右佐匹克隆对抑郁症伴失眠患者日间功能的影响

目的:探讨右佐匹克隆对抑郁症伴失眠患者日间功能的影响. 方法:将抑郁症伴失眠患者127例随机分为右佐匹克隆组66例和阿普唑仑组61例,分别给予右佐匹克隆和阿普唑仑观察2周.2周后采用日间功能障碍量表评定疗效及治疗中出现的症状量表(TESS)评定不良反应. 结果:治疗2周,日间功能障碍评定量表中除困倦项两组差异无统计学意义外(t=0.84,P＞0.05),其他项如白天乏力、打盹、精神差、反应迟钝、共济失调、判断力下降、意识模糊、精神紊乱上差异均有统计学意义(t分别=2.89,3.43,6.61,10.03,3.09,9.57,11.14,4.49;P均＜0.01).两组不良反应仅在嗜睡和头昏上差异有统计学意义(x2 =6.67,3.89;P ＜0.01或P＜0.05). 结论:右佐匹克隆对抑郁症伴失眠患者日间功能的影响以及不良反应显著低于阿普唑仑.     

Subclinical anxiety symptoms, sleep, and daytime dysfunction in older adults with primary insomnia

Both insomnia complaints and anxiety disorders are common in older adults, and are associated with poor daytime functioning. The present study investigated whether subclinical levels of anxiety were associated with sleep disturbance and daytime functioning in older adults who met diagnostic criteria for primary insomnia, and therefore did not meet criteria for depression or an anxiety disorder. After adjustment for depressive symptoms, elevated state anxiety was associated with higher levels of wake after sleep onset (measured by both actigraphy and sleep log) and shorter sleep onset latency (measured by sleep log). Higher levels of trait anxiety were associated with greater wake after sleep onset (measured by sleep log). Elevated state and trait anxiety were associated with worse social functioning, and higher levels of trait anxiety were associated with worse role functioning. Thus, subclinical anxiety symptoms may be an important target for clinical intervention to improve sleep and functioning in older adults with primary insomnia.     

Associations between sleep,daytime sleepiness and functional outcomes in adolescents with ADHD

Objective/backgroundAdolescents with attention-deficit/hyperactivity disorder (ADHD) experience greater difficulties in the domains of sleep, daytime sleepiness, and functioning compared to their peers. However, the relationship between these domains has not been fully elucidated. This study aimed to examine the relationship between sleep problems (including daytime sleepiness), ADHD severity, and functional outcomes (irritability, sluggish cognitive tempo, homework difficulties, and substance use) in a sample of adolescents with ADHD.Patients/methodsEighty-two adolescents (13–17 years) and their families participated in the study. Sleep was measured by both adolescent and parent-report. Adolescent irritability and sluggish cognitive tempo were reported by both adolescents and parents, while other variables were reported by a single reporter (homework difficulties – parent; ADHD severity – parent; substance use – adolescent). Analyses controlled for demographic factors and internalising and externalising comorbidities.ResultsA weak relationship was found between adolescent-reported sleep problems and daytime sleepiness, which became non-significant in adjusted analyses (β = −0.19, p = 0.115). In adjusted analyses, there was an association between adolescent-reported sleep problems and adolescent-reported irritability (β = −0.27, p = 0.023) as well as between adolescent-reported daytime sleepiness and parent-reported sluggish cognitive tempo (β = 0.28, p = 0.033). In adjusted analyses, parent-reported adolescent sleep problems were associated with ADHD severity (β = 0.54, p = <0.001), parent-reported sluggish cognitive tempo (β = 0.64, p = <0.001), both reporters of irritability (parent-report: β = 0.32, p = 0.004; adolescent-report: β = 0.29, p = 0.022), and homework problems (β = 0.37, p = 0.003). Parent-reported daytime sleepiness was associated with parent-reported sluggish cognitive tempo (β = 0.34, p = 0.024).ConclusionsThis study demonstrates the importance of a holistic assessment of adolescents with ADHD, not only focusing on symptomatology but also on sleep problems and functional outcomes. The importance of multi-informant assessment of sleep problems is also reinforced.     

Subclinical anxiety symptoms, sleep, and daytime dysfunction in older adults with primary insomnia

"Both Insomnia complaints and anxiety-related distress are common in older adults, and are associated with poor daytime functioning. We investigated whether subclinical levels of anxiety were associated with sleep disturbance and daytime functioning in older adults who met diagnostic criteria for primary insomnia, and therefore but did not meet criteria for depression or an anxiety disorder. After adjustment for depressive symptoms, elevated state anxiety was associated with higher levels of wake after sleep onset (measured by both actigraphy and sleep log) and shorter sleep sleep onset latency (measured by sleep log). Higher levels of trait anxiety were associated with greater wake after sleep onset (measured by sleep log). Elevated state and trait anxiety were associated with worse and social functioning, and higher levels of trait anxiety were associated with worse role functioning. Thus, subclinical anxiety symptoms may be an important target for clinical intervention to improve sleep and functioning in older adults with primary insomnia."     

Treatment of elderly primary insomnia patients with EVT 201 improves sleep initiation,sleep maintenance,and daytime sleepiness

ObjectiveTwo doses of EVT 201, a partial positive allosteric modulator of the GABA_A system, were evaluated in elderly primary insomnia patients with daytime sleepiness.Patients and methodsParticipants were 149 elderly patients with DSM-IV primary insomnia including evidence of daytime sleepiness (53 males, 96 females; mean age 71.3 yrs, range 65–86 yrs). A randomized, multicentre, double-blind, placebo-controlled, parallel-group design was used to assess the hypnotic efficacy of EVT 201 1.5 and 2.5 mg during seven consecutive nights. Polysomnography (PSG) was performed on nights 1, 6 and 7 of treatment. Daytime assessments on Day 8 included the multiple sleep latency test (MSLT), Rey Auditory Verbal Learning Test (RAVLT), Psychomotor Vigilance Task (PVT) and the Karolinska Sleepiness Scale (KSS). The primary endpoint was total sleep time (TST) and the key secondary endpoint was mean MSLT latency.ResultsCompared to placebo, EVT 201 1.5 and 2.5 mg increased TST (30.9, 56.4 min, respectively; p = 0.0001, p < 0.0001); reduced wake after sleep onset (WASO; ?15.2, ?36.1 min, respectively; p = 0.014, p < 0.0001); reduced latency to persistent sleep (LPS; ?15.9, ?19.9 min, respectively; p = 0.009, p = 0.001). The 2.5 mg dose also reduced WASO in hours 5–8 (?16.3 min, p = 0.001). Both doses also improved subjective sleep quality and usual subjective efficacy measures. A significantly longer mean MSLT latency was observed on Day 8 with both doses, compared to placebo (2 min increase; p = 0.03, both doses). The PVT, RAVLT, and POMS did not differ among treatment groups. No serious or unexpected treatment emergent adverse events were noted.ConclusionEVT 201 improved PSG measures of sleep onset and sleep maintenance and significantly reduced daytime physiological sleep tendency. These findings suggest that treatment of primary insomnia in older patients has the potential to improve daytime sleepiness as well as sleep.     

伴失眠的缓解期抑郁症患者客观睡眠质量与认知功能的关系

目的 探讨伴失眠的缓解期抑郁症患者客观睡眠质量与认知功能的关系。方法 在北京回龙观医院筛选缓解期抑郁症患者47例,采用失眠严重程度指数量表（ISI）和匹兹堡睡眠质量指数量表（PSQI）前四项计算的睡眠效率对患者进行分组,最终伴失眠组22例,不伴失眠组25例。通过多导睡眠监测（PSG）评定患者客观睡眠情况,采用重复性成套神经心理状态测验（RBANS）评定患者认知功能。建立回归模型探究伴失眠的缓解期抑郁症患者客观睡眠质量与认知功能的关系。结果伴失眠与不伴失眠的缓解期抑郁症患者RBANS即刻记忆因子评分差异有统计学意义（t=-2.102,P<0.05）。伴失眠组的睡眠效率（Z=-2.113,P<0.05）、N3期占比（Z=-3.175,P<0.01）和N3期持续时间（Z=-3.196,P<0.01）均小于不伴失眠组,夜间总清醒时间（Z=-2.058,P<0.05）、N1期占比（Z=-2.399,P<0.05）和N1期持续时间（Z=-2.463,P<0.05）均多于不伴失眠组。伴失眠组REM期占比增加与注意功能的改善相关（β=0.953,95%CI:0...     

Associations of adverse childhood experiences with adolescent total sleep time,social jetlag,and insomnia symptoms

Study objectiveAdverse childhood experiences (ACEs) are associated with sleep problems in adulthood, but less research has focused on ACEs and sleep during adolescence. The goal of the present study was to explore associations between ACEs reported at ages 5 and 9 years, and sleep (ie, total sleep time (TST), social jetlag, and insomnia symptoms) at age 15.MethodsParticipants comprised 817 families from the Fragile Families and Child Wellbeing Study, a nationally representative sample of children born to unwed parents. Number of ACEs was constructed from primary-caregiver reports at ages 5 and 9, and sleep measures (ie, TST, social jetlag, and insomnia symptoms) were derived from adolescent-reported sleep behaviors at age 15.ResultsAdjusting for sex and race/ethnicity, ACEs at age 9 were associated with longer weekend TST (B = 0.16, 95% CI = 0.04, 0.28), more social jetlag (B = 0.17, 95% CI = 0.07, 0.27), and higher odds of trouble falling asleep ≥3 times per week (Odds Ratio = 1.24, 95% CI = 1.01, 1.53). In females only, ACEs were associated with greater school night TST (B = 0.12, 95% CI = 0.01, 0.23). Results were similar after further adjustment for symptoms of anxiety and depression. Associations among ACEs, social jetlag, and insomnia symptoms appeared strongest among Non-Hispanic Black adolescents.ConclusionACEs appear to be related to multiple aspects of sleep in adolescence. Additional research is needed to confirm these associations and examine the extent to which sleep disturbances associated with ACEs account for later health outcomes.     

Nighttime sleep and daytime functioning correlates of the insomnia complaint in young adults

The nighttime and daytime correlates of the insomnia complaint (IC) were assessed in an in-class survey on a sample of 1238 first year university students (18.85 ± 1.45 years) at the Universidad Autónoma of Madrid, Spain. Evidence was found that the likelihood of complaining of insomnia was increased by perceiving difficulties with initiating and maintaining sleep, reporting low quality of nocturnal sleep, having a long sleep onset latency and having an evening circadian preference. The most strongly related daytime variables to IC being perceived difficulties in concentrating, feelings of irritability and fatigue, and symptoms of anxiety and depression. The data, in addition to confirm those of clinical studies on subjects complaining of insomnia, suggest that having an evening chronotype increases the vulnerability of adolescents and young adults to complain of insomnia.     

Patients with insomnia and subthreshold depression show marked worsening of insomnia after discontinuation of sleep promoting medication

Objective

To investigate whether the outcome of treatment with trazodone CR in primary insomnia differs between patients with and without subthreshold depression.

Methods

14 patients (9 females, mean age 57.3 ± 13.3) with primary insomnia and increased Beck Depression Inventory (BDI) scores (> 10) and 15 sex- and age-matched patients with primary insomnia and low BDI scores (≤ 10) were treated with trazodone CR 25-150 mg/d for 3 months and followed for 1 month after discontinuation of the medication. The Athens Insomnia Scale (AIS), Sheehan Disability Scale (SDS), and Clinical Global Impression scale (CGI) were completed at baseline, after each month of treatment and after the first week of run-out phase. Additional assessment tools comprised sleep diaries, the Leeds Sleep Evaluation Questionnaire (LSEQ) and actigraphic recordings.

Results

Subjective sleep time increased by 61.5 ± 72.3 min in the group with low BDI and 60.0 ± 59.4 min in the group with increased BDI at the end of the treatment phase. The significant improvements were also observed in the AIS, CGI, LSEQ and SDS. During the run-out phase the improvement was sustained in patients with low BDI, while AIS scores, sleep latency and total sleep time deteriorated in patients with increased BDI.

Conclusions

Patients with subthreshold depression, even if the depressive symptoms do not fulfill the time criteria for depressive episode, show marked worsening of insomnia after discontinuation of sleep promoting medication.     

Longitudinal effects of nocturnal insomnia symptom subtypes and nonrestorative sleep on the incidence of depression among community-dwelling older adults: results from the Health and Retirement Study

ObjectiveThe relationships between different insomnia symptom subtypes and the onset of depression among older adults are inconsistent. It may be that each subtype has a distinct temporal effect on depression not easily captured by the different follow-up intervals used in past studies. We systemically investigated the temporal effects by examining the links between subtypes and the onset of depression at different follow-up intervals among community-dwelling older adults.MethodsWe used the 2006 wave of the Health and Retirement Study as baseline (n = 9151). The outcome was the onset of depression at 2-year (2008 wave), 4-year (2010 wave), and 6-year (2012 wave) follow-ups. The independent variables were difficulty with falling asleep (initial insomnia), waking up during the night (middle insomnia), waking up too early and being unable to fall asleep again (late insomnia), and nonrestorative sleep at baseline. Factors known to be related to depression among older adults were included as covariates.ResultsOur findings showed that each insomnia symptom subtype had distinct temporal effects on the onset of depression. It appeared that the effects of initial insomnia may take longer to emerge than indicated in previous studies. Middle insomnia and late insomnia had weak relationships with depression. Nonrestorative sleep predicted the onset of depression at every follow-up period.ConclusionsWe found that documenting the temporal effects of insomnia symptom subtypes helps both to classify individuals’ insomnia symptoms and predict the onset of depression. We recommend taking temporal effects of insomnia symptom subtypes into account in future investigations and clinical practice.     

Good sleep, bad sleep: a meta-analysis of polysomnographic measures in insomnia, depression, and narcolepsy.

Primary insomnia, major depression, and narcolepsy are usually considered to be separate disorders, distinguished by different polysomnographic profiles. But do polysomnographic data provide adequate evidence to segregate the three disorders, or might they display fundamentally the same sleep disturbance, differing only in degree? To test the viability of these two alternate hypotheses, the authors performed a meta-analysis of controlled polysomnographic studies of these disorders. A summary measure of degree of sleep disturbance was constructed from five variables: wakefulness after sleep onset, percentage of stage 1 sleep, percentage of stage 3 + 4 sleep, rapid eye movement (REM) latency, and REM density. The results of available studies for each variable were combined using a weighted average of effect sizes. An overall "sleep disturbance index" was then calculated by combining the estimates for the five above listed variables. On both the individual measures and especially on the summary index, insomnia, depression, and narcolepsy were arrayed on a simple continuum of progressively more severe sleep disturbance--congruent with the clinical observation that these disorders display progressively more disturbed sleep. These findings suggest that sleep can be disturbed in only a limited number of ways: in evaluating sleep architecture, it may not be possible to elaborate much beyond a single axis of good-to-bad sleep. Thus, polysomnographic measures may not provide adequate evidence to classify insomnia, depression, and narcolepsy as separate entities.     

抑郁症与失眠症患者睡眠个人信念和态度的调查

目的:比较抑郁症与失眠症患者的睡眠个人信念和态度。方法:采用睡眠个人信念与态度量表简化版(DBAS-16)和匹兹堡睡眠质量指数(PSQI)对56例抑郁症患者和49例失眠症患者、42名正常对照者进行测评。结果:正常组PQSI总分及因子分均低于抑郁组和失眠组,差异均有统计学意义(P0.05);抑郁组PQSI日间功能因子分(2.59±0.78)高于失眠组(2.08±1.02),差异均有统计学意义(P0.05),PQSI总分及其他因子分差异均无统计学意义(P0.05);正常组的DBAS总分及因子分均高于抑郁组,且正常组DBAS总分及成分因子"对失眠后果的估计"、"对睡眠的担忧"和"对药物的认知"3个因子分高于失眠组,差异均有统计学意义(P均0.01);抑郁组与失眠组,DBAS总分及各因子分差异均无统计学意义(P0.05);抑郁组和失眠组的DBAS总分及因子分与PQSI总分及因子分分别存在不同的相关性。结论:与正常组相比,失眠组与抑郁组均存在不良的睡眠信念与态度成分,但未发现抑郁症与失眠症患者的不合理睡眠认知之间有差异。     

Associations of objective versus subjective social isolation with sleep disturbance,depression, and fatigue in community-dwelling older adults

Objective: Older adults are at higher risk of experiencing social isolation, which has been linked to impaired physical and mental health. The link between social isolation and health might be due to objective deprivation of social network and/or subjective experience of loneliness. This community-based cross-sectional study examined whether the associations between social isolation and behavioral symptoms including sleep disturbance, depression, and fatigue are mostly explained by its subjective component.

Methods: Randomly selected 2541 community-dwelling individuals in Los Angeles aged ≥60 years were telephone-interviewed regarding their objective and subjective social isolation (respectively social network size and loneliness), sleep disturbance, depression, and fatigue.

Results: When objective and subjective social isolation were separately included in multivariate regression models, both were significantly associated with behavioral symptoms. However, once they were simultaneously included in the same multivariate models, while subjective social isolation remained strongly associated (adjusted beta 0.24 for sleep disturbance [P?<?0.001], 0.44 for depression [P?<?0.001], 0.17 for fatigue [P?<?0.001]), objective social isolation was weakly or non-significantly associated (-0.04 for sleep disturbance [P?=?0.03], -0.01 for depression [P?=?0.48], -0.003 for fatigue [P?=?0.89]). Additionally, those with objective social isolation were found to have worse symptoms mostly when they also experienced subjective social isolation.

Conclusions: Older adults with objective social isolation may experience sleep disturbance, depression, and fatigue because they feel socially isolated, not just because they are deprived of social networks. Interventions that target social isolation might serve as potential treatments for improving behavioral health of older adults, especially by targeting its subjective component.     

Association between report of insomnia and daytime functioning

ObjectivesThe relationship between reports of insomnia and daytime functioning was investigated using hierarchical regression. The presence or absence of a report of insomnia was the predictor of primary interest. A number of covariates were included in the model: demographic variables, health variables, and quantitative sleep parameters.MethodsData were collected from a community sample in the Memphis, Tennessee area. Data from 734 volunteers, ranging in age from 20 to 96 years were analyzed. The sample included 235 individuals who reported having chronic insomnia and 499 individuals who reported no sleep problems. Participants completed a 2-week sleep diary, a battery of daytime functioning questionnaires, and a medical disorders checklist. Demographic information was also collected. The daytime functioning assessment included the Beck Depression Inventory, the State-Trait Anxiety Inventory, the Epworth Sleepiness Scale, the Insomnia Impact Scale, and the Fatigue Severity Scale. The hierarchical regression model included four sets. The first three sets consisted of 18 variables capturing demographic, health, and sleep diary parameters. The fourth set included a single dichotomous variable representing the presence or absence of a report of insomnia.ResultsReports of insomnia were a significant predictor of all five daytime functioning measures, which is consistent with previous research. We also showed that reports of insomnia were able to uniquely explain a significant amount of variability in self-reported daytime functioning after controlling for demographics, health, and sleep diary variables. The pattern of individual variables that reached significance in the first three sets varied depending on which daytime functioning measure was predicted, however, age, the presence of pain, the presence of mental health problems, SOL, and WASO were the most commonly significant predictors of poor daytime functioning from these sets across measures.ConclusionsIndividuals’ perceptions of their sleep are related to differences in their reported daytime functioning, which are not accounted for by demographic factors, health surveys, or quantitative sleep assessments. Reports of insomnia may be related to a set of common cognitive factors among individuals who report having insomnia which cause them to be distressed with their sleep and increase their dissatisfaction with daytime functioning. Relevance of the findings to insomnia research and clinical management are discussed.     

失眠的认知行为治疗对失眠障碍患者睡眠质量和认知功能的影响

背景 失眠障碍已成为当前社会的一种常见疾病,失眠的认知行为治疗（CBTI）是失眠障碍的非药物治疗方法之一,其对失眠障碍患者睡眠质量和认知功能影响的研究有限。目的 探索CBTI对失眠障碍患者睡眠质量和认知功能的影响,为失眠障碍的非药物治疗提供参考。方法 选取2021年1月-2022年10月在四川省精神卫生中心就诊、符合《精神障碍诊断与统计手册（第5版）》（DSM-5）诊断标准的47例失眠障碍患者为研究对象。患者接受为期6周的CBTI治疗。治疗前,采用汉密尔顿抑郁量表24项（HAMD-24）和汉密尔顿焦虑量表（HAMA）评定患者的抑郁和焦虑症状,在治疗前及治疗6周后采用匹兹堡睡眠质量指数量表（PSQI）和蒙特利尔认知评估量表（MoCA）评定患者的睡眠情况和认知功能。采用Spearman相关分析考查治疗后失眠障碍患者PSQI总评分减分值与MoCA总评分增分值的相关性。结果 治疗6周后,失眠障碍患者PSQI的主观睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、日间功能障碍因子评分及PSQI总评分均低于治疗前,差异均有统计学意义（t=5.569~15.290,P均<0.01）,MoCA的视空间与执行功能、命名、注意力、语言能力、抽象思维、记忆力因子评分及总评分均高于治疗前,差异均有统计学意义（t=-11.273~-4.277,P均<0.01）。Spearman相关分析显示,经6周CBTI治疗后,失眠障碍患者PSQI总评分减分值与MoCA总评分增分值呈正相关（r=0.323,P=0.027）。结论 CBTI可能有助于改善失眠障碍患者的睡眠质量和认知功能。CBTI干预后,失眠障碍患者睡眠质量的提高可能与认知功能的改善存在一定的关联。     

Association between sleep patterns and daytime functioning in children with insomnia: The contribution of parent-reported frequency of night waking and wake time after sleep onset

ObjectiveThe aim of this study was to investigate the association between sleep patterns and daytime functioning in children with insomnia. Furthermore, the role of frequency of night waking and wake time after sleep onset for daytime functioning was analyzed in the context of total sleep time and sleep onset latency.MethodsFamilies with children with parent-perceived sleep problems were recruited for diagnostic clarification and subsequent treatment (if indicated) at an outpatient clinic. Out of 49 families seeking help, 34 children (age 5.2–10.9 years, mean 7.1 years) and their parents were included in the present study. Sleep and sleep problems were assessed by a structured clinical interview according to the diagnostic criteria of the International Classification of Sleep Disorders (ICSD-II). Parents kept a sleep diary over two weeks. In addition, they answered the Child Behavior Checklist, questions concerning the daytime sleepiness of their children, as well as a structured clinical interview assessing comorbid mental disorders.ResultsReduced parent-reported total sleep time predicted more delinquent behavior and more concentration problems. Independent of total sleep time and frequency of night waking, longer parent-reported wake time after sleep onset was associated with greater daytime sleepiness, which in turn predicted more social problems.ConclusionsBesides total sleep time, wake time after sleep onset could be another important determinant for specific aspects of daytime functioning in children with insomnia.