Abstract：
The world-wide prevalence of insomnia disorder reaches up to 10% of the adult population. Women are more often afflicted than men, and insomnia disorder is a risk factor for somatic and mental illness, especially depression and anxiety disorders. Persistent hyperarousals at the cognitive, emotional, cortical and/or physiological levels are central to most theories regarding the pathophysiology of insomnia. Of the defining features of insomnia disorder, the discrepancy between minor objective polysomnographic alterations of sleep continuity and substantive subjective impairment in insomnia disorder remains enigmatic. Microstructural alterations, especially in rapid eye movement sleep (\"rapid eye movement sleep instability\"), might explain this mismatch between subjective and objective findings. As rapid eye movement sleep represents the most highly aroused brain state during sleep, it might be particularly prone to fragmentation in individuals with persistent hyperarousal. In consequence, mentation during rapid eye movement sleep may be toned more as conscious-like wake experience, reflecting pre-sleep concerns. It is suggested that this instability of rapid eye movement sleep is involved in the mismatch between subjective and objective measures of sleep in insomnia disorder. Furthermore, as rapid eye movement sleep has been linked in previous works to emotional processing, rapid eye movement sleep instability could play a central role in the close association between insomnia and depressive and anxiety disorders.
摘要：
世界范围内失眠症的患病率高达10%的成年人。女人比男人更容易受苦，失眠是躯体和精神疾病的危险因素，尤其是抑郁症和焦虑症。持续的认知过度唤醒，情感,皮质和/或生理水平是关于失眠病理生理学的大多数理论的核心。在失眠障碍的定义特征中，睡眠连续性的轻微客观多导睡眠图改变与失眠障碍的实质性主观损害之间的差异仍然是一个谜。微结构改变，特别是在快速眼动睡眠（“快速眼动睡眠不稳定”），也许可以解释这种主观和客观发现之间的不匹配。由于快速眼动睡眠代表了睡眠中最高度兴奋的大脑状态，在持续性过度觉醒的个体中，它可能特别容易碎裂。因此，快速眼动睡眠期间的情绪可能更像有意识的觉醒体验，反映睡前的担忧。建议快速眼动睡眠的这种不稳定性与失眠障碍的主观和客观睡眠测量之间的不匹配有关。此外，因为快速眼动睡眠在以前的作品中已经与情绪处理联系在一起，快速眼动睡眠不稳定可能在失眠与抑郁和焦虑障碍之间的密切关联中起重要作用。
