Stress and Sleep Reactivity: A Prospective Investigation of the Stress-Diathesis Model of Insomnia
Stress and Sleep Reactivity: A Prospective Investigation of the Stress-Diathesis Model of Insomnia
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DOI：
10.5665/sleep.3916
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发表时间：
2014-08-01
期刊：
影响因子：
5.6
通讯作者：
Roth, Thomas
中科院分区：
文献类型：
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作者：
Drake, Christopher L.;Pillai, Vivek;Roth, Thomas
研究目的：前瞻性地评估睡眠反应性作为失眠的一种素质，并描述这种素质和自然主义压力在正常睡眠者失眠发展中的相互作用。设计：纵向。设置：以社区为基础。参与者：来自失眠途径演变队列（EPIC）的2,316名成年人，无失眠或抑郁病史测量和结果：参与者报告了他们在基线（时间1）遇到的压力事件的数量，以及他们在响应每个压力源时所经历的认知侵入的水平。压力事件（OR = 1.13; P < 0.01）和压力引起的认知侵入（OR = 1.61; P < 0.01）是一年后（时间2）失眠风险的重要预测因素。侵入性事件介导了应激事件对失眠的影响（P < 0.05）。特质睡眠反应性显著增加失眠的危险性（OR = 1.78; P < 0.01）。此外，睡眠反应性缓和了压力诱导的侵入的影响（P < 0.05），因此，失眠的风险作为侵入的函数在睡眠反应性高的个体中显着更高。两年后（时间3），特质睡眠反应性也构成抑郁症的显著风险（OR = 1.67; P < 0.01）。结论：本研究表明，发病前的睡眠反应性是一个重要的危险因素，事件失眠，它引发失眠加剧的压力引起的入侵的影响。睡眠反应也是抑郁症的一个诱因，失眠是其中的一个中介。这些发现支持失眠的压力素质模型，同时强调睡眠反应是一种重要的素质。
Study Objectives: To prospectively assess sleep reactivity as a diathesis of insomnia, and to delineate the interaction between this diathesis and naturalistic stress in the development of insomnia among normal sleepers.Design: Longitudinal.Setting: Community-based.Participants: 2,316 adults from the Evolution of Pathways to Insomnia Cohort (EPIC) with no history of insomnia or depression (46.8 +/- 13.2 y; 60% female).Interventions: None.Measurements and Results: Participants reported the number of stressful events they encountered at baseline (Time 1), as well as the level of cognitive intrusion they experienced in response to each stressor. Stressful events (OR = 1.13; P < 0.01) and stress-induced cognitive intrusion (OR = 1.61; P < 0.01) were significant predictors of risk for insomnia one year hence (Time 2). Intrusion mediated the effects of stressful events on risk for insomnia (P < 0.05). Trait sleep reactivity significantly increased risk for insomnia (OR = 1.78; P < 0.01). Further, sleep reactivity moderated the effects of stress-induced intrusion (P < 0.05), such that the risk for insomnia as a function of intrusion was significantly higher in individuals with high sleep reactivity. Trait sleep reactivity also constituted a significant risk for depression (OR = 1.67; P < 0.01) two years later (Time 3). Insomnia at Time 2 significantly mediated this effect (P < 0.05).Conclusions: This study suggests that premorbid sleep reactivity is a significant risk factor for incident insomnia, and that it triggers insomnia by exacerbating the effects of stress-induced intrusion. Sleep reactivity is also a precipitant of depression, as mediated by insomnia. These findings support the stress-diathesis model of insomnia, while highlighting sleep reactivity as an important diathesis.