but still significant, after adjusting for depression symptoms.

Conclusion

Distress from interpersonal problems is associated with greater self-reported arousal and higher percent REM. Individuals with insomnia who report more distress from interpersonal problems have greater insomnia severity and cognitive presleep arousal, perhaps due to rumination. These findings extend our knowledge of the association between interpersonal stressors and sleep. Assessment and consideration of interpersonal distress could provide a novel target for insomnia treatment.     

Insomnia symptoms,objectively measured sleep,and disease severity in chronic obstructive pulmonary disease outpatients

BackgroundSleep disturbances are known to have a negative impact on a range of clinical outcomes in chronic obstructive pulmonary disease (COPD). We examined the associations of insomnia symptoms and objectively measured sleep parameters to a composite score for body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index (a multidimensional index of COPD severity), arterial blood gases, nocturnal respiratory disturbances, periodic limb movements (PLM), psychologic distress, pain, age, and sex.MethodsThe sample comprised 73 COPD outpatients (mean age, 63.6 years; standard deviation {SD}, 7.5; range 47–85 years; 41.1% women). Insomnia symptoms were measured with the Bergen Insomnia Scale (BIS) and sleep efficiency (SE), slow-wave sleep (SWS), and total sleep time (TST) were assessed with clinical polysomnography (PSG).ResultsBODE index was positively associated with composite BIS score (P = .040). Patients with more severe COPD presented more complaints of nonrestorative sleep compared to patients with less severe COPD (P = .010). In multivariate analysis, the composite BIS score was independently associated with PLM (P < .001), nocturnal respiratory disturbances (P = .001), pain (P = .031), and psychologic distress (P = .044) but not with the BODE index. Objectively measured sleep variables were not associated with any of the health-related variables.ConclusionInsomnia symptoms in COPD patients result from a wide range of health-related factors. More severe COPD may be associated with a subjective experience of nonrestorative sleep but not with objectively measured sleep variables.     

Prevalence of insomnia symptoms: results from an urban district in Ankara,Turkey

Objective. Characteristics of insomnia symptoms in Turkey are not well established. The goal of this study was to determine the prevalence of insomnia and related symptoms in an urban district of Turkey. Method. The study was carried out in Ankara, in an urban district with a population of 2665. Out of the 1332 people in the sample, 1034 in the 15–65 age range were included in the study. Interviews were conducted according to the “Sleep Disorders Assessment Questionnaire” developed by the researchers. The Insomnia Severity Index (ISI) was also given to the subjects with a sleep problem to measure the subjective quality and quantity of insomnia symptoms. Results and conclusion. A total of 29.4% of all participants reported a sleep problem, out of which 23.7% defined one or more of the insomnia symptoms which included difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), early morning awakening (EMA), non-restorative sleep (NRS) and sleep deprivation (SD). Insomnia risk was found to be significantly increased with age, female sex, smoking and chronic medical illness. A total of 75.9% of participants who reported insomnia symptoms did not seek medical help for their complaint. According to the ISI, among the subjects with insomnia symptoms, 79 (32.2%) had subthreshold insomnia, 43 (17.6%) had clinical insomnia, 12 (4.9%) had severe clinical insomnia, while 88 (35.9%) did not score in the range indicating insomnia. The findings are discussed in the light of previous research and in relation to sociocultural factors emphasizing the need for public education on sleep disorders as medical conditions.     

Prevalence and Clinical Correlates of Insomnia in Depressive Disorders: The CRESCEND Study

Objective

To investigate the prevalence, clinical manifestations, and clinical correlates of insomnia in a large cohort of Korean patients with depressive disorders.

Methods

We recruited 944 patients with depressive disorders from the Clinical Research Center for Depression of South Korea (CRESCEND) study. Psychometric scales were used to assess depression (HAMD), anxiety (HAMA), psychotic symptoms (BPRS), global severity (CGI-S), and functioning (SOFAS). Insomnia levels were determined by adding the scores for all items on the HAMD insomnia subscale. The clinical characteristics of the patients with ''low insomnia'' (summed score ≤3 on the HAMD subscale) and ''high insomnia'' (score ≥4) were compared using statistical analyses. A logistic regression model was constructed to identify factors associated with ''high insomnia'' status.

Results

Symptoms of insomnia were present in 93% of patients, while simultaneous early, middle, and late insomnia affected 64.1%. The high insomnia patients were characterized by significantly greater age, higher symptom levels (including core, gastrointestinal somatic and anxiety symptoms, and suicidal ideation), higher global severity and incidence of physical disorders, and greater insight. Explanatory factors of ''high insomnia'' status were older age, higher gastrointestinal somatic and anxiety symptom levels, higher global severity, and greater insight.

Conclusion

In clinical psychiatry, insomnia has been significantly underdiagnosed and undertreated. It affects most patients with depressive disorders, and is indicative of the global severity of depression. Active efforts to diagnose and treat insomnia in patients with depressive disorders should be strongly encouraged. Further research is needed to improve the diagnosis and treatment of insomnia in depressive patients.     

Insomnia treatment in the third trimester of pregnancy reduces postpartum depression symptoms: A randomized clinical trial

Mental health is an important medical issue in perinatal care, and there is increasing evidence that insomnia during pregnancy is associated with postpartum depression (PPD). Therefore, the present study evaluated the effect of insomnia treatment during the third trimester of pregnancy on PPD symptoms. Fifty-four pregnant women with insomnia were randomly assigned to trazodone, diphenhydramine, or placebo treatment. Sleep quality was measured by actigraphy at baseline, and after 2 and 6 weeks of treatment. In addition, depression was assessed 2 and 6 weeks after delivery. Trazodone and diphenhydramine improved sleep profile compared to placebo after 6 weeks of treatment. Further, depressive symptoms were reduced 2 and 6 weeks after delivery in trazodone and diphenhydramine groups compared to placebo. No differences in depressive symptoms were observed between the trazodone and diphenhydramine groups. These findings indicate that insomnia treatment with trazodone or diphenhydramine during the third trimester of pregnancy may prevent PPD.