만성불면증에서 모순불면증의 비율과 관련된 임상요인: 후향적 관찰 연구
Proportion and Associated Clinical Factors of Paradoxical Insomnia in Patients With Chronic Insomnia: A Retrospective and Observational Study
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Objectives: Paradoxical insomnia, a type of sleep disorder, is characterized by misperception and underestimation of an individual’s sleep time. In this study, we investigated the percentage and clinical factors associated with paradoxical insomnia in patients with chronic insomnia, who underwent polysomnography.Methods: The study included 148 patients with chronic insomnia. The study population was categorized into paradoxical and non-paradoxical insomnia groups. The following criteria were used to define paradoxical insomnia: 1) total sleep time >390 min and sleep efficiency ≥85.0%, and 2) significant discrepancy of >1 hour between subjective and objective sleep measurements. We analyzed demographic data, polysomnographic parameters, and perceived sleep time in all patients.Results: Among 148 patients with chronic insomnia, 33 (22.6%) had paradoxical insomnia. We observed significant intergroup differences in age, sex, and the Insomnia Severity Index (ISI). Sleep architecture patterns were relatively better in the paradoxical than in the non-paradoxical insomnia group. Logistic regression analysis was performed to determine clinical factors associated with paradoxical insomnia. Female sex (odds ratio [OR] 2.96, 95% confidence interval [CI] 1.19–7.37), age (OR 0.97, 95% CI 0.94–0.99), and ISI (OR 1.18, 95% CI 1.05–1.31) were significantly associated with paradoxical insomnia.Conclusions: Approximately 20.0% of patients with chronic insomnia were classified into the paradoxical insomnia group, and female sex, age, and ISI were identified as clinical factors associated with this type of sleep disorder.
Abstract
Objectives: Paradoxical insomnia, a type of sleep disorder, is characterized by misperception and underestimation of an individual’s sleep time. In this study, we investigated the percentage and clinical factors associated with paradoxical insomnia in patients with chronic insomnia, who underwent polysomnography.Methods: The study included 148 patients with chronic insomnia. The study population was categorized into paradoxical and non-paradoxical insomnia groups. The following criteria were used to define paradoxical insomnia: 1) total sleep time >390 min and sleep efficiency ≥85.0%, and 2) significant discrepancy of >1 hour between subjective and objective sleep measurements. We analyzed demographic data, polysomnographic parameters, and perceived sleep time in all patients.Results: Among 148 patients with chronic insomnia, 33 (22.6%) had paradoxical insomnia. We observed significant intergroup differences in age, sex, and the Insomnia Severity Index (ISI). Sleep architecture patterns were relatively better in the paradoxical than in the non-paradoxical insomnia group. Logistic regression analysis was performed to determine clinical factors associated with paradoxical insomnia. Female sex (odds ratio [OR] 2.96, 95% confidence interval [CI] 1.19–7.37), age (OR 0.97, 95% CI 0.94–0.99), and ISI (OR 1.18, 95% CI 1.05–1.31) were significantly associated with paradoxical insomnia.Conclusions: Approximately 20.0% of patients with chronic insomnia were classified into the paradoxical insomnia group, and female sex, age, and ISI were identified as clinical factors associated with this type of sleep disorder.
참고문헌 (28)
- Roth T, "Insomnia : definition, prevalence, etiology, and consequences", J Clin Sleep Med, 3(5 Suppl), pp.S7~S10 (2007)[DOI]
- Morin CM, "Epidemiology of insomnia : prevalence, course, risk factors, and public health burden", Sleep Med Clin, 17, pp.173~191 (2022)[DOI]
- Patel D, "Insomnia in the elderly : a review", J Clin Sleep Med, 14, pp.1017~1024 (2018)[DOI]
- Trinder J, "Subjective insomnia without objective findings : a pseudo diagnostic classification?", Psychol Bull, 103, pp.87~94 (1988)[DOI]
- American Academy of Sleep Medicine, "International classification of sleep disorders. 2nd ed", American Academy of Sleep Medicine, 9~11 (2005)
- Rezaie L, "Paradoxical insomnia and subjective-objective sleep discrepancy : a review", Sleep Med Rev, 40, pp.196~202 (2018)[DOI]
- Manconi M, "Measuring the error in sleep estimation in normal subjects and in patients with insomnia", J Sleep Res, 19, pp.478~486 (2010)[DOI]
- Wasey W, "Paradoxical insomnia in a frustrated patient treated with hypnotics for ten years", Cureus, 13, pp.e16234~ (2021)[DOI]
- Harvey AG, "A cognitive model of insomnia", Behav Res Ther, 40, pp.869~893 (2002)[DOI]
- Natale V, "Actigraphy in the assessment of insomnia : a quantitative approach", Sleep, 32, pp.767~771 (2009)[DOI]
- Harvey AG, "(Mis)perception of sleep in insomnia : a puzzle and a resolution", Psychol Bull, 138, pp.77~101 (2012)[DOI]
- Pérusse AD, "REM sleep as a potential indicator of hyperarousal in psychophysiological and paradoxical insomnia sufferers", Int J Psychophysiol, 95, pp.372~378 (2015)[DOI]
- Edinger JD, "Derivation of research diagnostic criteria for insomnia : report of an American Academy of Sleep Medicine Work Group", Sleep, 27, pp.1567~1596 (2004)[DOI]
- 조용원, "Validation of a Korean Version of the Insomnia Severity Index", Journal of Clinical Neurology, 10(3), pp.210~215 (2014), 대한신경과학회[DOI]
- Carney CE, "Assessing depression symptoms in those with insomnia : an examination of the beck depression inventory second edition(BDI-II)", J Psychiatr Res, 43, pp.576~582 (2009)[DOI]
- Beck AT, "An inventory for measuring clinical anxiety : psychometric properties", J Consult Clin Psychol, 56, pp.893~897 (1988)[DOI]
- Castelnovo A, "The paradox of paradoxical insomnia : a theoretical review towards a unifying evidence-based definition", Sleep Med Rev, 44, pp.70~82 (2019)[DOI]
- Salin-Pascual RJ, "Long-term study of the sleep of insomnia patients with sleep state misperception and other insomnia patients", Am J Psychiatry, 149, pp.904~908 (1992)[DOI]
- 문혜진, "Clinical Characteristics of Primary Insomniacs with Sleep-State Misperception", Journal of Clinical Neurology, 11(4), pp.358~363 (2015), 대한신경과학회[DOI]
- Zeng LN, "Gender difference in the prevalence of insomnia : a meta-analysis of observational studies", Front Psychiatry, 11, pp.577429~ (2020)[DOI]
- Kawai K, "A study of factors causing sleep state misperception in patients with depression", Nat Sci Sleep, 14, pp.1273~1283 (2022)[DOI]
- Tsuchiyama K, "Discrepancy between subjective and objective sleep in patients with depression", Psychiatry Clin Neurosci, 57, pp.259~264 (2003)[DOI]
- 최수정, "액티와치로 측정한 객관적 짧은 수면시간, 주관적 짧은 수면시간, 정상 수면시간 불면증 아형의 임상적 특성", Journal of sleep medicine, 19(1), pp.12~20 (2022), 대한수면연구학회[DOI]
- Van Someren EJW, "Brain mechanisms of insomnia : new perspectives on causes and consequences", Physiol Rev, 101, pp.995~1046 (2021)[DOI]
- Malik J, "Sleep-wake classification via quantifying heart rate variability by convolutional neural network", Physiol Meas, 39, pp.085004~ (2018)[DOI]
- Carskadon MA, "Principles and practice of sleep medicine", pp.16~26 (2011), Elsevier
- Littner M, "Practice parameters for using polysomnography to evaluate insomnia : an update", Sleep, 26, pp.754~760 (2003)[DOI]
- Withrow D, "Relation between ambulatory actigraphy and laboratory polysomnography in insomnia practice and research", J Sleep Res, 28, pp.e12854~ (2019)[DOI]
