Insomnia and Impaired Quality of Life in the United States
Insomnia and Impaired Quality of Life in the United States
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DOI：
10.4088/jcp.17m12020
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发表时间：
2018-09-01
影响因子：
5.3
通讯作者：
Blanco, Carlos
中科院分区：
文献类型：
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作者：
Olfson, Mark;Wall, Melanie;Blanco, Carlos
目的：分析失眠与其他疾病的个体水平和人群水平的负担，描述失眠与其他疾病的共病情况，包括这些共病对疼痛、生活事件和精神障碍的依赖性。方法：对2012-2013年全国酒精及相关疾病流行病学调查的34,712名成年人的资料进行分析。采用SF-6D测量质量调整寿命年(QALY)，SF-6D是一种由简表2版衍生而来的6维健康状况分类。美国每年与失眠相关的QALY损失(560万；95%CI，5.33-586万)显著高于其他18种被评估的疾病，包括关节炎(494万；95%CI，462-526万)、抑郁症(402万；95%CI，387-417万)和高血压(363万；95%CI，332万-393万)。在控制了人口因素后，从肥胖(调整后的优势比[AOR]=1.25)到躁狂(调整后的优势比=5.04)的所有检查都与失眠风险增加有关。进一步控制疼痛、应激性生活事件和精神障碍降低了失眠与这些情况同时发生的几率。与疼痛相关的失眠共患病率下降最多的是纤维肌痛(31.8%)和关节炎(20.1%)；与生活事件相关的失眠共病下降最多的是躁狂症(13.4%)和药物使用障碍(11.2%)，与精神障碍相关的失眠共病下降最多的是消化性溃疡疾病(11.2%)和肝病(11.1%)。失眠与常见疾病的共同出现与疼痛有不同的关系，在较小程度上与紧张的生活事件和精神障碍有关。
Objective: This analysis characterizes the individual-level and population-level burden of insomnia in relation to other medical conditions and describes the comorbidity of insomnia with other medical conditions, including the dependence of these comorbidities on pain, life events, and mental disorders.Methods: Information from 34,712 adults in the National Epidemiologic Survey on Alcohol and Related Conditions-III (2012-2013) was analyzed. Quality-adjusted life-years (QALYs) were measured with the SF-6D, a 6-dimensional health state classification derived from the Short-Form-12, version 2.Results: In the last 12 months, 27.3% of adults reported insomnia. The US annual loss of QALYs associated with insomnia (5.6 million; 95% CI, 5.33-5.86 million) was significantly larger than that associated with any of the other 18 medical conditions assessed, including arthritis (4.94 million; 95% CI, 4.62-5.26 million), depression (4.02 million; 95% CI, 3.87-4.17 million), and hypertension (3.63 million; 95% CI, 3.32-3.93 million). After control for demographic factors, all conditions examined from obesity (adjusted odds ratio [aOR] = 1.25) to mania (aOR = 5.04) were associated with an increased risk of insomnia. Further controlling for pain, stressful life events, and mental disorders decreased the odds of the co-occurrence of insomnia with these conditions. The decrease in insomnia comorbidity associated with pain was greatest for fibromyalgia (31.8%) and arthritis (20.1%); the decrease in insomnia comorbidity associated with life events was greatest for mania (13.4%) and drug use disorders (11.2%), and the decrease in insomnia comorbidity associated with mental disorders was greatest for peptic ulcer disease (11.2%) and liver diseases (11.1%).Conclusions: Insomnia is prevalent and associated with substantial population-level burden in self-assessed health. The co-occurrence of insomnia with common medical conditions is differentially related to pain and to a lesser extent to stressful life events and mental disorders.