Subjective-objective sleep discrepancy among older adults: associations with insomnia diagnosis and insomnia treatment.
Subjective-objective sleep discrepancy among older adults: associations with insomnia diagnosis and insomnia treatment.
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DOI：
10.1111/jsr.12220
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发表时间：
2015-02
影响因子：
4.4
通讯作者：
Monk TH
中科院分区：
文献类型：
--
作者：
Kay DB;Buysse DJ;Germain A;Hall M;Monk TH
睡眠的主观和客观测量之间的差异与失眠和年龄增长有关。失眠的认知行为疗法可以改善睡眠质量并减少主客观睡眠差异。这项研究描述了失眠老年人和对照组之间在睡眠差异方面的差异，并检验了这样的假设：失眠认知行为疗法后睡眠差异的减少与失眠老年人报告的症状改善程度相关。参与者包括 63 名 60 岁以上患有失眠症的成年人和 51 名对照者。在基线时，参与者佩戴腕部活动记录仪完成 7 天的睡眠日记。在接受失眠认知行为治疗后，失眠患者重复了这种睡眠评估。睡眠差异变量是通过从治疗前和治疗后各自自我报告的估计值中减去活动记录睡眠开始潜伏期和入睡后觉醒来计算的。研究了睡眠差异的平均水平和夜间变异性。比较各组之间的基线睡眠差异。研究了失眠老年人治疗前和治疗后失眠严重指数评分和睡眠差异变量的变化。与对照组相比，失眠老年人的夜间睡眠差异显着更大且变化更大，所有患者的 p ≤ 0.001。采用认知行为疗法治疗失眠与失眠严重指数评分显着降低相关，该评分与睡眠开始差异后觉醒的平均水平和夜间变异性相关，所有p <.001。对睡眠差异模式的研究可能会指导针对晚年失眠的更有针对性的治疗。
Discrepancy between subjective and objective measures of sleep is associated with insomnia and increasing age. Cognitive behavioral therapy for insomnia improves sleep quality and decreases subjective-objective sleep discrepancy. This study describes differences between older adults with insomnia and controls in sleep discrepancy, and tests the hypothesis that reduced sleep discrepancy following cognitive behavioral therapy for insomnia correlates with the magnitude of symptom improvement reported by older adults with insomnia. Participants were 63 adults >60 years of age with insomnia, and 51 controls. At baseline, participants completed sleep diaries for 7 days while wearing wrist actigraphs. After receiving cognitive behavioral therapy for insomnia, insomnia patients repeated this sleep assessment. Sleep discrepancy variables were calculated by subtracting actigraphic sleep onset latency and wake after sleep onset from respective self-reported estimates, pre- and post-treatment. Mean level and night-to-night variability in sleep discrepancy were investigated. Baseline sleep discrepancies were compared between groups. Pre- to post-treatment changes in Insomnia Severity Index score and sleep discrepancy variables were investigated within older adults with insomnia. Sleep discrepancy was significantly greater and more variable across nights in older adults with insomnia than controls, p ≤.001 for all. Treatment with cognitive behavioral therapy for insomnia was associated with significant reduction in Insomnia Severity Index score that correlated with changes in mean level and night-to-night variability in wake after sleep onset discrepancy, p <.001 for all. Study of sleep discrepancy patterns may guide more targeted treatments for late-life insomnia.