BACKGROUND:Insomnia is widely reported and widely treated in general practice, yet relatively little research has focused on the natural history of the condition in primary care settings. As a result, there is at present little information to enable clinicians to assess insomnia risk, or anticipate outcomes in older general practice populations.

AIM:To estimate, using 8-year longitudinal data, the risk of insomnia onset associated with selected health and lifestyle factors.

METHOD:Survivors from a nationally representative sample (n = 1042) of elderly people originally interviewed in 1985 were reassessed in 1989 (n = 690) and 1993 (n = 410). At the first follow up in 1989, 84 new cases of insomnia were identified (a weighted incidence rate per person per year at a risk of 3.1%; 95% CI = 2.7-3.5). In logistic regression analyses controlling for age and sex, the risk of insomnia onset was then assessed in relation to the selected factors.

RESULTS:Three factors assessed in 1985 were significantly and independently related to incident insomnia: psychometric ratings consistent with depressed mood odds ratio (OR) = 4.41; 95% CI = 3.32-5.43); health index scores indicating lower physical health status (OR = 1.19; 95% CI = 1.06-1.31 per unit change in scale score); and moderate and low levels of physical activity (OR = 1.91 and 2.14; 95% CI = 1.91-3.62 and 2.14-3.64 respectively). However, although depressed mood represented a major risk factor, the most likely source of risk was physical rather than mental ill-health.

CONCLUSIONS:Psychiatric, somatic and lifestyle factors significantly and independently increase the risk of insomnia in older general practice patients. In predicting incident sleep disturbance, these factors exceed in importance the age and sex of patients.

译文

背景:失眠已被广泛报道并在一般实践中得到了广泛的治疗,但是相对较少的研究集中在初级保健机构中病情的自然史上。因此,目前尚无足够的信息可帮助临床医生评估失眠风险或预测老年全科人群的结局。

AIM :使用8年纵向评估数据,与选定的健康和生活方式因素相关的失眠风险。

方法:对来自全国代表性样本(n = 1042)的老年人的幸存者进行了重新评估,该样本最初于1985年接受采访。在1989年(n = 690)和1993(n = 410)。在1989年的首次随访中,发现了84例新的失眠病例(加权平均每人每年的发病率,风险为3.1%; 95%CI = 2.7-3.5)。在控制年龄和性别的逻辑回归分析中,然后根据所选因素评估了失眠的风险。

结果:1985年评估的三个因素具有显着性和独立性发生失眠:心理测验评分与沮丧的情绪几率之比(OR)= 4.41; 95%CI = 3.32-5.43);健康指数得分,表明身体健康状况较低(OR = 1.19; 95%CI =单位得分变化每单位1.06-1.31);中度和低度的体育活动(OR分别为1.91和2.14; 95%CI分别为1.91-3.62和2.14-3.64)。但是,尽管情绪低落是主要的危险因素,但最可能的危险来源是身体而不是精神疾病。

结论:精神,躯体和生活方式因素显着且独立增加老年全科患者失眠的风险。在预测事件性睡眠障碍时,这些因素的重要性超过了患者的年龄和性别。

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