The Natural History of Insomnia A Population-Based 3-Year Longitudinal Study
The Natural History of Insomnia A Population-Based 3-Year Longitudinal Study
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DOI：
10.1001/archinternmed.2008.610
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发表时间：
2009-03-09
影响因子：
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通讯作者：
Gregoire, Jean-Pierre
中科院分区：
文献类型：
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作者：
Morin, Charles M.;Belanger, Lynda;Gregoire, Jean-Pierre
背景：尽管失眠的患病率很高，但有关失眠自然史的信息却很少。随着时间的推移，失眠发作的持续程度或缓解程度很难预测。我们检查了失眠的自然史并描述了 3 年来最常见的轨迹。方法：根据基线时是否存在失眠情况，从更大的人群样本中选择了 388 名成年人（平均 [SD] 年龄，44.8 [13.9] 岁；61% 为女性）。他们在 3 次年度随访评估中完成了标准化睡眠/失眠调查问卷。对于每次随访评估，根据使用失眠标准诊断标准的算法，将参与者分为 3 组中的一组（患有失眠综合征的个体、有失眠症状的个体和睡眠良好的个体）。计算每组的持续失眠率、缓解率和复发率。结果：在研究样本中，74% 的人报告失眠至少 1 年（连续 2 次评估），46% 的人报告在整个 3 年的研究中持续失眠。对于基线时失眠较严重（即失眠综合征）的人以及女性和老年人，失眠的病程更有可能持续存在。缓解率为54%；然而，27% 的失眠症缓解者最终又复发了。基线时患有亚综合征失眠的个体缓解综合征状态的可能性比恶化的可能性高出 3 倍，尽管持续性也是该组中最常见的过程。结论：这些研究结果表明，失眠通常是一种持续性疾病，特别是当它达到失眠症的诊断阈值时。
Background: Despite its high prevalence, little information is available about the natural history of insomnia. The extent to which episodes of insomnia will persist or remit over time is difficult to predict. We examined the natural history of insomnia and describe the most common trajectories over 3 years.Methods: Three hundred eighty-eight adults (mean [SD] age, 44.8 [13.9] years; 61% women) were selected from a larger population-based sample on the basis of the presence of insomnia at baseline. They completed standardized sleep/insomnia questionnaires at 3 annual follow-up assessments. For each follow-up assessment, participants were classified into 1 of 3 groups (individuals with an insomnia syndrome, individuals with insomnia symptoms, and individuals with good sleep) on the basis of algorithms using standard diagnostic criteria for insomnia. Rates of persistent insomnia, remission, and relapse were computed for each group.Results: Of the study sample, 74% reported insomnia for at least 1 year (2 consecutive assessments) and 46% reported insomnia persisting over the entire 3-year study. The course of insomnia was more likely to be persistent in those with more severe insomnia at baseline (ie, insomnia syndrome) and in women and older adults. Remission rate was 54%; however, 27% of those with remission of insomnia eventually experienced relapse. Individuals with subsyndromal insomnia at baseline were 3 times more likely to remit than worsen to syndrome status, although persistence was the most frequent course in that group as well.Conclusion: These findings indicate that insomnia is often a persistent condition, in particular when it reaches the diagnostic threshold for an insomnia disorder.