BACKGROUND & AIMS: :Ramelteon, a potent agonist for the melatonin MT1 and MT2 brain receptors, has recently been granted approval by the US FDA for the treatment of insomnia associated with sleep onset. The drug has not exhibited potential for abuse or dependency in laboratory tests, nor does it interact with neurotransmitter receptors most associated with these phenomena, hence it has the great advantage of being a nonscheduled drug. Few data have been published in peer-reviewed journals describing its efficacy and side effects in patients with insomnia; however, side effects noted to date appear minor. No comparison study has been performed to determine whether the recommended dose of ramelteon 8 mg has any advantage over physiologic doses of melatonin (0.3 mg), particularly for long-term use.

背景与目标： Ramelteon是褪黑激素MT1和MT2脑受体的有效激动剂，最近已获得美国FDA批准用于治疗与睡眠发作有关的失眠症。该药物在实验室测试中未显示出滥用或依赖性的潜力，也未与与这些现象最相关的神经递质受体相互作用，因此具有作为非计划药物的巨大优势。很少有数据在同行评审的杂志上发表，描述其对失眠患者的疗效和副作用。但是，迄今为止注意到的副作用似乎很小。没有进行比较研究来确定推荐剂量的雷米替宁8 mg是否比生理剂量的褪黑激素（0.3 mg）有任何优势，特别是对于长期使用而言。

BACKGROUND & AIMS: BACKGROUND:Increasing evidence supports the usefulness of brain magnetic resonance imaging (MRI) for the diagnosis of human prion diseases. From the neuroradiological point of view, fatal familial insomnia is probably the most challenging to diagnose because brain lesions are mostly confined to the thalamus. OBJECTIVE:To determine whether multisequence MRI of the brain can show thalamic alterations and establish pathoradiologic correlations in a patient with familial fatal insomnia. DESIGN:Radioclinical prospective study. We describe a patient with fatal familial insomnia and normal MRI images. Because the MRI study was performed only 4 days before the patient's death, we were able to compare radiological data with the lesions observed at the neuropathologic level. PATIENT:A 55-year-old man with familial fatal insomnia. MAIN OUTCOME MEASURE:Magnetic resonance spectroscopy combined with the measurement of apparent diffusion coefficient of water in different brain areas. RESULTS:The neuroradiological study showed, in the thalamus but not in the other brain regions studied, an increase of apparent diffusion coefficient of water and a metabolic pattern indicating gliosis. These alterations closely correlated with neuropathologic data showing an almost pure gliosis that was restricted to the thalami. CONCLUSION:Considering fatal familial insomnia as a model of thalamic-restricted gliosis, this case demonstrates that multisequences of magnetic resonance can detect prion-induced gliosis in vivo, as confirmed by a neuropathologic examination performed only a few days after radiological examination.

背景与目标： 背景：越来越多的证据支持脑磁共振成像（MRI）在诊断人类病毒疾病方面的实用性。从神经放射学的角度来看，致命的家族性失眠可能是最具有挑战性的诊断方法，因为脑部病变大多局限在丘脑内。
目的：确定多发性颅脑MRI是否可以显示出家族性致命性失眠患者的丘脑改变并建立病理放射学相关性。
设计：放射临床前瞻性研究。我们描述了致命的家族性失眠和MRI正常的患者。由于MRI研究仅在患者死亡前4天进行，因此我们能够将放射学数据与在神经病理学水平上观察到的病变进行比较。
患者：55岁，患有家族性致命失眠。
主要观察指标：磁共振波谱学结合水在不同脑区的表观扩散系数的测量。
结果：神经放射学研究显示，在丘脑中而非其他大脑区域中，水的表观扩散系数增加，并且代谢模式表明神经胶质增生。这些改变与神经病理学数据紧密相关，神经病理学数据显示几乎仅限于丘脑的单纯神经胶质增生。
结论：考虑到致命性家族性失眠是丘脑限制性神经胶质细胞增生的模型，此病例表明，磁共振影像的多序列可以在体内检测病毒诱发的神经胶质增生，放射学检查仅在几天后进行的神经病理学检查证实了这一点。

BACKGROUND & AIMS: OBJECTIVE:Insomnia is a major health problem, and the need for effective and accessible treatment is urgent. The aim of the current study was to evaluate the short-term efficacy of an unguided Internet-based cognitive-behavioral treatment program for insomnia (CBTi), called SHUTi (Sleep Healthy Using the Internet). METHODS:This study used a parallel arm randomized controlled trial in Norway. Participants were randomly allocated to the SHUTi condition or a Web-based patient education condition. Both groups were assessed before and after the nine-week intervention period (online sleep diaries and questionnaires). The SHUTi participants were reassessed in a six-month nonrandomized follow-up. Primary outcome measures were the Insomnia Severity Index (ISI) and the Bergen Insomnia Scale (BIS). RESULTS:A total of 181 participants were included in the study; SHUTi condition (n = 95), patient education condition (n = 86). Intention-to-treat mixed-model repeated-measures analysis revealed that the SHUTi group had better short-term outcomes compared with the patient education group on most sleep measures. The SHUTi group showed a significant decrease on the primary outcomes, the ISI (dbetween = -1.77, 95% CI = -2.23, -1.31) and the BIS (dbetween = -1.00, 95% CI = -1.32, -.68). Improvements were maintained among the completing SHUTi participants at the six-month nonrandomized follow-up. However, dropout attrition was high. CONCLUSION:Unguided Internet-based CBTi produced significant short-term improvements in sleep in patients with chronic insomnia. This highlights the benefits of making Internet-delivered CBTi programs available as a standard first-line treatment option in public health services. Nevertheless, the rate of dropout attrition (participants not completing post-assessment) in this trial limits the generalizability of the findings.

背景与目标： 目的：失眠是一个主要的健康问题，迫切需要有效和容易获得的治疗。本研究的目的是评估一种名为SHUTi（使用互联网睡眠健康）的基于互联网的无指导性失眠认知行为治疗计划（CBTi）的短期疗效。
方法：本研究在挪威进行了一项平行臂随机对照试验。参与者被随机分配到SHUTi状况或基于Web的患者教育状况。在九周的干预期前后（在线睡眠日记和问卷）对两组进行了评估。在为期六个月的非随机随访中，对SHUTi参与者进行了重新评估。主要结局指标为失眠严重程度指数（ISI）和卑尔根失眠量表（BIS）。
结果：总共181名参与者被纳入研究。 SHUTi病状（n = 95），患者教育病状（n = 86）。意向治疗混合模型重复测量分析显示，与大多数患者的睡眠测量教育组相比，SHUTi组的短期预后要好。 SHUTi组显示主要结局，ISI（介于-1.77、95％CI = -2.23，-1.31）和BIS（介于-1.00、95％CI = -1.32，-。68之间）显着降低。 。在为期六个月的非随机随访中，完成的SHUTi参与者保持了改善。但是，辍学率高。
结论：基于互联网的无指导的CBTi在慢性失眠患者的睡眠中产生了显着的短期改善。这凸显了将Internet提供的CBTi程序作为公共卫生服务中的标准一线治疗选项提供的好处。但是，该试验中的辍学率（参加者未完成评估后）的流失率限制了研究结果的普遍性。

BACKGROUND & AIMS: BACKGROUND:We aimed at evaluating the amplitude changes of the motor evoked potentials (MEPs) induced by of low-frequency (LF) repetitive transcranial magnetic stimulation (rTMS) over the primary motor cortex (M1) in10 patients with primary insomnia (PI) and in 10 age-matched healthy controls. METHODS:Median peak-to-peak MEP amplitudes were assessed in all subjects at three times: at baseline (T0), after the first train of a single rTMS session (T1), and after the whole rTMS procedure (T2). This consists of 20 trains of 1 Hz stimulation with 50 stimuli per train and an intertrain interval of 30 s. RESULTS:Resting motor threshold (RMT) and MEPs amplitude did not differ between the two groups at T0. A reduction of MEP size was observed at both T1 and T2 in all subjects, but this was significantly less pronounced in patients than in control subjects. CONCLUSIONS:The lack of MEP inhibition reflects an altered response to LF rTMS in patients with PI. These rTMS findings are indicative of an altered cortical plasticity in inhibitory circuits within M1 in PI. Subjects with PI exhibited an impairment of the LTD-like mechanisms induced by inhibitory rTMS, thus providing further support to the involvement of GABA neurotransmission in the pathophysiology of PI.

背景与目标： 摘要背景：我们旨在评估10例原发性失眠（PI）和失眠患者的原发性运动皮层（M1）上的低频（LF）重复经颅磁刺激（rTMS）诱发的运动诱发电位（MEP）的幅度变化。在10个与年龄匹配的健康对照中。
方法：对所有受试者的中值峰峰值MEP振幅进行了三次评估：在基线（T0），一次单次rTMS训练后（T1）和整个rTMS程序（T2）之后。这由20列1 Hz刺激的火车组成，每列50刺激，火车间隔为30 s。
结果：两组患者在T0时的运动阈值（RMT）和MEP幅值无差异。在所有受试者的T1和T2处均观察到MEP大小的减少，但是与对照组相比，患者的MEP明显不足。
结论：缺乏MEP抑制作用反映了PI患者对LF rTMS的反应有所改变。这些rTMS发现表明PI中M1内抑制回路的皮质可塑性发生了变化。 PI受试者表现出由抑制性rTMS诱导的LTD样机制的损伤，因此为GABA神经传递参与PI的病理生理提供了进一步的支持。

BACKGROUND & AIMS: A yoked control study used sleep recordings from 10 insomniacs to produce similar sleep patterns in a group of matched normal sleepers for 7 nights to determine if specific electroencephalographic (EEG) sleep patterns were responsible for the secondary insomnia symptoms reported by the insomniacs. Specifically, it was found that insomniacs display increased tension/confusion, decreased vigor, personality disturbance, subjective over-estimation of poor sleep, increased body temperature, increased 24-hour whole body metabolic rate, and increased multiple sleep latency test (MSLT) values. Normal sleepers given the nocturnal EEG parameters of insomniacs displayed decreased tension, decreased vigor, decreased body temperature, and decreased MSLT values. The spectrum of changes seen in the normal sleepers given an insomniac sleep pattern was characteristic of mild partial sleep deprivation and not consistent with symptoms found in patients with primary insomnia. It was concluded that the secondary symptoms reported by patients with primary insomnia are probably not related to their poor sleep per se. Data from previous studies that varied physiological arousal were used to support the contention that the secondary symptoms of insomnia, including poor sleep, occur secondary to central nervous system hyperarousal.

背景与目标： 一项带轭的对照研究使用了10个失眠症的睡眠记录，在一组匹配的正常睡眠者中产生了7个晚上的相似睡眠模式，以确定特定的脑电图（EEG）睡眠形态是否是失眠症患者报告的继发性失眠症状的原因。具体而言，发现失眠症患者会表现出紧张/精神错乱，精力下降，人格障碍，对睡眠不足的主观估计过高，体温升高，24小时全身新陈代谢率升高以及多次睡眠潜伏期测试（MSLT）值升高。夜间睡眠时脑电图参数失眠的正常睡眠者表现出紧张度降低，活力降低，体温降低和MSLT值降低。给定失眠睡眠模式的正常睡眠者所见变化范围是轻度部分睡眠剥夺的特征，并且与原发性失眠患者的症状不一致。结论是，原发性失眠患者报告的继发症状可能与其睡眠不良有关。来自先前研究的各种生理刺激的数据被用来支持这样的论点，即失眠的继发症状，包括睡眠不足，是继发于中枢神经系统亢奋的。

BACKGROUND & AIMS: STUDY OBJECTIVES:To explore the sleep onset process in primary insomnia patients, new rules for scoring 4-second epochs were implemented to score sleep and artifacts during initial sleep onset. Conventional scorings in 20-second and 60-second epochs were also obtained. METHODS:The start of the initial 60-second epoch of stage 1 was used to define "time zero" (t0). Sleep onset periods from 11 patients and 11 individually age- and sex-matched controls spanned from 5 minutes before t0 through 29 minutes after t0. Using the new rules, the periods were scored blind to group assignment. This t0 time-referenced the data analysis to one plausible midpoint in the sleep onset process. In parallel, latencies were time-referenced from good night time. RESULTS:Reliability in scoring sleep and artifacts was adequate (kappa = 0.68 & 0.63, respectively, p <0.001). Group differences in sleep latencies were marginal in 60-second and 20-second scoring but significant with a definition of 4-second sleep latency. Patients had more 4-second epochs scored as awake (Mantel-Haenszel chi2 = 271, d.f. = 1, p <0.001) and containing artifact (M-H chi2 = 143, p <0.001). Patients took longer to achieve 30 continuous 4-second epochs of NREM sleep (Breslow chi2 = 4.03, d.f. = 1, p = 0.045) after t0. Patients accumulated sleep more slowly with all 3 scoring rules after t0. A slower rate of accumulating sleep after t0 was detected only with the 4-second scoring (p = 0.047). CONCLUSIONS:Evidence was present for momentary state-switching instabilities in the patients during the initial sleep onset process. Using rules for scoring small epochs may reveal such instabilities more readily than traditional scoring methods.

背景与目标： 研究目的：为了探讨原发性失眠患者的睡眠发作过程，实施了对4秒内评分的新规则，以对初始睡眠发作期间的睡眠和假象进行评分。还获得了20秒和60秒内的常规得分。
方法：从阶段1的最初60秒开始，开始定义“时间零”（t0）。 11位患者和11位年龄和性别相匹配的对照的睡眠发作期从t0之前的5分钟到t0之后的29分钟。使用新规则，对期间进行了盲目评分以进行小组分配。这在睡眠发作过程中将数据分析时间参考了一个合理的中点。同时，从晚安时间开始，延迟就以时间为基准。
结果：对睡眠和伪像评分的可靠性足够（kappa分别为0.68和0.63，p <0.001）。在60秒和20秒的评分中，睡眠延迟的组间差异很小，但以4秒的睡眠延迟定义很明显。患者在清醒时得分更高的4秒时间段（Mantel-Haenszel chi2 = 271，d.f. = 1，p <0.001）并且包含伪影（M-H chi2 = 143，p <0.001）。患者在t0后花了更长的时间才能达到NREM睡眠连续30个4秒钟的时间（Breslow chi2 = 4.03，d.f。= 1，p = 0.045）。在t0之后，使用所有3个评分规则，患者的睡眠积累都更加缓慢。仅在4秒评分中才检测到t0之后积累睡眠的速度较慢（p = 0.047）。
结论：存在证据表明患者在最初的睡眠发作过程中存在短暂的状态转换不稳定性。使用规则对小时期进行评分可能比传统的评分方法更容易揭示这种不稳定性。

BACKGROUND & AIMS: OBJECTIVE:Insomnia is a debilitating comorbidity of chronic pain. This pilot trial tested the utility of a hybrid treatment that simultaneously targets insomnia and pain-related interference. METHODS:Chronic pain patients with clinical insomnia were randomly allocated to receive 4 weekly 2-h sessions of hybrid treatment (Hybrid Group; n = 10) or to keep a pain and sleep diary for 4 weeks, before receiving the hybrid treatment (Monitoring Group; n = 10). Participants were assessed at the beginning and end of this 4-week period. Primary outcomes were insomnia severity and pain interference. Secondary outcomes were fatigue, anxiety, depression and pain intensity. Ancillary information about the hybrid treatment's effect on psychological processes and sleep (as measured with sleep diary and actigraphy) are also presented, alongside data demonstrating the treatment's clinical significance, acceptability and durability after one and six months. Data from all participants (n = 20) were combined for this purpose. RESULTS:Compared to symptom monitoring, the hybrid intervention was associated with greater improvement in sleep (as measured with the Insomnia Severity Index and sleep diary) at post-treatment. Although pain intensity did not change, the Hybrid Group reported greater reductions in pain interference, fatigue and depression than the Monitoring Group. Overall, changes associated with the hybrid intervention were clinically significant and durable at 1- and 6-month follow-ups. Participants also rated highly on treatment acceptability. CONCLUSION:The hybrid intervention appeared to be an effective treatment for chronic pain patients with insomnia. It may be a treatment approach more suited to tackle challenges presented in clinical practice, where problems seldom occur in isolation.

背景与目标： 目的：失眠症是一种使慢性疼痛衰弱的合并症。这项试验性试验测试了同时针对失眠和疼痛相关干扰的混合疗法的实用性。
方法：将临床失眠的慢性疼痛患者随机分配至接受混合治疗前的每周2 h混合疗法疗程（Hybrid组; n = 10）或保持疼痛和睡眠日记4周（监测组） ; n = 10）。在这4周的开始和结束时对参与者进行评估。主要结果是失眠严重程度和疼痛干扰。次要结果是疲劳，焦虑，抑郁和疼痛强度。还提供了有关混合疗法对心理过程和睡眠的影响的辅助信息（通过睡眠日记和书法记录），并显示了该疗法在一个月和六个月后的临床意义，可接受性和持久性的数据。为此，将所有参与者（n = 20）的数据合并在一起。
结果：与症状监测相比，混合干预与治疗后的睡眠改善（通过失眠严重度指数和睡眠日记测量）有关。尽管疼痛强度没有改变，但混合动力组报告的疼痛干扰，疲劳和抑郁感减轻程度比监测组更大。总体而言，与混合干预相关的变化在1个月和6个月的随访中具有临床意义和持久性。参与者在治疗可接受性方面也给予很高的评价。
结论：混合干预似乎是治疗慢性疼痛失眠患者的有效方法。这可能是一种更适合解决临床实践中出现的挑战的治疗方法，在临床实践中，很少会孤立地出现问题。

BACKGROUND & AIMS: :Objective/Background: Insomnia is a pervasive and costly disorder that is particularly prevalent within the U.S. Veteran population. Although Cognitive Behavioral Therapy for Insomnia (CBT-I) is the recommended first-line treatment for insomnia, high rates of sedative-hypnotic prescribing continue. There is little research investigating the rates and factors impacting insomnia treatment recommendations, both behavioral and pharmacological. Participants: A cohort of 5,254 Veterans referred for either CBT-I or prescribed a sedative-hypnotic medication at a single VA Medical Center composed the group of participants. Methods: The current study evaluated the rates of insomnia treatment recommendations and the extent to which demographic variables, psychiatric disorders, and sleep disorders contributed to referrals for CBT-I or prescriptions for sedative-hypnotic medications within a large administrative data set. Results: Military service-related disability, insomnia diagnosis, and having one or more psychiatric diagnoses were associated with a greater likelihood of receiving a CBT-I referral (alone or in addition to a sedative-hypnotic medication) rather than a sedative-hypnotic prescription alone. A diagnosis of posttraumatic stress disorder was associated with a greater likelihood of receiving a sedative-hypnotic medication alone versus a CBT-I referral. Conclusions: Overall, the findings suggest that sedative-hypnotic medications were overwhelmingly the primary treatment recommendation despite evidence to support CBT-I as the recommended first-line treatment. However, key factors were identified that increased the likelihood of Veterans being referred for CBT-I. Suggestions for better identifying and understanding key factors that impact treatment recommendations are discussed.

背景与目标： ：目的/背景：失眠是一种普遍且代价高昂的疾病，在美国退伍军人人群中尤为普遍。尽管推荐的失眠认知行为疗法（CBT-1）是一线治疗失眠症，但镇静催眠处方的使用率仍然很高。很少有研究调查失眠治疗建议的发生率和因素，包括行为学和药理学。参与者：由5254名退伍军人组成的队列，由一组VA医疗中心转介参加CBT-1或开具镇静催眠药。方法：本研究评估了失眠治疗建议的比率以及人口统计变量，精神疾病和睡眠障碍在多大行政数据集中促成转诊CBT-1或镇静催眠药物处方的程度。结果：与军事服务有关的残疾，失眠诊断以及进行一项或多项精神病诊断与接受CBT-I转诊（单独或除镇静催眠药物之外）而非镇静催眠处方的可能性更大。独自的。创伤后应激障碍的诊断与单独接受镇静催眠药物相比，与CBT-1转诊的可能性更大。结论：总的来说，研究结果表明，尽管有证据支持镇静催眠药物支持CBT-1作为推荐的一线治疗，但绝大多数还是主要的推荐治疗药物。但是，已确定了关键因素，这些因素增加了退伍军人转介CBT-1的可能性。讨论了有关更好地识别和理解影响治疗建议的关键因素的建议。

BACKGROUND & AIMS: :Do patients with primary insomnia differ from good sleepers with respect to the number or duration of awakenings or to the stages from which awakenings occur? To address this question, polysomnography (PSG) records were evaluated in 10 good sleepers (GS) and 10 primary insomnia patients (PI). PSG records were evaluated for occurrence and duration of awakenings and for the stage immediately preceding each awakening. PIs woke more frequently and for longer durations than did GSs. PIs' awakenings tended to occur from Stages 1 or 2; GSs' occurred from epochs scored as movement times. The data from this study represent the first attempt to characterize the stages from which awakenings occur in sleep maintenance insomnia.

背景与目标： ：原发性失眠患者的觉醒次数或持续时间或觉醒发生的阶段是否与良好的睡眠者有所不同？为了解决这个问题，对10位良好睡眠者（GS）和10位原发性失眠患者（PI）进行了多导睡眠监测（PSG）记录评估。对PSG记录的觉醒发生时间和持续时间以及每次觉醒之前的阶段进行了评估。与GS相比，PI的唤醒频率更高，持续时间更长。 PI的唤醒通常发生在第1或第2阶段。 GSs是从记为运动时间的时代开始的。这项研究的数据代表了首次尝试表征睡眠维持性失眠的觉醒阶段。

BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: :Cognitive therapy has been shown effective in the treatment of several psychological and health-related disorders. It is also increasingly used in the management of insomnia. This article outlines some principles and applications of this therapeutic approach as adapted to the treatment of insomnia. Based on Beck's model, this psychotherapeutic approach seeks to modify sleep-related dysfunctional beliefs and thoughts and maladaptive cognitive processes involved in the exacerbation and perpetuation of insomnia. This is accomplished through the use of several cognitive restructuring procedures. After outlining a conceptual model of insomnia, which emphasizes the mediating role of dysfunctional cognitions in the development and maintenance of chronic insomnia, the rationale and general principles of cognitive therapy for insomnia are presented, followed by a description of the treatment procedures, clinical case illustrations, and practical implementation issues. Future directions include the need to refine cognitive interventions and to examine the unique contribution of this therapeutic component to the overall efficacy of multifaceted cognitive-behavioral therapy.

背景与目标： ：认知疗法已被证明可有效治疗多种心理和健康相关疾病。它也越来越多地用于失眠的管理。本文概述了适用于失眠治疗的这种治疗方法的一些原理和应用。根据贝克的模型，这种心理治疗方法旨在改变与睡眠有关的功能障碍的信念和思想，以及与失眠加重和永存有关的适应不良的认知过程。这是通过使用几种认知重构程序来完成的。在概述了失眠的概念模型（强调失调认知在慢性失眠的发展和维持中的中介作用）之后，介绍了失眠认知疗法的基本原理和一般原则，随后介绍了治疗程序和临床病例说明，以及实际的实施问题。未来的方向包括需要完善认知干预措施，并检查该治疗成分对多方面认知行为疗法整体疗效的独特贡献。

BACKGROUND & AIMS: BACKGROUND:Cognitive arousal is central to models of sleep disturbance and insomnia, but findings remain mixed regarding whether cognitive arousal is associated with objective sleep disturbance and physiologic hyperarousal. This study explored associations of objective nocturnal wakefulness and indicators of physiologic hyperarousal with cognitive arousal in healthy sleepers and individuals with insomnia. METHODS:In sum, 52 adults (51.9% women; 18 with insomnia disorder, 34 healthy sleepers) underwent two overnight polysomnography (PSG) studies (adaptation + baseline nights) and a multiple sleep latency test (MSLT). Baseline depression was assessed and presleep cognitive arousal and somatic arousal were recorded for each night. Multivariate regression was used to evaluate associations of PSG sleep parameters with insomnia, cognitive arousal, and somatic arousal. RESULTS:Analyses showed that high levels of nocturnal cognitive arousal were associated with prolonged sleep latency, lower sleep efficiency, and shorter total sleep time by PSG on both nights. An association between nocturnal cognitive arousal and wake after sleep onset was observed on night one only. Moreover, greater nocturnal cognitive arousal was associated with greater likelihood of obtaining short sleep and with longer MSLT sleep latencies. Insomnia diagnosis, depression, and somatic arousal were not associated with PSG sleep parameters or MSLT latency. CONCLUSIONS:Heightened cognitive arousal at night is linked to objective sleep disturbances and indicators of physiologic hyperarousal at night and during the day. For patients with insomnia, cognitive arousal may contribute to the 24-hr physiologic hyperarousal. Cognitive arousal may be a critical therapeutic target for severe or treatment-resistant sleep disturbance.

背景与目标： 背景：认知唤醒是睡眠障碍和失眠模型的核心，但关于认知唤醒是否与客观睡眠障碍和生理性过度兴奋有关的研究结果尚不明确。本研究探讨了健康睡眠者和失眠者的客观夜间觉醒和生理性高听觉指标与认知唤醒的相关性。
方法：总而言之，对52名成人（51.9％的女性; 18名失眠症，34名健康睡眠者）进行了两次通宵多导睡眠图（PSG）研究（适应基线夜晚）和一次多重睡眠潜伏期测试（MSLT）。评估基线抑郁症，并每晚记录入睡前的认知唤醒和躯体唤醒。多变量回归用于评估PSG睡眠参数与失眠，认知唤醒和躯体唤醒的关联。
结果：分析表明，夜间PSG的高夜间睡眠意识觉醒与长时间的睡眠潜伏期，较低的睡眠效率和较短的总睡眠时间有关。仅在一个晚上观察到夜间认知唤醒与睡眠发作后苏醒之间的关联。此外，更大的夜间认知唤醒与获得短暂睡眠和更长的MSLT睡眠潜伏期的可能性更大有关。失眠的诊断，抑郁和躯体唤醒与PSG睡眠参数或MSLT潜伏期无关。
结论：夜间增强的认知唤醒与夜间和白天的客观睡眠障碍和生理性高音指标有关。对于失眠患者，认知唤醒可能会导致24小时生理性兴奋。认知唤醒可能是严重或难以治疗的睡眠障碍的关键治疗目标。

BACKGROUND & AIMS: OBJECTIVE:To examine the distribution, consistency, and correlates of sleep time perceptions in primary insomnia sufferers and normal sleepers across settings (laboratory and home). METHODS:Fifty-two middle-aged and older insomnia sufferers and 49 matched normal sleepers underwent multiple nights of laboratory and home polysomnography (PSG) and provided concurrent subjective estimates of their sleep. Descriptive statistics, cluster analyses, and inferential tests were used to examine the nature of sleep time perceptions, identify subgroups with distinctive patterns such as perceptions, and explore factors that may contribute to these subgroups' distinctive sleep perceptions. RESULTS:Consistent with previous studies, the insomnia sufferers, as a group, showed a greater tendency to underestimate the time they slept than did the normal sleepers, but the accuracy of sleep time perceptions varied widely within each sample. Correlational analyses showed that study participants in each sample showed a moderate level of consistency in how accurately they estimated sleep time across nights. Subsequent cluster analyses conducted to identify subgroups with distinctive patterns of sleep time perceptions yielded four subgroups within the insomnia sample and three subgroups within the normal sleeper sample. Although the sleep setting significantly affected sleep perceptions for one insomnia subgroup, both laboratory and home objective-subjective sleep comparisons provided similar impressions regarding the relative accuracy of each subgroup's nocturnal sleep/wake perceptions. Finally, varying patterns of subgroup differences were noted across several common psychometric measures. CONCLUSIONS:The underestimation of sleep time is not a generic characteristic that separates all insomnia sufferers from normal sleepers. Sleep setting, personality traits, and perhaps constitutional factors appear to influence perceptions of sleep and wake time duration.

背景与目标： 目的：研究原发性失眠患者和正常睡眠者在不同环境（实验室和家庭）中的睡眠时间知觉分布，一致性和相关性。
方法：对52名中老年失眠患者和49名相匹配的正常睡眠者进行了多夜的实验室和家庭多导睡眠图（PSG）检查，并同时提供了他们的睡眠主观估计。描述性统计，聚类分析和推论测试用于检查睡眠时间知觉的性质，识别具有独特模式（例如知觉）的亚组，并探索可能有助于这些亚组独特的睡眠知觉的因素。
结果：与以前的研究一致，失眠症患者作为一个整体，比正常的睡眠者表现出低估其睡眠时间的趋势更大，但是在每个样本中，睡眠时间感知的准确性差异很大。相关分析表明，每个样本中的研究参与者在估计夜间睡眠时间的准确性上均表现出中等程度的一致性。随后进行的聚类分析确定了具有独特的睡眠时间感知模式的亚组，在失眠样本中产生了四个亚组，在正常睡眠者样本中产生了三个亚组。尽管睡眠设置显着影响了一个失眠亚组的睡眠感知，但实验室和家庭客观-主观睡眠比较均对每个亚组的夜间睡眠/觉醒感知的相对准确性提供了相似的印象。最后，在几种常见的心理测量方法中，注意到了亚组差异的变化模式。
结论：低估睡眠时间并不是将所有失眠症患者与正常睡眠者区分开的普遍特征。睡眠环境，人格特质，也许还有体质因素似乎会影响对睡眠和唤醒时间长短的看法。

BACKGROUND & AIMS: BACKGROUND:It has been shown that restless legs syndrome (RLS) in adults may be linked to abnormalities in iron stores. Whether reduced iron stores play a role in children is not clear. METHODS:We evaluated the status of iron stores and sleep in three teenagers who presented with severe sleep onset insomnia, subjective sleep latency exceeding 60 min and excessive daytime sleepiness. RESULTS:The three teenagers were found to have RLS and laboratory evaluation confirmed reduced body stores of iron with a low percent iron saturation (mean value 9.7%) and a low serum ferritin level (mean value 17 microg/l). None had marked anemia. The three patients were treated with oral iron for 4-5 months. As a group they had an increase in percent iron saturation (from a mean of 9.7 to 22.7%) and serum ferritin (from a mean of 17 to 27 microg/l) and a marked reduction of the symptoms of RLS, with mean subjective sleep latency decreasing from 143 to 23 min, sleep efficiency increasing from 75.7 to 84.0% and the number of periodic movements per hour of sleep decreasing from 20.5 to 10.5. INTERPRETATION:These findings support the hypothesis that abnormal iron stores or metabolism may result in RLS causing insomnia in teenagers. We recommend evaluation of iron status including serum iron, total iron binding capacity and ferritin levels in teenagers with chronic insomnia of unexplained origin even when anemia is mild or absent.

背景与目标： 背景：研究表明，成年人的不安腿综合征（RLS）可能与铁存储异常有关。减少铁存储是否在儿童中发挥作用尚不清楚。
方法：我们评估了三名青少年的铁存储和睡眠状况，这些青少年表现为严重的睡眠发作性失眠，主观睡眠潜伏期超过60分钟和白天过度嗜睡。
结果：发现这三名少年患有RLS，实验室评估证实铁的体内储备减少，铁饱和度低（平均值9.7％），血清铁蛋白水平低（平均值17 microg / l）。没有明显的贫血。这三例患者接受了口服铁剂治疗4-5个月。作为一个小组，他们的铁饱和度百分比（从9.7到22.7％）和血清铁蛋白（从17到27 microg / l的平均值）增加，并且RLS症状明显减轻，平均主观睡眠潜伏期从143分钟减少到23分钟，睡眠效率从75.7％增加到84.0％，每小时每小时的周期性运动次数从20.5减少到10.5。
解释：这些发现支持以下假设，即异常的铁存储或新陈代谢可能导致RLS导致青少年失眠。我们建议评估铁源的状态，包括血清铁，总铁结合能力和铁蛋白水平，这些铁源包括患有轻度或无贫血的原因不明的慢性失眠少年。