Correlation Between Subjective Sleep Perception And Rapid Eyes Movement Sleep In Patients With Insomnia Disorder

Objective:To analyze the different characteristics of subjective and objective sleep quality between patients with insomnia disorder and normal controls,and to explore the correlation between rapid eyes movement(REM)sleep and sleep perception in patients with insomnia disorderMethods:According to the DSM-5 diagnostic criteria,49 patients with Insomnia Disorders(ID)and 32 Normal Controls(NC)were recruited.All the subjects were assessed by Diagnostic Interview for Sleep Patterns and Disorder(DISP),Pittsburgh Sleep Quality Index(PSQI),Insomnia Severity Index(ISI),Hamilton Anxiety Scale(HAMA),Hamilton Depression Scale-17 Items(HAMD-17),Patient Health Questionnaire(PHQ-9),Generalized Anxiety Disorder(GAD-7),Dysfunctional Beliefs and Attitudes about Sleep(DBAS-16),State-Trait Anxiety Inventory(STAI),The Penn State Worry Questionnaire(PSWQ),Ruminative Responses Scale(RRS)and polysomnography(PSG),which examine their sleep characteristic,emotion and cognition.According to the PSG results and the subjective sleep condition measured by PSQI,the ID group were divided into subjective insomnia group(SI,n=22)and non-subjective insomnia group(NSI,n=27).The objective and subjective sleep characteristics and rapid eyes REM sleep parameters were analyzed by SPSS 26.0Results:1.The total score of PSQI,ISI,HAMA,HAMD,PHQ-9,GAD-7,SAI and PSWQ were higher in ID group than NC group.Except for ISI,there were no significant difference in clinical rating scales between SI group and NSI group2.Compared with NC group,ID group had decreased sleep perception(P=0.012),increased wakefulness time after sleep onset(P<0.001)and REM sleep latency(P=0.03 6)3.Compared with NSI group,SI group had longer REM sleep time(P<0.001),higher R%[(20.47±3.43)%v.s.(16.69±6.47)%;P=0.012],decreased REM sleep latency[(109.73±28.20)min v.s.(143.15±69.79)min;P=0.029]and increased REM sleep microarousal(P=0.017)4.In ID group,GAD-7 positively correlated with subjective sleep latency,REM sleep wakefulness time and REM circles(r=-0.327,P=0.022;r=0.299,P=0.037;r=0.285,P=0.047),PHQ-9 positively correlated with REM sleep microarousal(r=0.410,P=0.003),ISI negatively correlated with sleep perception(r=-0.381,P=0.007)and positively correlated with sleep circles(r=0.407,P=0.001)5.The sleep perception negatively correlated with REM duration and its proportion,REM circles and REM sleep microarousal(r=-0.537,P<0.001;r=-0.346,P=0.015;r=-0.640,P<0.001;r=-0.293,P=0.041),while positively correlated with REM sleep latency(r=0.389,P=0.006)Conclusion:1.Patients with insomnia disorder show sleep disturbance both subjectively and objectively,it’s difficult to distinguish patients with subjective insomnia from insomnia disorder by subjective measures2.SI group had a better objective sleep quality,there is significant difference in REM parameters between SI group and NSI group3.Sleep perception shows the correlation with REM sleep duration,R%,REM sleep microarousal,REM circles and REM sleep latency,analysis of multiple linear regression showed that REM circles and REM sleep duration have a preferable prediction to sleep perception.