Towards quantitative cutoffs for insomnia: how current diagnostic criteria mischaracterize remission.
Towards quantitative cutoffs for insomnia: how current diagnostic criteria mischaracterize remission.
复制标题
失眠的定量截止点：当前的诊断标准如何错误地描述缓解情况。
DOI：
10.1016/j.sleep.2016.01.013
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发表时间：
2016
期刊：
影响因子：
4.8
通讯作者：
Drake,ChristopherL
中科院分区：
文献类型：
--
作者：
Pillai,Vivek;Roth,Thomas;Drake,ChristopherL
ObjectiveAlthough sleep symptoms of insomnia can be quantified, none of the current diagnostic systems stipulate quantitative cutoffs for sleep-onset latency (SOL) or wake time after sleep onset (WASO). Diagnoses are based instead on idiographic patient reports of “difficulty” falling/staying asleep. Therefore, we examined whether remission of insomnia as per the diagnostic criteria results from a normalization of quantitative sleep disturbance, or if it is simply reflective of tolerance to sleep symptoms.MethodsThis study involved a yearlong prospective investigation of 649 adults (48.1 ± 11.6 years; 69.3% female) with DSM-5-based insomnia. Participants completed measures of sleep disturbance, perceived sleep-related distress, daytime sleepiness, functional impairment, and workplace productivity at baseline and follow-up one year later.ResultsA total of 271 participants no longer met the DSM-5-based insomnia criteria at follow-up. However, 66% of these remitters reported ≥31 min of SOL and/or WASO. Daytime impairment in this subgroup of remitters was no different from that among individuals who met the diagnostic criteria at both baseline and follow-up (ie, chronic insomniacs). By contrast, follow-up impairment was significantly lower (F= 12.3;P< 0.01) among remitters whose sleep disturbance returned below empirically derived quantitative cutoffs (both SOL and WASO <31 min) than in chronic insomniacs.ConclusionThis is the first study on the long-term course of insomnia based on the newly established DSM-5 criteria. A troubling implication of findings is that a majority of insomniacs stop meeting the diagnostic criteria despite continued sleep disturbance and impairment. “Remission” in these cases is attributable instead to tolerance of sleep symptoms. Incorporating quantitative criteria into current diagnoses may offer a more sensitive assay of treatment needs.
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Means, MK
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Zammit, Gary K.
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STEPANSKI, E;KOSHOREK, G;ROTH, T
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慢性失眠的长期随访。
影响因子：
5.6
作者：
Mendelson,WB
通讯作者：
Mendelson,WB