| Insomnia is one of the most common sleep disorder characterized by difficulty to falling or maintaining sleep, and a subjective experience that sleep quality or quantity are less than the normal requirements.Many reasons can cause insomnia. That caused by psychological, physiological or environmental factors is known as secondary insomnia; and not any certain causes of insomnia is known as primary insomnia.Insomnia as a common disease of modern society, and its incidence has increased year by year.Survey, 33% Americans, 4%~22% Europeans suffering from insomnia, while our country's current incidence of insomnia is also up to 10%~20%. Numerous studies show that patients with insomnia is associated with anxiety, depression and other psychopathology symptoms. Hongjun,etc. reported there is illness in insomnia patients,associated with anxiety,nervous,emotional disorders,such as easy fatigue. Mellinger, etc. reported that insomnia patients are often associated with emotional disorders, especially depression, anxiety, and nervous symptoms such as irritability. Ford, etc. reported those who suffer from insomnia associated with anxiety and depressive symptoms. Panjiyang,etc. believe that patients with insomnia not only have severe nervous anxiety, but significantly higher depression than the normal sleep group. Bad sleep quality is often easy to produce or increase psychosomatic symptoms, and psychosomatic symptoms can make the quality of sleep even worse, and cause a vicious circle in patients with insomnia.Therefore,the study of sleep quality, anxiety, depression and differences in primary and secondary insomnia patients, and relationship between sleep quality with anxiety and depression, can be more effective in preventing insomnia and to effectively guide treatment of insomnia. 1,Subjects:Randomly selected 173 cases of insomnia patients for treatment at neurology out-patient department of our hospital from May 2008 to August 2008. And that are divided into the primary insomnia group (119 cases) and the secondary insomnia group (54 cases) based on the availability of the exact cause of insomnia. There are 15 cases originated of mental illness, 39 cases originated of body disease in 54 cases of secondary insomnia patients. Primary insomnia group, all patients are in line with in the diagnostic criteria for insomnia of Chinese mental and psychological disease classification and diagnostic criteria (CCMD-Ⅲ). Seconda- ry group, all patients with insomnia are in line with of course standards, severe standards, symptoms standards of insomnia diagnostic criteria of the CCMD-Ⅲand has specific primary disease.1.1. Primary insomnia group: male 21 cases, female 98 cases; age 19~75 years old, average 43.9 years of age; University College and above 20 cases, middle school and high school diploma 61 cases, 38 cases of primary and secondary schools the following academic qualifications; course of one month to 10 years.1.2.. Secondary insomnia group: male 8 cases, female 46 cases; age 21~71 years old, average 47.1 years of age; University College and above 8 cases, middle school and high school diploma 29 cases, 17 cases of primary and secondary schools the following academic qualifications; course of one month to 20 years.There is no significant difference in the sex, age, education level by statistical tests (p> 0.05), and two sets of data are comparable.2,Assessment method:the evaluation scale2.1. Athens Insomnia Scale (Athens Insomnia Scale, AIS), is a sleep selfassessment instrument.It is composed of eight questions,including sleep induction, awakenings during the night, final awakening, total sleep duration, sleep quality, well-being, functioning capacity, and sleepiness during the day. 0,1,2,3 points for each question by assessing four cumulative elements of a total score, total score of less than 4 points: no sleep disorders; if the total score at 4 to 6 points: suspicious insomnia; if the total score at 6 points or more: insomnia. The higher the score, the poorer sleep quality.2.2. General Hospital Anxiety and Depression Scale (Hospital Anxiety and Depression Scale, HAD), created by Zigmond and Snaith in 1983, mainly used to screen anxiety and depression of patients in general hospital. HAD Scale is composed of by two subscales of anxiety (HAD-A) and depression (HAD-D), it can be assessed separately the situation of anxiety and depression. Each subscale includes the seven projects, and A project is on behalf of anxiety items, D on behalf of depression items.Each of them adopt 4 scoring system. Superposition of two sets of items separately would be to arrive at their respective scores. Total 0-7 points represents normal; total 8-10 points represents mild depression or anxiety; score 11-14 points represents moderate depression or anxiety; score 15-21 points represents serious depression or anxiety. In this study, subscale scores 8 points or more, defined as anxiety and depression, and further evaluation with scale HAMA and HAMD.2.3. Hamilton Anxiety Scale (Hamilton Anxiety Scale, HAMA) 14 item version: it was established by Hamiltony in 1959, using conversation and observation of the way of assessment. Evaluation criteria: HAMA total score <7 points, without anxiety; 7≤HAMA total score <14 points, there is probably anxiety; 14 points≤HAMA total score <21 points, certainly there is anxiety; 21 points≤HAMA total score <29 points, certainly there is clearly anxiety; HAMA total score≥29 points, probably as serious anxiety.2.4. Hamilton Depression Rating Scale (Hamilton Depression Scale, HAMD) 17 item version: it was established by Hamiltony in 1960, using conversation and observation of the way of assessment. Evaluation criteria: HAMD total score <7 points, no depression; 7≤HAMD total score <17 points, there is probably depression; 17 points≤HAMA total score <24 points, are possible with mild or moderate depression; HAMD total score≥24 points, probably suffering from severe depression.2.5. statistical treatmentAnalysising the experimental data with t tests,χ2 test, and linear correlation analysis by application of SAS (statistical analysis system) software.3,Result: 3.1. AIS evaluation results :The total number of patients with insomnia is 173, including the 119 cases primary insomnia group and 54 cases secondary group,and AIS scores of all the cases is more than 6 points. Compared with primary insomnia, secondary insomnia group scores higher in the AIS scores, sleep latency, sleep interruption, final awakening, total sleep time, the impact of emotions on the day , the impact of physical function during the day (physical or mental : such as memory, cognition and attention, etc.) and sleepiness during the day.But the t tests shows no significant difference (P> 0.05) in the two groups, there is no sta- tistical significance. In the evaluation of overall sleep quality, the scores of secondary insomnia group is lower than that of primary insomnia group.3.2. HAD, HAD-A, HAD-D, HAMA, HAMD Evaluation Results: Compared with primary insomnia, secondary insomnia group scores higher in anxiety, emotional depression. there is a significant difference in HAD and HAD-A scores,P <0.05; But there is no significant difference between the secondary insomnia group and the primary insomnia group in the HAD-D, HAMA and HAMD scores, P> 0.05.3.3. The incidence of anxiety and depression in patients with insomnia: The anxiety exists in 92 cases of all 173 insomnia patients, accounting for 53.18%; the depression exists in 102 cases of all 173 insomnia patients, accounting for 58.96%; the anxiety and depression co-existence exists in 79 cases of all 173 insomnia patients, accounting for 45.66%. The anxiety exists in 57 cases of 119 primary insomnia patients, accounting for 47.90%; the depression exists in 67 cases of 119 primary insomnia patients, accounting for 56.30%; the anxiety and depression co-existence exists in 48 cases of 119 primary insomnia patients, accounting for 40.34%. The anxiety exists in 35 cases of 54 secondary insomnia patients, accounting for 64.81%; the depression exists in 35 cases of 54 secondary insomnia patients, accounting for 64.81%; the anxiety and depression co-existence exists in 31 cases of 54 secondary insomnia patients, accounting for 57.41%. By theχ2 test, the incidence of secondary insomnia group is higher than the incidence of primary insomnia group in the anxiety and the coexistence of anxiety and depression, but the incidence of depression is no significant difference between the two groups. 3.4. The correlation Analysis between AIS with HAD, HAD-A, HAD-D, HAMA, HAMD: The linear correlation analysis shows that there is a positively correlations between AIS scores with HAD, HAD-A, HAD-D, HAMA and HAMD scores in the insomnia patients, r value between 0 to 1, P <0.01, the correlations has statistical significance.4,Conclusion:4.1. Compared with the primary insomnia group,the secondary insomnia group scores higher in the AIS total score and factor scores (for the exception of the overall evaluation of sleep quality), but there is no significant difference in the two groups (p> 0.05),that notes sleep quality of the primary and secondary insomnia patients is no significant difference.4.2. The secondary insomnia group score higher than the primary insomnia group in the anxiety and depression(HAMA, HAMD), but this difference has yet to reach statistical significance (p>0.05), that shows the severity of the anxiety and depression is no significant difference in primary and secondary insomnia patients.4.3. The incidence of the anxiety and the coexistence of anxiety and depression in the secondary insomnia group is higher than the primary insomnia group (p<0.05), while the incidence of depression is no significant difference between the two groups (p> 0.05).4.4. The linear correlation analysis showes that higher the Athens Insomnia Scale (AIS) score is, higher the anxiety and depression scale (HAMA, HAMD) in the primary and secondary patients with insomnia, p value <0.01, that descrips that the degree of insomnia and anxiety and depression are positively correlated. Poorer sleep quality in patients with insomnia, more serious the anxiety and depression.In summary, sleep is affected by environmental, physical and mental condition and other factors, insomnia is not only a process of physiological disorder, but alao a process of psychological disorder. The study promptes that both of the primary and secondary insomnia patients have poor sleep quality. This study suggests that both of the primary and secondary patients with insomnia have poor sleep quality, including sleep latency(time more than 30 minutes to fall asleep), sleep interruption, final awakening, total sleep time(less than six hours per night), Patients feel sleepy during the day, not satisfied with the overall quality of sleep. Patients` emotional and physical function (physical or spiritual: such as memory, cognition and attention, etc.) are subject to different degrees during the day. Compared with primary insomnia, secondary insomnia patients with AIS, HAMA, HAMD score higher, but there is no significant difference (p> 0.05). That shows that the sleep quality and the severity of anxiety and depression emotions between the secondary with primary insomnia patients is no significant difference. But the incidence of anxiety and coexistence of anxiety and depression in the secondary insomnia group is higher than that in the primary insomnia group (p <0.05), while the incidence of depression is no significant difference between the two groups (p> 0.05). The study also shows there is a strong correlation between the quality of sleep (AIS) with depression and anxiety (HAMA, HAMD) in the patients with insomnia (p <0.01) , that is, the poorer sleep quality, and the more serious anxiety and depression. Therefore, in the course of treatment of insomnia, the original body and mental illness should be treated, their anxiety and depression should be controlled, and the ease of the heart strengthened, then the better therapeutic effect will be achieved through an integrated treatment.
|
PDF Full Text Request