The subjective-objective mismatch in sleep perception among those with insomnia and sleep apnea

被引:122
作者
Bianchi, Matt T. [1 ,2 ]
Williams, Kathryn L. [1 ]
Mckinney, Scott [1 ]
Ellenbogen, Jeffrey M. [1 ,2 ]
机构
[1] Massachusetts Gen Hosp, Dept Neurol, Sleep Div, Boston, MA 02114 USA
[2] Harvard Univ, Sch Med, Div Sleep Med, Boston, MA USA
关键词
misperception; paradoxical; self-report; subjective; STATE MISPERCEPTION; TIME-ESTIMATION; LONG-TERM; DURATION; ADULTS; METAANALYSIS; VARIABILITY; PERFORMANCE; SUFFERERS; ONSET;
D O I
10.1111/jsr.12046
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
The diagnosis and management of insomnia relies primarily on clinical history. However, patient self-report of sleep-wake times may not agree with objective measurements. We hypothesized that those with shallow or fragmented sleep would under-report sleep quantity, and that this might account for some of the mismatch. We compared objective and subjective sleep-wake times for 277 patients who underwent diagnostic polysomnography. The group included those with insomnia symptoms (n=92), obstructive sleep apnea (n=66) or both (n=119). Mismatch of wake duration was context dependent: all three groups overestimated sleep latency but underestimated wakefulness after sleep onset. The insomnia group underestimated total sleep time by a median of 81min. However, contrary to our hypothesis, measures of fragmentation (N1, arousal index, sleep efficiency, etc.) did not correlate with the subjective sleep duration estimates. To unmask a potential relationship between sleep architecture and subjective duration, we tested three hypotheses: N1 is perceived as wake; sleep bouts under 10min are perceived as wake; or N1 and N2 are perceived in a weighted fashion. None of these hypotheses exposed a match between subjective and objective sleep duration. We show only modest performance of a Naive Bayes Classifier algorithm for predicting mismatch using clinical and polysomnographic variables. Subjective-objective mismatch is common in patients reporting insomnia symptoms. We conclude that mismatch was not attributable to commonly measured polysomnographic measures of fragmentation. Further insight is needed into the complex relationships between subjective perception of sleep and conventional, objective measurements.
引用
收藏
页码:557 / 568
页数:12
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