Sensitivity and specificity of measures of the insomnia experience: A comparative study of psychophysiologic insomnia, insomnia associated with mental disorder and good sleepers
Sensitivity and specificity of measures of the insomnia experience: A comparative study of psychophysiologic insomnia, insomnia associated with mental disorder and good sleepers
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DOI：
10.1093/sleep/28.1.104
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发表时间：
2005-01-01
期刊：
影响因子：
5.6
通讯作者：
Espie, CA
中科院分区：
文献类型：
--
作者：
Kohn, L;Espie, CA
研究目标：通过调查常用失眠研究工具在区分心理生理性失眠、与精神障碍相关的失眠和良好睡眠者方面的敏感性和特异性，探讨心理生理性失眠的拟议解释机制。设计：对心理生理性失眠受试者、与精神障碍相关失眠者和良好睡眠者的反应进行横断面、组间比较，对心理测量稳健的自我报告工具进行比较。背景：成人社区门诊的参与者参与者：54 名成年人（36 名女性，18 名男性；平均年龄 40 岁），分为 3 组（每组 n = 18）。患有心理生理性失眠的参与者符合《国际睡眠障碍分类》、《精神障碍诊断和统计手册》第四版修订标准，并且没有精神障碍史。患有与精神障碍相关的失眠的参与者满足相同的睡眠障碍标准，并符合《精神障碍诊断和统计手册》第四版（DSM-IV 轴 I 障碍的结构化临床访谈）抑郁症标准。大多数人患有焦虑症。心理生理性失眠和精神障碍相关性失眠人群的失眠持续时间约为10年。良好睡眠者作为对照组，包括自我报告的没有睡眠问题或精神障碍病史的良好睡眠者。干预：不适用。测量和结果：方差分析，经多重比较调整，表明睡眠相关刺激控制测量没有组间差异，并且与精神障碍相关的失眠受试者自我报告的躯体唤醒高于良好睡眠者或心理生理性失眠者。患有与精神障碍和心理生理性失眠相关的失眠的受试者的睡眠卫生状况较差，并且以精神唤醒程度较高为特征。 Logistic回归表明，“努力专注于睡眠”将心理生理性失眠（100％敏感性，94％特异性）和与精神障碍相关的失眠（100％，100％）与良好睡眠者区分开来，并且只有抑郁症状学才能将与精神障碍相关的失眠与心理生理性失眠区分开。结论：心理生理性失眠和与精神障碍相关的失眠可能处于连续状态失眠的严重程度，而不是截然区分。与精神障碍相关的失眠可能对心理干预有反应。区分失眠者和睡眠良好者的具体因素需要进一步研究。
Study objectives: To explore proposed explanatory mechanisms in psychophysiologic insomnia by investigating the sensitivity and specificity of commonly used insomnia research tools in discriminating psychophysiologic insomnia, insomnia associated with mental disorder, and good sleepers.Design: Cross-sectional, between-group comparison of responses from subjects with psychophysiologic insomnia, those with insomnia associated with mental disorder, and good sleepers to psychometrically robust self-report instruments.Setting: Attendees at adult community outpatient clinics.Participants: Fifty-four adults (36 women, 18 men; average age 40 years) across 3 groups (n = 18 per group). Participants with psychophysiologic insomnia met combined International Classification of Sleep Disorders, Revised and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and had no history of mental disorder. Participants with insomnia associated with mental disorder satisfied the same criteria for sleep disturbance and met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (Structured Clinical Interview for DSM-IV axis-I Disorders) criteria for depressive disorder. The majority had comorbid anxiety disorder. Insomnia duration in the groups with psychophysiologic insomnia and insomnia associated with mental disorder was around 10 years. Good sleepers served as a control group and included self-reported good sleepers with no history of sleep problems or psychiatric disorder.Intervention: N/A.Measurements and Results: Analyses of variance, adjusted for multiple comparisons, indicated no between-group differences on a measure of sleep-related stimulus control, and self-reported somatic arousal was higher in subjects with insomnia associated with mental disorder than in good sleepers or those with psychophysiologic insomnia. Subjects with insomnia associated with mental disorder and psychophysiologic insomnia had poorer sleep hygiene and were characterized by heightened men-tal arousal. Logistic regression indicated that "effortful preoccupation with sleep" discriminated subjects with both psychophysiologic insomnia (100% sensitivity, 94% specificity) and insomnia associated with mental disorder (100%, 100%) from good sleepers and that only depressive symptomatology discriminated insomnia associated with mental disorder from psychophysiologic insomnia,Conclusion: Psychophysiologic insomnia and insomnia associated with mental disorder may be on a continuum of insomnia severity, rather than categorically distinct. Insomnia associated with mental disorder may respond to psychological intervention. Factors specifically discriminating insomniacs from good sleepers require further investigation.