Laura Palagini1, Mauro Mauri2, Liliana Dell'Osso2, Dieter Riemann3, Christopher L Drake4. 1. Department of Clinical Experimental Medicine, Psychiatric Unit, University of Pisa, Italy. Electronic address: lpalagini@tiscali.it. 2. Department of Clinical Experimental Medicine, Psychiatric Unit, University of Pisa, Italy. 3. Department of Clinical Psychology and Psychophysiology/Sleep Medicine, Center for Mental Disorders, University of Freiburg Medical Center, Freiburg, Germany. 4. Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, MI, USA.
Abstract
OBJECTIVE: Research into the cause of chronic insomnia has identified hyperarousal as a key factor, which is likely to have both trait and state components. Sleep-related cognition, metacognition, and sleep reactivity also play an important role in insomnia. Our aim was to investigate how these insomnia-related constructs are associated with trait predisposition and pre-sleep arousal in subjects with an insomnia disorder. METHODS: Fifty-three individuals with insomnia disorder (according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (F = 33; 52 + 10)) and 30 healthy controls (F = 18; 51.8 + 12 years) were evaluated with a set of questionnaires, including the Ford Insomnia Response to Stress Test (FIRST), Metacognition Questionnaire - Insomnia (MCQI), Arousal Predisposition Scale (APS), and Pre-sleep Arousal Scale (PSAS). Statistical analyses included multiple regression to elucidate the independent determinants of APS and PSAS. RESULTS: Participants with insomnia presented higher FIRST, MCQI, APS, PSAS scores (p-values <0.001) than healthy controls. In insomnia, APS and cognitive PSAS were best determined by MCQI (respectively, B = 0.09, p = 0.001, B = 0.08, p = 0.02), somatic PSAS by cognitive arousal (PSAS B = 0.35, p = 0.004) CONCLUSIONS: This study suggests that in insomnia disorders, trait predisposition toward hyperarousal and pre-sleep-cognitive-state-dependent arousal may be closely related to sleep-related metacognitive processes. Sleep-related metacognitive processes may be associated with trait hyperarousal within the framework of a mutual relationship, and could, in turn, modulate cognitive pre-sleep-state arousal. A broad range of cognitive and metacognitive processes should be considered when dealing with subjects with insomnia.
OBJECTIVE: Research into the cause of chronic insomnia has identified hyperarousal as a key factor, which is likely to have both trait and state components. Sleep-related cognition, metacognition, and sleep reactivity also play an important role in insomnia. Our aim was to investigate how these insomnia-related constructs are associated with trait predisposition and pre-sleep arousal in subjects with an insomnia disorder. METHODS: Fifty-three individuals with insomnia disorder (according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (F = 33; 52 + 10)) and 30 healthy controls (F = 18; 51.8 + 12 years) were evaluated with a set of questionnaires, including the Ford Insomnia Response to Stress Test (FIRST), Metacognition Questionnaire - Insomnia (MCQI), Arousal Predisposition Scale (APS), and Pre-sleep Arousal Scale (PSAS). Statistical analyses included multiple regression to elucidate the independent determinants of APS and PSAS. RESULTS:Participants with insomnia presented higher FIRST, MCQI, APS, PSAS scores (p-values <0.001) than healthy controls. In insomnia, APS and cognitive PSAS were best determined by MCQI (respectively, B = 0.09, p = 0.001, B = 0.08, p = 0.02), somatic PSAS by cognitive arousal (PSAS B = 0.35, p = 0.004) CONCLUSIONS: This study suggests that in insomnia disorders, trait predisposition toward hyperarousal and pre-sleep-cognitive-state-dependent arousal may be closely related to sleep-related metacognitive processes. Sleep-related metacognitive processes may be associated with trait hyperarousal within the framework of a mutual relationship, and could, in turn, modulate cognitive pre-sleep-state arousal. A broad range of cognitive and metacognitive processes should be considered when dealing with subjects with insomnia.
Authors: Isa Okajima; Noriko Tanizawa; Megumi Harata; Sooyeon Suh; Chien-Ming Yang; Shirley Xin Li; Mickey T Trockel Journal: Int J Environ Res Public Health Date: 2021-12-24 Impact factor: 3.390