慢性睡眠問題與自殺行為風險增加有關


  April 16, 2009 — 新研究結果顯示,慢性睡眠問題與自殺風險顯著增加有關。
  
  一項以群眾為基礎的大型研究結果顯示,相較於無失眠問題者,有睡眠問題的人有自殺意圖的風險高出三倍。
  
  除此之外,難以入睡、維持睡眠以及容易早醒都顯著地與自殺想法、計畫與實行有關。
  
  主要作者、安納保密西根大學的研究人員、波蘭華沙醫學大學的精神科副教授Marcin Wojnar醫師向Medscape精神學表示,我們的研究結果顯示,有睡眠困難的人們,即使沒有精神狀態問題,同樣處於自殺的高風險。這些研究數據也顯示,失眠可能是一般大眾一個可改變的自殺危險因子。
  
  這項研究發現發表在義大利佛羅倫斯世界精神學會國際年會的精神病治療上,並發表於2月號的精神學研究期刊上(Wojnar M等人,J Psychiatr Res. 2009;43:526-531)。
  
  【第一個以群眾為基礎的研究】
  自殺是過早死亡的一個常見原因;在美國,每年有將近3萬人自殺死亡。除此之外,據估計有超過395,000急診就診紀錄是因為非致命性的自我傷害。
  
  睡眠問題也是很常見的,在過去一年中,近三分之一的美國成人報告有一個以上的睡眠障礙。此外,作者們表示,睡眠問題強烈地與共同發生的精神疾病有關,接著與自殺的風險增加有關。
  
  根據Wojnar博士表示,即使睡眠問題與自殺之間的連結經常在許多臨床病患身上被報導,但這個議題並未在一般大眾身上好好地進行研究。
  
  透過來自國家並存疾病調查-重複試驗(NCS-R),這是以美國群眾為代表的國家樣本,研究者們針對5,692位個體,檢驗一年間三種失眠特徵與三種自殺行為之間的關聯性。這些資料中,大約有35%報告在過去的12個月間曾經發生至少一種睡眠障礙。
  
  早起與各種自殺行為有最一致的關係,勝算比(ORs)分別為2.0、2.1與2.7,對應至自殺想法、自殺計畫與自殺企圖。研究者進一步發現困難入睡是自殺想法(OR為1.9)以及計畫(OR為2.2)一個顯著的預測因子。而難以維持睡眠是自殺想法(OR為2.0)與企圖(OR為3.0)的顯著預測因子。
  
  【機轉仍然不明】
  Wojnar博士表示,睡眠問題如何影響自殺行為目前仍然未知。然而,他指出,睡眠不足可能對於認知功能有不良影響,使他們判斷不良、難以控制衝動、容易疲倦且無望,這些都與自殺念頭及企圖有關。
  
  睡眠品質不佳可能也與血清素系統功能失調有關,這被證實在睡眠、精神異常與自殺中扮演重要角色。
  
  不論機轉為何,Wojnar博士表示其研究發現對於臨床有重要影響,且暗示醫師應該常規地篩檢病患是否有睡眠問題。
  
  Wojnar博士附帶表示,他的下一個研究步驟將包括在波蘭族群身上重複驗證這些研究結果。
  
  這項研究由美國退伍軍人事務、國家藥物濫用機構、國家酒精濫用與酒精成癮機構、與國家精神健康機構贊助。研究者們表示無相關資金上的往來。
  

Chronic Sleep Problems Linked to Increased Risk for Suicidal Behavior

By Caroline Cassels
Medscape Medical News

April 16, 2009 — Chronic sleep problems significantly increase the risk for suicidal behavior, new research suggests.

A large population-based study shows that individuals with sleep problems are almost 3 times more likely to report a suicide attempt than those without insomnia complaints.

Furthermore, difficulty initiating or maintaining sleep as well as early morning wakening were all significantly associated with suicidal thoughts, plans, and attempts.

"Our study suggests individuals with sleep disturbances are at heightened risk of suicide even in the absence of a psychiatric condition. These data also suggest that insomnia may be an important modifiable risk factor for suicide in the general population," principal investigator Marcin Wojnar, MD, PhD, a research fellow at the University of Michigan, in Ann Arbor, and associate professor of psychiatry at the Medical University, in Warsaw, Poland, told Medscape Psychiatry.

The study findings were recently presented at the World Psychiatric Association International Congress on Treatments in Psychiatry, in Florence, Italy, and were also published in the February issue of the Journal of Psychiatric Research (Wojnar M et al. J Psychiatr Res. 2009;43:526-531).

First Population-Based Study

Suicide is a common cause of premature mortality; approximately 30,000 people in the United States die by suicide every year. Furthermore, it is estimated that over 395,000 emergency-department visits are for the treatment of nonfatal self-injury.

Sleep problems are also common, with approximately one-third of US adults reporting 1 or more sleep complaints within the past year. Further, the authors note that sleep problems are strongly associated with co-occurring psychiatric disorders, which in turn are linked to an increased risk for suicidality.

According to Dr. Wojnar, while links between sleep problems and suicidality have been frequently described in clinical samples, the issue has not been well studied in the general population.

Using data from the National Comorbidity Survey–Replications study (NCS-R), a national sample representative of the US population, the investigators examined the relationship over 1 year between 3 characteristics of insomnia and 3 suicidal behaviors in 5692 subjects. Approximately 35% of those studied reported experiencing at least 1 type of sleep disturbance in the preceding 12 months.

Early morning wakening had the most consistent link for all suicidal behaviors, with odds ratios (ORs) of 2.0, 2.1, and 2.7 for suicidal ideation, planning, and attempts, respectively. Further, the investigators found that difficulty initiating sleep was a significant predictor of suicidal ideation (OR, 1.9) and planning (OR, 2.2).

Difficulty maintaining sleep was a significant predictor of suicidal ideation (OR, 2.0) and attempt (OR, 3.0).

Underlying Mechanism Not Well Understood

Exactly how sleep problems influence suicidal behavior is not well understood, said Dr. Wojnar. However, he said, it is possible that insufficient sleep may have a negative impact on cognitive function, leading to poor judgment, less impulse control, and increased fatigue and hopelessness, all of which may contribute to suicidal thoughts and behavior.

It is also possible that poor sleep quality causes dysfunction of the serotonin system, which has been shown to play an important role in sleep, psychiatric disorders, and suicide.

Whatever the underlying mechanism, Dr. Wojnar said the study's findings have important clinical implications and suggest physicians should routinely screen their patients for sleep disturbances.

Dr. Wojnar added that his next research steps include an attempt to replicate these results in a similar population-based study in Poland.

The study was funded by the US Department of Veterans Affairs, the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, and the National Institute of Mental Health. The authors report no disclosures.

World Psychiatric Association International Congress: Abstract NRS4.5. Presented April 1, 2009.

    
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