Insomnia with objective short sleep duration: The most biologically severe phenotype of the disorder

被引:536
作者
Vgontzas, Alexandros N. [1 ]
Fernandez-Mendoza, Julio [1 ]
Liao, Duanping [2 ]
Bixler, Edward. [1 ]
机构
[1] Penn State Univ, Coll Med, Dept Psychiat, Sleep Res & Treatment Ctr, Hershey, PA 17033 USA
[2] Penn State Univ, Coll Med, Dept Publ Hlth Sci, Hershey, PA 17033 USA
基金
美国国家卫生研究院;
关键词
Insomnia; Physiological hyperarousal; Short sleep duration; Polysomnography; Actigraphy; Morbidity; Mortality; HEART-RATE-VARIABILITY; RANDOMIZED CONTROLLED-TRIAL; MATCHED NORMAL SLEEPERS; MIDDLE-AGED ADULTS; GENERAL-POPULATION; PSYCHOPHYSIOLOGICAL INSOMNIA; COGNITIVE PERFORMANCE; CLINICAL-IMPLICATIONS; DAYTIME ALERTNESS; CONSTANT ROUTINE;
D O I
10.1016/j.smrv.2012.09.005
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Until recently, the association of chronic insomnia with significant medical morbidity was not established and its diagnosis was based solely on subjective complaints. We present evidence that insomnia with objective short sleep duration is the most biologically severe phenotype of the disorder, as it is associated with cognitive-emotional and cortical arousal, activation of both limbs of the stress system, and a higher risk for hypertension, impaired heart rate variability, diabetes, neurocognitive impairment, and mortality. Also, it appears that objective short sleep duration is a biological marker of genetic predisposition to chronic insomnia. In contrast, insomnia with objective normal sleep duration is associated with cognitive-emotional and cortical arousal and sleep misperception but not with signs of activation of both limbs of the stress system or medical complications. Furthermore, the first phenotype is associated with unremitting course, whereas the latter is more likely to remit. We propose that short sleep duration in insomnia is a reliable marker of the biological severity and medical impact of the disorder. Objective measures of sleep obtained in the home environment of the patient would become part of the routine assessment of insomnia patients in a clinician's office setting. We speculate that insomnia with objective short sleep duration has primarily biological roots and may respond better to biological treatments, whereas insomnia with objective normal sleep duration has primarily psychological roots and may respond better to psychological interventions alone. (C) 2012 Elsevier Ltd. All rights reserved.
引用
收藏
页码:241 / 254
页数:14
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