青少年失眠状况和睡眠质量及二者相关性分析

目的调查青少年失眠状况和睡眠质量及二者之间的相关性。方法对技工学校学生统一发放4733份调查问卷,最终获得有效问卷3342份,记录社会人口学资料,包括性别、年龄、身高、体重、健康状况、户籍、是否为独生子女、父母受教育程度、家庭收入、学习压力、吸烟和饮酒等,以及睡眠和情绪相关量表评分,包括失眠严重指数(ISI)中文版、匹兹堡睡眠质量指数(PSQI)、Epworth嗜睡量表(ESS)、焦虑自评量表(SAS)和Beck抑郁量表(BDI)。结果 3342名青少年中存在失眠997例(29.83%)、日间嗜睡568例(17.00%)、焦虑243例(7.27%)和抑郁1287例(38.51%)。根据ISI中文版评分分为非失眠组(2345名)和失眠组(997例),失眠组女性(P=0.000)、健康状况不良(P=0.000)、非独生子女(P=0.006)、有学习压力(P=0.000)和吸烟(P=0.027)比例,以及ISI中文版评分(P=0.000)、ESS评分(P=0.000)、SAS评分(P=0.000)和BDI评分(P=0.000)均高于非失眠组。Pearson相关分析显示,ISI中文版评分和PSQI评分均与ESS评分(r=0.361,P=0.000;r=0.064,P=0.000)、SAS评分(r=0.326,P=0.000;r=0.069,P=0.000)和BDI评分(r=0.529,P=0.000;r=0.067,P=0.000)呈正相关,且ISI中文版评分的上述相关性(r=0.300～0.600)高于PSQI评分(r0.100)。进一步偏相关分析显示,ISI中文版评分与PSQI评分呈负相关(r=-0.056,P=0.001)。结论失眠组女性更多、健康状况更差、非独生子女更多、学习压力更大、吸烟比例更高,以及日间嗜睡、焦虑和抑郁更严重。与PSQI量表相比,ISI量表中文版与日间嗜睡、焦虑和抑郁的关系更紧密,可能更适用于筛查和评价青少年失眠状况。     

生物反馈治疗卒中后焦虑抑郁状态伴失眠的研究

目的 研究生物反馈治疗卒中恢复期焦虑抑郁状态伴失眠的疗效及安全性。 方法 纳入卒中恢复期焦虑抑郁伴失眠患者,均给予生物反馈训练,训练方法为每周五次,每次 30 min的自主神经系统放松康复训练。所有患者在训练前后评定汉密尔顿焦虑量表（Hamilton Anxiety Scale,HAMA）、汉密尔顿抑郁量表（Hamilton Depression Scale,HAMD）、匹兹堡睡眠质量指数量表 （Pittsburgh Sleep Quality Index,PSQI）、患者健康问卷-9（Patient Health Questionnaire-9,PHQ-9）、简 易精神状态检查表（Mi ni -mental State Examination,MMSE）、Fugle-Meyer肢体功能评分（Fugl e-Meyer Scale,FMS）、美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale,NIHSS）以及 Barthel指数（Barthel Index,BI）,并采集患者的睡眠时间,对比分析训练前后这些量表评分及睡眠时 间的变化。 结果 研究共纳入并完成3 0例患者的数据统计。治疗后患者睡眠时间较治疗前显著增 加[（4.81±1.58）h vs（7.30±1.34）h,P＜0.001]。HA M A[（17.50±8.41）vs（9.00±7.01）]和 HAMD（[ 19.53±7.82）vs（9.23±4.42）]评分均有显著改善（均P＜0.001）。训练4周后患者的MMSE评 分有提高,Fugl e-Meyer分数增加,Barthel指数增加,但无统计学意义,NIHSS评分降低,差异有显著性 （P =0.033）。 结论 生物反馈疗法有利于卒中后焦虑抑郁伴失眠患者的睡眠和情绪改善,提高康复效果。     

Suicidal ideation and insomnia symptoms in subjects with obstructive sleep apnea syndrome

ObjectiveInsomnia symptoms are prevalent in subjects with obstructive sleep apnea syndrome (OSA) and are important risk factors for suicidal ideation (SI). However, the significance of SI has not been clearly demonstrated in persons with both OSA and insomnia. We aimed to investigate the prevalence of SI and its relationship with insomnia symptoms, mood, and other relevant factors.MethodsA total of 117 consecutive subjects with untreated OSA (apnea–hypopnea index ≥5/h) participated in the study. They completed questionnaires regarding SI ([BDI-II], item 9), insomnia symptoms (Insomnia Severity Index [ISI]), depressive mood (modified BDI-II [mBDI-II], which excluded items on SI and sleep disturbances), dysfunctional beliefs and attitudes about sleep (DBAS), social support, and quality of life.ResultsThe overall prevalence of SI was 20.5% in subjects with OSA. A total of 32 subjects (27.4%) reported significant insomnia symptoms (ISI ≥ 15). Higher SI was associated with higher scores on ISI, DBAS, and mBDI-II and lower scores on social support and quality of life questionnaires. The severity of insomnia was positively correlated with depressive mood. The relationship between SI and insomnia severity was insignificant after adjusting for depressive symptom severity.ConclusionPatients with OSA may have SI and insomnia symptoms. Collinearity was observed between sleep and mood disturbances. Yet, it is remarkable to find a significant association between OSA and SI, which are additional contributions to insomnia. This study suggests the necessity of integrated approaches to SI and related factors for the comprehensive treatment of OSA.     

Validation of the Insomnia Severity Index (ISI) for identifying insomnia in young adult cancer survivors: comparison with a structured clinical diagnostic interview of the DSM-5 (SCID-5)

ObjectivesInsomnia is a common problem affecting young adult cancer survivors (YACS) even years after treatment, yet it often goes unidentified and untreated. The Insomnia Severity Index is a widely-used insomnia measure, but has not been studied as an insomnia screener for YACS. The goal of this study was to validate the ISI in YACS by determining its utility in identifying YACS with insomnia disorder diagnosed with the Structured Clinical Interview for the DSM-5 (SCID-5).Methods250 YACS completed the ISI and SCID-5 Insomnia Module. Area under the curve (AUC) was calculated to reflect the ISI's discrimination between YACS with and without SCID-5 insomnia disorder. An ISI cut-off score with sensitivity ≥0.85 and specificity ≥0.75 was deemed acceptable.ResultsOf 250 participants, 52 met criteria for SCID-5 insomnia disorder diagnosis. The ISI had excellent discrimination, with an AUC = 0.91. A cut-off score ≥8 met study clinical screening criteria with sensitivity of 0.85 and specificity of 0.77. A cut-off score ≥7 with a higher sensitivity (0.96) but lower specificity (0.70) was noted as a potential alternative. Cut-off scores ≥12 and ≥ 14 were recommended for applications prioritizing overall accuracy.ConclusionsResults support validity of the ISI for identifying YACS with insomnia disorder. For clinical screening, data support the use of an ISI cut-off score ≥8 in YACS, and additional cut-off scores were found for research purposes or higher sensitivity. Results of this study and prior studies of the ISI offer important reminders that cut-off scores derived from different populations are not generalizable.     

Validation of the Insomnia Severity Index as an outcome measure for insomnia research

Background: Insomnia is a prevalent health complaint that is often difficult to evaluate reliably. There is an important need for brief and valid assessment tools to assist practitioners in the clinical evaluation of insomnia complaints.Objective: This paper reports on the clinical validation of the Insomnia Severity Index (ISI) as a brief screening measure of insomnia and as an outcome measure in treatment research. The psychometric properties (internal consistency, concurrent validity, factor structure) of the ISI were evaluated in two samples of insomnia patients.Methods: The first study examined the internal consistency and concurrent validity of the ISI in 145 patients evaluated for insomnia at a sleep disorders clinic. Data from the ISI were compared to those of a sleep diary measure. In the second study, the concurrent validity of the ISI was evaluated in a sample of 78 older patients who participated in a randomized-controlled trial of behavioral and pharmacological therapies for insomnia. Change scores on the ISI over time were compared with those obtained from sleep diaries and polysomnography. Comparisons were also made between ISI scores obtained from patients, significant others, and clinicians.Results: The results of Study 1 showed that the ISI has adequate internal consistency and is a reliable self-report measure to evaluate perceived sleep difficulties. The results from Study 2 also indicated that the ISI is a valid and sensitive measure to detect changes in perceived sleep difficulties with treatment. In addition, there is a close convergence between scores obtained from the ISI patient's version and those from the clinician's and significant other's versions.Conclusions: The present findings indicate that the ISI is a reliable and valid instrument to quantify perceived insomnia severity. The ISI is likely to be a clinically useful tool as a screening device or as an outcome measure in insomnia treatment research.     

Cognitive behavioural therapy with behavioural analysis for pharmacological treatment-resistant chronic insomnia

This study aimed to determine whether (1) cognitive behavioural therapy with behavioural analysis for insomnia (CBTi-BA) is more effective for insomnia and co-morbid depressive symptoms than treatment as usual (TAU) and (2) whether CBTi-BA promotes earlier reduction of the daily dose of hypnotic medication in chronic insomnia resistant to pharmacological treatment. A total of 63 patients with chronic insomnia aged 20–77 years who already received hypnotic medication regularly were assigned to two interventions: combined therapy or TAU alone. The subjects provided demographic information and completed self-rating scales for insomnia and depressive symptoms. After treatment, the combined therapy group showed significant decreases in the symptoms of both insomnia and depression and significant reductions in the daily dose of hypnotic medication compared with the group receiving TAU alone. In the combined therapy group, 71% of the participants reported a reduction in insomnia to normal levels and 79% succeeded in decreasing the daily dose of hypnotics to 50% or less of the baseline dose. These results revealed that CBTi-BA can reduce insomnia and depressive symptoms as well as the daily dose of hypnotic medication in patients with chronic insomnia resistant to pharmacological treatment.     

奥氮平对难治性抑郁症的辅助治疗作用

目的：观察奥氮平联合文拉法辛治疗难治性抑郁症的疗效和不良反应。方法：将92例难治性抑郁症患者随机分成两组,合用组为奥氮平联合文拉法辛,单用组为单用文拉法辛,疗程6周。以汉密尔顿抑郁量表（HAMD）和汉密尔顿焦虑量表（HAMA）评定临床疗效;以治疗中出现的症状量表（TESS）评定不良反应。结果：治疗后两组HAMD和HAMA的评分均显著降低（P〈0．01）,以合用组疗效显著（P〈0．01或P〈0．05）。结论：奥氮平联合文拉法辛治疗难治性抑郁症的疗效优于单用文拉法辛,耐受性好。     

失眠伴抑郁与单纯失眠患者失眠认知行为治疗的疗效分析

目的分析失眠认知行为疗法(cognitive behavioral therapy on insomnia,CBT-i)对失眠伴抑郁患者以及单纯失眠患者的疗效。方法71例符合失眠症诊断的患者,根据贝克抑郁量表(Beck Depression Inventory,BDI)得分分为单纯失眠组(<14分,33例)和失眠伴抑郁组(≥14分,38例)。2组患者每天填写睡眠日记,并给予8周标准的CBT-i治疗,在治疗前(基线)、治疗第4周、治疗第8周、治疗结束后4周(第3个月)、治疗结束后16周(第6个月)采用匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI)、失眠严重程度指数(Insomnia Severity Index,ISI)、BDI、贝克焦虑量表(Beck Anxiety Inventory,BAI)、SF-36健康调查简表对2组患者睡眠质量、抑郁焦虑程度、个人健康状况等进行评估,采用独立样本t检验进行组间比较,采用重复测量方差分析进行各时间点组内比较。结果与基线时比较,单纯失眠组和失眠伴抑郁组第8周、第3个月和6个月随访时入睡潜伏期、睡眠效率、PSQI、ISI、BDI、BAI、SF-36组内比较差异均有统计学意义。失眠伴抑郁组较单纯失眠组在基线、第8周、第3个月和6个月随访时BAI(t=-6.340、-3.301、-3.511、-2.982)、SF-36(t=4.162、3.195、2.022、3.629)评分差异有统计学意义(P<0.01或0.05),2组ISI评分在第6个月随访时差异有统计学意义[(7.3±4.6)分与(4.7±3.4)分,t=-2.044,P=0.048]。2组入睡潜伏期和睡眠效率以及PSQI的评分在第8周、第3个月和6个月随访时与基线的变化量差异均无统计学意义;而2组BAI、BDI评分在第8周与第3个月和6个月随访时与基线的变化量差异有统计学意义。结论CBT-i对失眠伴抑郁患者和单纯失眠患者均有效,且可以缓解失眠伴抑郁患者的抑郁症状以及改善患者生活质量。     

Preventing depression in adolescents with epilepsy

PURPOSE: The goal of the work described in this article was to test the possibility of preventing depression among adolescents with epilepsy. METHODS: Adolescents with newly diagnosed epilepsy (104 patients) were screened for depression. The risk for depression was increased in 30 (28.8%) patients (mean age 17.4, 60% females) who were randomized into two equal treatment groups: (1) cognitive-behavioral intervention (CBI) group and (2) treatment with counseling as usual (TAU) group. The Beck Depression Inventory (BDI), Center for Epidemiological Study on Depression (CES-D) scale, Hamilton Depression Scale (HAMD), and Quality of Life in Epilepsy Inventory (QOLIE-31) were administered at baseline and during the 9-month follow-up. RESULTS: Initial BDI and HAMD scores for the two groups were comparable. Depression was diagnosed during follow-up in three patients in the TAU group. Subthreshold depressive disorder significantly improved at follow-up in the BCI group compared with the TAU group (P<0.05). QOLIE-31 Total scores significantly correlated with both mood improvement and seizure-free state.     

Identifying the best sleep measure to screen clinical insomnia in a psychiatric population

BackgroundInsomnia symptoms are highly prevalent among patients with psychiatric disorders, and this mandates the need to identify the best self-administered sleep measure to screen for clinical insomnia among them.MethodsA total of 400 psychiatric outpatients completed the Pittsburgh Sleep Quality Index, Insomnia Severity Index (ISI), Epworth Sleepiness Scale, Flinders Fatigue Scale, Functional Outcomes of Sleep Questionnaire, and Dysfunctional Beliefs and Attitudes about Sleep Scale in a cross-sectional study. The sensitivity, specificity, positive, and negative predictive values of these six sleep scales were assessed and compared in relation to both ICD-10 and DSM-5 insomnia disorder status established using the interviewer-administered Brief Insomnia Questionnaire.ResultsReceiver operator characteristic curves with the area under the curve (AUC) revealed the ISI to be the most accurate measure to discriminate cases and non-cases on both ICD-10 (AUC = 0.88, 95% CI = 0.84–0.92) and DSM-5 (AUC = 0.82, 95% CI = 0.78–0.86) criteria with “good” accuracy. The cut-off scores of ≥14 and ≥ 11 for the ISI provided optimal sensitivity and specificity for the detection of ICD-10 and DSM-5 insomnia, respectively.DiscussionWith the new calling from DSM-5 to treat sleep symptoms in the presence of a co-existing mental condition, early detection of psychiatric patients with clinically significantly insomnia using a simple but accurate self-report sleep measure becomes important. Our study suggests that the ISI could be used as a potential screening tool for comorbid insomnia disorder in patients with mental disorders.     

The effects of bright light therapy on depression and sleep disturbances in patients with Parkinson's disease: a systematic review and meta-analysis of randomized controlled trials

BackgroundDepression and sleep disturbance are well-recognized non-motor features in patients with Parkinson's disease (PD). This meta-analysis aimed to explore the potential role of bright light therapy (BLT) in depression and sleep disturbances in Parkinson's Disease (PD).MethodsFour databases were independently searched by two reviewers: PubMed, Cochrane, Web of Science and Embase until February 2021. We evaluated the following depression related scales: Beck's Depression Inventory (BDI); the Geriatric Depression Rating Scale, 30-item (GDS-30); the Hamilton Depression Rating Scale (HDRS); the Hospital Anxiety and Depression Scale (HADS); the Epworth sleepiness scale (ESS); the Fatigue Severity Scale (FSS); the Pittsburgh sleep quality index (PSQI); the Parkinson's disease sleep scale (PDSS); Scales for Outcomes in Parkinson's disease Sleep Scale (SCOPA) and the Insomnia severity index (ISI) to access the effects of bright light therapy on depression and sleep disturbances in patients with PD. Effect size (standardized mean deviation [SMD] and 95% confidence interval [CI]) were used to analyze the continuous results data of intervention group and control light group. Data from five randomized, controlled trials totaling 173 patients with PD was included.ResultsBLT significantly improved depression symptoms (BDI, GDS-30, HDRS and HADS) of PD patients (0.34, 95% CI = 0.06–0.61). Insomnia symptoms (SCOPA and ISI) for patients with PD were significantly improved by BLT as well (1.15, 95% CI = 0.71–1.60). Whereas, no difference was observed in the control light group in improving the depression or insomnia symptoms of PD patients.ConclusionBLT is an effective intervention for improving depressive symptoms and sleep disturbances in patients with PD.     

Are the Insomnia Severity Index and Pittsburgh Sleep Quality Index valid outcome measures for Cognitive Behavioral Therapy for Insomnia? Inquiry from the perspective of response shifts and longitudinal measurement invariance in their Chinese versions

ObjectiveThe purpose of this study was to examine whether the Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) are valid outcome measures for Cognitive Behavioral Therapy for Insomnia (CBT-I). Specifically, we tested whether the factorial parameters of the ISI and the PSQI could remain invariant against CBT-I, which is a prerequisite to using their change scores as an unbiased measure of the treatment outcome of CBT-I.MethodsA clinical data set including scores on the Chinese versions of the ISI and the PSQI obtained from 114 insomnia patients prior to and after a 6-week CBT-I program in Taiwan was analyzed. A series of measurement invariance (MI) tests were conducted to compare the factorial parameters of the ISI and the PSQI before and after the CBT-I treatment program.ResultsMost factorial parameters of the ISI remained invariant after CBT-I. However, the factorial model of the PSQI changed after CBT-I treatment. An extra loading with three residual correlations was added into the factorial model after treatment.ConclusionsThe partial strong invariance of the ISI supports that it is a valid outcome measure for CBT-I. In contrast, various changes in the factor model of the PSQI indicate that it may not be an appropriate outcome measure for CBT-I. Some possible causes for the changes of the constructs of the PSQI following CBT-I are discussed.     

Validation study of the Italian version of the Insomnia Severity Index (ISI)

To test the factorial structure of the Italian version of the Insomnia Severity Index (ISI) using a confirmatory approach and to assess its psychometric properties. ISI questionnaire was completed by 272 patients (average age 41.28, range 18–73) with insomnia diagnosis performed by a sleep medicine physician and retrospectively enrolled in the study. All patients underwent Cognitive Behavioral Treatment for Insomnia (CBT-I) and completed sleep diaries before starting the treatment. Data from sleep diaries were analyzed for assessing concurrent validity of the ISI. Confirmatory factor analysis (CFA) for ordinal Likert-type items was applied to compare four competing models proposed in the literature. 244 patients, out of the 272, completed the ISI at the end of CBT-I. A comparison of ISI score before and after treatment was performed. The CFA analysis confirmed the presence of three main factors conceptualized as severity and impact of the disease along with sleep satisfaction. Significant correlations of the first three items of the questionnaire, investigating three different subtypes of insomnia, and the subjective measures from the sleep diaries were found, thus supporting the concurrent validity of the test. Sleep efficiency (SE) had a significant inverse correlation with the severity and satisfaction factors and with ISI’s total score. After CBT-I treatment, a significant reduction of ISI’s scores was observed, thus confirming the effectiveness of the CBT-I treatment. The internal reliability coefficient was 0.75. The ISI questionnaire maintains good psychometric properties in the Italian version, thus confirming that this instrument is reliable for detecting insomnia severity and identifying patients’ symptoms.     

北京市350名职业人员睡眠质量和情绪调节的认知策略调查

目的 了解受过高等教育职员的睡眠质量及其所采用的情绪调节认知策略.方法 采用匹兹堡睡眠质量指数(PSQI)问卷、失眠严重指数(ISI)问卷、简式简明心境问卷(POMS-SF)和认知情绪调节问卷(CERQ),对采取整群随机抽样法抽取的北京市6所单位的350名大专以上在职人员的睡眠质量与情绪调节策略进行调查.结果 (1)98例(28%)存在睡眠质量问题(PSQI≥7分),146例(41.7%)日常状态受失眠影响(ISI＞7分);(2)遭遇负性生活事件后,在所有受访人员中使用频率最高的3种情绪调节策略依次为积极重新评价、重新关注计划、积极重新关注;(3)在情绪调节认知策略的灾难化维度上,主观不失眠组(ISI≤7分)得分(34.21±12.85)分,低于轻度失眠组(7分＜ISI≤14分)[(39.62±15.02)分]与中重度失眠组(ISI≥15分)[(41.48±11.25)分],差异有统计学意义(t=3.466,P=0.001;t=2.625,P=0.009);在沉浸维度上,主观不失眠组得分(46.43±12.78)分,低于轻度失眠组[(49.92±13.55)分]与中重度失眠组[(51.67±11.44)分],差异有统计学意义(t=2.332,P=0.020;t=1.974,P=0.049).结论 受访职员睡眠质量问题及主观失眠现象较多见,多能运用积极认知策略调节情绪;主观失眠组职员有更多灾难化、沉浸的消极认知策略的运用.     

难治性抑郁症停药清洗合并MECT一周及后续治疗反应

目的探讨对难治性抑郁症患者,停药清洗1周并同期合并无抽搐电休克治疗(MECT)的效果,并评价1周后续用先前抗抑郁药的治疗反应。方法将符合《中国精神障碍分类与诊断手册(第3版)》(CCMD-3)抑郁症诊断标准的40例难治性抑郁症患者,予1周的清洗,清洗期停用除苯二氮艹卓类药物以外的所有精神科药物,同期合并MECT治疗,清洗期结束后继续使用原抗抑郁药物,共观察6周。在MECT治疗前及治疗后第1、2、4、6周末分别采用汉密尔顿抑郁量表(HAMD-17)、汉密尔顿焦虑量表(HAMA)评定疗效,用副反应量表(TESS)评定不良反应。结果①6周末痊愈14例,显效17例,进步7例,无效2例。有效率77.5%。②治疗第1周末(清洗期合并MECT后)HAMD-17、HAMA评分较治疗前差异有统计学意义(P均0.01)。治疗第4周末(即重新开始续用原抗抑郁药后第3周)和第6周末HAMD-17、HAMA评分与第1周末比较差异均有统计学意义(P0.05或0.01)。结论停药清洗1周合并MECT对难治性抑郁症效果良好,经过清洗合并MECT后可提高原抗抑郁药物的疗效。     

氟西汀合并奥氮平治疗难治性抑郁症对照研究

目的探讨小剂量奥氮平合并氟西汀治疗难治性抑郁症的疗效和不良反应。方法将74例难治性抑郁症患者随机分为2组,研究组在氟西汀(20mg/d)治疗的同时合并应用奥氮平(5~10mg/d);对照组仅用氟西汀(20mg/d)治疗,两组作4周的持续治疗观察,于入组前及入组后第1、2、4周末分别用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)及副反应量表进行评定。结果两组在治疗后第2、4周末,HAMD、HAMA总分及减分率的差异有统计学意义,两组间有效率的差异也有统计学意义。研究组和对照组分别有48.5%和38.9%出现不良反应,差异无统计学意义。结论小剂量奥氮平在难治性抑郁症的治疗中有增效作用,优于单用氟西汀,且安全性较好,在临床上可以作为治疗难治性抑郁症的一个备选方案。     

Comparison of impact of insomnia on depression and quality of life in restless legs syndrome/Willis–Ekbom disease and primary insomnia patients

BackgroundAlthough insomnia is common among people with restless legs syndrome (RLS), its impact on the daily suffering of those with RLS remains unclear. This study aimed to compare the differential impact of clinical insomnia on depression and quality of life (QoL) among people with RLS, primary insomnia, and healthy controls.MethodsA total of 148 people with RLS, 115 with primary insomnia, and 117 healthy controls were enrolled into this cross-sectional study. Participants completed sleep, depression, and QoL questionnaires. Clinical insomnia was defined as Korean version of the Insomnia Severity Index (K-ISI) ≥ 15. Correlation coefficients between sleep measures and both depression and QoL were calculated. Multivariate regression was used to identify the clinical factors that were most closely associated with depression and QoL among people with RLS and primary insomnia.ResultsParticipants with RLS had insomnia and sleep quality at intermediate levels between the healthy controls and primary insomnia subjects, but those with clinical insomnia had equivalent depression and QoL scores regardless of RLS diagnosis. Insomnia severity correlated with depression and QoL in RLS and primary insomnia. Multivariate regression, however, revealed that RLS severity was the most overall predictive factor for depression and QoL among those with RLS. Insomnia severity was the strongest predictor in primary insomnia.ConclusionInsomnia was more closely associated with depression and QoL among people with primary insomnia than those with RLS, but clinical insomnia may have a significant impact in RLS as well. Future RLS studies should account for sleep quality in addition to RLS symptom severity when investigating mood and QoL.     

Insomnia severity is an indicator of suicidal ideation during a depression clinical trial

ObjectiveInsomnia has been linked to suicidal ideas and suicide death in cross-sectional and longitudinal population-based studies. A link between insomnia and suicide has not been previously examined in the setting of a clinical trial. Herein we describe the relationship between insomnia and suicidal thinking during the course of a clinical trial for depression with insomnia.MethodsSixty patients aged 41.5 ± 12.5 years (2/3 women) with major depressive episode and symptoms of insomnia received open-label fluoxetine for 9 weeks and also received blinded, randomized eszopiclone 3 mg or placebo at bedtime after the first week of fluoxetine. Insomnia symptoms were assessed with the Insomnia Severity Index (ISI), and suicidal ideation was assessed with The Scale for Suicide Ideation (SSI). Depression symptoms were assessed with the depressed mood item and the anhedonia item from the Hamilton Rating Scale for Depression-24 (HRSD24), as well as a sum score for all non-sleep and non-suicide items from the HRSD (HRSD20). Measurements were taken at baseline and weeks 1, 2, 4, 6, and 8. SSI was examined by generalized linear mixed models for repeated measures as the outcome of interest for all 60 participants with ISI and various mood symptoms as independent variables, with adjustment for age, gender, treatment assignment, and baseline SSI.ResultsHigher levels of insomnia corresponded to significantly greater intensity of suicidal thinking (p < 0.01). The depressed mood item of the HRSD, and the sum of the HRSD20, both corresponded to greater suicidal thinking (p < 0.001). The anhedonia item did not correspond with suicidal thinking. When both ISI and the depressed mood item, or ISI and the anhedonia item, were included together in the same model, the ISI remained an independent predictor of suicidal thinking.ConclusionsThe results support the concept that insomnia may be a useful indicator for suicidal ideation and now extend this idea into clinical trials. Insomnia remains an independent indicator of suicidal ideation, even taking into account the core symptoms of depression such as depressed mood and anhedonia. The complaint of insomnia during a depression clinical trial might indicate that more direct questioning about suicide is warranted.     

Response to placebo acupuncture in insomnia: a secondary analysis of three randomized controlled trials

ObjectiveTo determine the patient characteristics that are associated with a response to noninvasive placebo acupuncture for insomnia.MethodsWe performed a secondary analysis of three randomized, double-blind, placebo-controlled trials of acupuncture for primary insomnia and residual insomnia associated with major depression. A total of 86 participants were randomized to receive placebo acupuncture three times per week for three consecutive weeks. Outcome was assessed at 1-week posttreatment. Response was defined as an Insomnia Severity Index (ISI) score improved by eight points or more from baseline to 1-week posttreatment. Sociodemographic, clinical, and baseline characteristics including sleep diary-derived and actigraph-derived sleep parameters as predictors of placebo response were examined using univariate and multivariate logistic regression.ResultsThe effect size of placebo acupuncture was estimated at 0.18 for total sleep time, 0.08 for sleep efficiency, and 0.92 for ISI score. Eighteen (20.9%) of the 86 participants were responders. Responders had a higher ISI score (p = 0.03), higher sleep diary–derived total sleep time (p = 0.02), less discrepancy between sleep diary–derived and actigraph-derived total sleep time (p = 0.03), and higher expectation toward acupuncture (p = 0.03) at baseline compared to nonresponders. Multivariate regression analysis found that only ISI score remained significant (odds ratio = 1.23, 95% confidence interval = 1.02–1.50, p = 0.03).ConclusionsBaseline sleep parameters and perceived effectiveness were shown to predict the placebo response of acupuncture for insomnia. Although the study was limited by a small sample size, our findings highlighted the potential implication of sleep duration and sleep-state misperception in the treatment of insomnia.     

Which symptoms predict recurrence of depression in women treated with maintenance interpersonal psychotherapy?

Background: Even low levels of residual symptoms are known to increase the risk of relapse and early recurrence of major depression. It is not known if ongoing psychotherapy lessens this risk. We therefore examined the impact of persistent symptoms, including mood, insomnia, and anxiety symptoms, on time to recurrence in women receiving maintenance interpersonal psychotherapy (IPT‐M) for recurrent depression. Methods: We analyzed data on 131 women aged 20–60 from a 2‐year randomized trial of weekly versus twice‐monthly versus monthly IPT‐M. Participants achieved remission with IPT alone (n=99) or IPT plus sequential antidepressant medication (n=32). Medications were tapered before starting maintenance treatment. Residual symptoms were assessed with the Hamilton Rating Scale for Depression (HRSD; total score and subscales); insomnia was also assessed in 76 women with the Pittsburgh Sleep Quality Index (PSQI). Data analyses used Cox proportional hazards regression models. Results: Neither overall burden of residual symptoms (HRSD total score), nor HRSD mood and anxiety subscale scores predicted recurrence during ongoing IPT‐M. In contrast, persistent insomnia measured both by the HRSD‐17 insomnia subscale and the PSQI predicted recurrence. Women with persistent insomnia who required sequential pharamacotherapy had the highest recurrence rate (65%) compared to women requiring sequential treatment without insomnia (13%), or women who had recovered with IPT alone but had persistent insomnia (21%) or no insomnia (18%). Conclusions: Persistent insomnia following the recovery from an episode of recurrent major depression is associated with increased risk of recurrence despite maintenance psychotherapy, particularly for those withdrawn from antidepressant medication. Depression and Anxiety, 2008. © 2008 Wiley‐Liss, Inc.