目的:评估睡眠障碍患者自我报告的失眠症,并探讨与精神疾病的关系,合并症,主观睡眠评估,和多导睡眠图研究结果。
方法:来自摄入问卷和多导睡眠图评估的结果,对2004年至2019年间从美国30个州的240个睡眠中心收集的数据进行了回顾性分析。在总共540,000名患者中,包括371,889人回答了特定于失眠症的问题。患者“经常”或“总是”对特定于睡眠状态的问题做出反应被认为是“症状阳性”,”而“几次”或“从不”被认为是“症状阴性”(对照)。
结果:研究样本为54.5%的男性,平均年龄54岁(范围,2-107年)。对于任何睡眠状态,不同睡眠状态的频率为16.0%,睡眠为8.8%,6.0%的催眠幻觉,4.8%与睡眠有关的进食障碍,2.1%为睡眠麻痹,梦游症为1.7%。经常失眠症与诊断出的抑郁症高度相关(比值比=2.72)。所有失眠症都与年轻和女性以及抑郁症状有关,焦虑,失眠,不安的腿,疼痛,医疗条件,疲劳,和困倦。与客观睡眠指标的关联显示出合并睡眠的特征,并且在非快速眼动睡眠和快速眼动睡眠失眠症之间的区别较弱。机器学习对睡眠状态患者与对照患者进行了准确的分类(平衡准确率在71%至79%之间)。苯二氮卓类药物,抗精神病药,阿片类药物增加了患失眠症的几率,而抗组胺药和褪黑激素降低了几率。发现Z-药物增加了与睡眠有关的进食障碍的可能性。
结论:我们的研究结果表明,失眠症可能与临床相关,然而研究不足,抑郁和焦虑的症状。需要进一步的调查来量化多发病的性质,包括因果关系和对诊断和治疗的影响。
OBJECTIVE: To assess self-reported parasomnias in patients with sleep disorders and explore relationships with psychiatric illness, comorbidities, subjective sleep assessments, and polysomnographic study results.
METHODS: Results from intake questionnaires and polysomnographic assessments, collected from 240 sleep centers across 30 US states between 2004 and 2019, were analyzed retrospectively. Of 540,000 total patients, 371,889 who answered
parasomnia-specific questions were included. Patients responding \"often\" or \"always\" to
parasomnia-specific questions were considered \"symptom-positive,\" whereas a \"few times\" or \"never\" were considered \"symptom-negative\" (controls).
RESULTS: The study sample was 54.5% male with mean age 54 years (range, 2-107 years). Frequencies for the different parasomnias were 16.0% for any
parasomnia, 8.8% for somniloquy, 6.0% for hypnagogic hallucinations, 4.8% for sleep-related eating disorder, 2.1% for sleep paralysis, and 1.7% for somnambulism. Frequent parasomnias were highly associated with diagnosed depression (odds ratio = 2.72). All parasomnias were associated with being younger and female and with symptoms of depression, anxiety, insomnia, restless legs, pain, medical conditions, fatigue, and sleepiness. Associations with objective sleep metrics showed characteristics of consolidated sleep and differentiated weakly between nonrapid eye movement sleep and rapid eye movement sleep parasomnias. Machine learning accurately classified patients with
parasomnia versus controls (balanced accuracies between 71% and 79%). Benzodiazepines, antipsychotics, and opioids increased the odds of experiencing parasomnias, while antihistamines and melatonin reduced the odds. Z-drugs were found to increase the likelihood of a sleep-related eating disorder.
CONCLUSIONS: Our findings suggest that parasomnias may be clinically relevant, yet understudied, symptoms of depression and anxiety. Further investigation is needed to quantify the nature of multimorbidity, including causality and implications for diagnosis and treatment.