| Objective: 1. To establish the sleep-wake disorders database by using the MS SQL Sever database platform. The database included 10 kinds of sleep disorders. 315 cases of patients with sleep-wake disorders from Neurology Clinic and Sleep Disorder Clinic were registered according to the database module.2. Using the advanced search function of the database to analysis of the proportion of various diseases of sleep-wake disorders and the related factors of occurrence of insomnia disorders; and evaluating the sleep, anxiety and depression sleep condition, depression and anxiety, cognitive function of patients with insomnia disorder with the application of sleep related scales(PSQI, ISI, ESS), anxiety and Depression Scale(HAMA, HAMD), cognitive impairment scale(Mo CA). 3. A retrospective analysis of evaluation of the change of sleep, anxiety and depression among 105 cases of persistent insomnia disorder with mild to moderate depression patients using benzodiazepines combined with SNRIs drugs for 1 months and 3 months, thus providing clinical data for clinical features of the disease, neuropsychological characteristics, and prognosis of follow-up of this disease, and to further explore effective treatment method for the continuous insomnia patients neuropsychological characteristics.Methods: 1. Through the designing of the basic framework of the sleep-wake disorders database, establishing the basic information acquisition module, using MS SQL Sever data platform and browser based access model(B/S) develope sleep-wake disorders database, and 315 cases of patients with sleep-wake disorders from Neurology Clinic and Sleep Disorder Clinic were registered. Input part of the database includes basic information, patient information, sleep related examination, laboratory examination, imaging examination, assessment of scale, diagnosis, treatment and follow-up of patients in nine modules.(1)The basic information module includes: name, gender, age, height, weight, nature of work stressors;(2)Patient information module includes: history of present illness, past history, with each system symptoms and family history;(3)sleep related examination module includes: polysomnography(PSG), multiple sleep latency test(M SLT);(4)Laboratory examination module includes: blood routine, liver function, renal function,myocardial enzymes, immune, homocysteine, blood fat;(5)imaging examination module includes: Structural imaging examination(such as MRI or CT), vascular structure examination(head and neck vascular ultrasound examination, carotid CTA or MRA);(6)Assessment of scale module includes: Montlit cognitive assessment scale(MOCA), Pittsburgh sleep quality index(PSQI), Epworth daytime sleep scale(ESS), insomnia severity index(ISI), Seoul Hamilton Anxiety Scale(HAMA), Hamilton Depression Scale(HAMD);(7)the diagnostic information module includes: all kinds of diseases and disorders of sleep wake- type, other system disease diagnosis;(8)Treatment module include: Drug of taking time and dosage of treatment for various types of sleep-wake disorders;(9)follow-up module includes: condition changes and response after treatment, physical examination, the amount of assessment, laboratory examination, imaging examination, diagnosis and, adjustment of treatment.2. According to the diagnostic and Statistical Manual of mental disorders(DSM-5) will divide sleep disorders into insomnia disorder, excessive sleepiness disorder, narcolepsy, breathing related sleep disorders, circadian sleep wake disorders, non REM the sleep wake disorders, nightmare disorder, REM sleep behavior disorder, restless legs syndrome, substance / drug induced sleep disorder and other common sleep disorders according to the diagnostic criteria of ICSD-3 supplement of patients in database; Analysis of the proportion disease of various types of sleep disorders and further research for patients with insomnia; 201 cases conforming to diagnosis of insomnia disorder with DSM-5 at the age of 16~75 were selected, while 110 cases of non-insomnia volunteers signed the informed consent were selected as normal control group, using the basic information questionnaire, anxiety Depression Scale(HAMA, HAMD), cognitive impairment scale(Mo CA) for evaluating basic information depression and anxiety cognitive function of patients with insomnia, making a analysis of differences between insomnia group and non insomnia group.3. 105 cases conforming to diagnosis of persistent insomnia disorder with DSM-5 at the age of 16~75 were selected, 54 patients using benzodiazepines(Zolpidem Tartrate Tablets and Lorazepam Tablets) combined with SNRIs drugs(duloxetine) were considered as study group, 51 patients using benzodiazepines(Zolpidem Tartrate Tablets and Lorazepam Tablets) were considered as control group, 54 cases of non-insomniavolunteers were considered as normal control group, making a follow-up of changes of sleep, anxiety and depression of between single drug and drug combination groups after taking drugs 1 months and 3 Months by using of sleep and anxiety, depression scale, analysing the difference of scales in Sleep scale, anxiety and depression scale between two groups, so as to explore SNRIs drugs of effectiveness in the treatment of patients with persistent insomnia.Result: 1. The establishment of the sleep-wake disorders database, the database includes the patient's basic information, case information, sleep related examination, laboratory examination, imaging examination, the scale to assess, diagnosis, treatment and follow-up of nine modules. The database supports cases increased, delete, change and supports statistical query of multi project with any combination. The sleep-wake disorders database platform was completed in November 2015, and used in the same month, 315 cases have been entered by the end of March 2016. 2. Among 315 patients in database, insomnia disorder was 201 cases(63.80%), Other sleep- wake disorder of 114 patients(36.20) include excessive sleepiness disorder 4 cases(1.27%) narcolepsy 11 cases(3.49%), breathing related sleep disorders 55 cases(17.46%), circadian sleep wake disorders 1 cases(0.32%), non REM the sleep wake disorders 1 case(0.32%), the nightmare disorder(5 cases(1.59%), REM sleep behavior disorder 28 cases(8.89%), restless leg syndrome 8 cases(2.54%) and substance / drug induced sleep disorder 1 cases(0.32%). The treatment of 78 cases, accounted for the total number of visits to 24.76%. 3. According to the course Insomnia disorder can be divided into four categories:(1)acute and short-term insomnia disorder 38 cases(18.9%)(2)discontinuous insomnia 29 cases(14.43%)(3)continuous insomnia 115 cases(57.21%)(4)recurrent insomnia disorder 19 cases(9.45%) 4. According to the symptoms insomnia disorder can be divided into seven categories:(1)a difficulty falling asleep: 44 cases(21.89%)(2)B maintain sleep difficulties: 13 cases(6.47%) C wake up early and wake up difficult to sleep: 19 cases(9.45%).(3)(4)a&b: 25 cases(12.44%)(5) a&c :32 cases(15.92%)(6) b&c:30 cases(14.93%)(7)mixed type(a&b&c):38 cases(18.91%)?5. Insomnia disorder accompanied with other diseases(healed): diseases of the circulatory system of 52 cases 25.87%, digestive system diseases of 22 cases(10.95%) and nervous system diseases of 20 cases(9.95%), metabolic diseases of 19 cases(9.45%), endocrine system diseases of 10 cases(4.98%), system of Department of gynaecology disease of 9 cases(6.57%) and diseases of the nervous system of 5 cases(2.49%), blood system diseases of 2 cases(1.00%), rheumatic diseases of 2 cases(1.00%) and urinary system diseases of 1 case(0.50%), 1 case of disease of immune system(0.50%) 6. Single factor analysis showed that BMI, sex, Sleep companion, the nature of the work, character, source of stress, siesta, drinking coffee, tea, insomnia disorder family history, comorbidity of circulatory system diseases, metabolic diseases, diseases of the digestive system in the incidence of insomnia were statistically significant(P <0.05) between two groups. The scores of sleep scale in insomnia group(ISI score, PSQI total score and each factor scores including subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, use of sleep medication, daytime dysfunction) were higher than non insomnia group, the difference was statistically significant(P <0.05). The scores of anxiety, depression scale(HAMD, HAMA scores and the factor scores) in insomnia group were higher than non insomnia group, the difference was statistically significant(P < 0.05). The difference between two groups of cognitive dysfunction score(MOCA score) was no significant difference(P > 0.05), but the scores of insomnia group in the two points of attention and delayed recall were lower than those of the non-insomnia group, and the differences were statistically significant(P<0.05). 7. Binary logistic regression analysis showed that BMI, gender, stressor, siesta habit, drinking coffee, tea, insomnia disorders family history, comorbidity diseases of the circulatory system, the scores of HAMD and HAMA were related to the occurrence of insomnia disorder(P < 0.05). 8. Comparing with non-insomnia group, the types of insomnia group according to the course of the disease(acute and short-term, intermittent and persistent, recurrent) in anxiety / somatization, sleep disorders of HAMD and in somatic anxiety of HAMA were different(P < 0.05).9. With follow-up of patients of persistent insomnia disorder combined with mild to moderate depression, the results showed that:(1) the single drug group: compared medication after 1 month, 3 months with before, PSQI, HAMD, HAMA score were decreased, the difference was statistically significant(P < 0.05).(2)The treatment group: compared medication after 1 month, 3 months with before, PSQI, HAMD, HAMA score were decreased, the difference was statistically significant(P < 0.05).(3)The single drug group and combination group compared in treatment for 1 month and 3 months later, PSQI, HAMD, HAMA scores and scores were lower, and the difference was statistically significant(P < 0.05).Conclusion: 1. The establishment of the sleep-wake disorders database, the database includes the patient's basic information, case information, sleep related examination, laboratory examination, imaging examination, the scale to assess, diagnosis, treatment and follow-up of nine modules. The database supports cases increased, delete, change and supports statistical query of multi project with any combination. It can be used for sleep-wake disorder information storage and management, exploration of sleep wake-disorder causes and influencing factors, clinical characteristics and neuropsychological characteristics of disease outcome and effective treatment to provide data support for large-scale, multi center for sleep disorders research provides clinical research. 2. The sleep wake disorders database insomnia disorder ratio was the highest, followed by: obstructive sleep apnea, REM sleep behavior disorder, restless leg syndrome, paroxysmal sleeping sickness, nightmare disorder, excessive sleepiness disorder, circadian sleep wake disorders, non rapid eye movement(REM) sleep-wake disorders, substance / drug induced sleep disorder. The non first attendance rate is larger than the first visit rates. 3. According to the course the highest incidence of Insomnia disorder was persistent insomnia disorder, followed by acute and short-term insomnia, intermittent insomnia disorder, recurrent insomnia disorder. 4. Of which 7 categories of Insomnia according to the symptoms, A difficult to fall asleep has the highest incidence, followed by mixed type, a&c,b&c,a&b,c wake upearly and wake up difficult to sleep, b maintain sleep difficulties. 5. Insomnia disorder accompanied by other diseases(healed): proportion of circulatory system diseases was the highest, followed by diseases of the digestive system, nervous system diseases, metabolic diseases, endocrine system diseases, gynecological diseases, diseases of the nervous system, blood system diseases, rheumatic diseases, urinary system disease, immune system disease. 6.(1)low BMI, female, with stress source, without a siesta habit, habit of drinking coffee and tea, the common diseases of circulatory system disease, insomnia disorders family history and symptoms of anxiety and depression are independent risk factors of insomnia disorder.(2)Age, marital status, work status, cultural degree, family income per member, accompany sleep, nature of work, character, mode of medical expenditure, smoking, drinking, comorbidity metabolic diseases and digestive system diseases, shift work, the independent effects of surgical trauma history have no effect on insomnia. 7. The degree of association insomnia disorder with anxiety, depression is the greatest, but insomnia disorder patients overall cognitive impairment is not obvious, only in attention and delayed recall two areas was significantly impaired. Compared persistent insomnia disorder with other various types of insomnia disorder, more serious in anxiety / somatization symptoms and sleep disorders. 8. Compared with the persistent insomnia disorder, other various types of sleep disorder have a lower level in sleep quality(PSQI), mainly in subjective sleep quality, sleep efficiency and daytime dysfunction; The overall cognitive function(Mo CA) damage of persistent sleep disorders is not obvious, but the fields of attention and delayed recall damage obviously; the anxiety and depression status(HAMD, HAMA) of persistent insomnia is much more serious, mainly in the anxiety / somatization symptoms, sleep disorders. Therefore, in clinical patients with chronic persistent insomnia have poorly sleep quality, and should be evaluated the anxiety and depression early, and their emotional problems should be paid attention. 9. Found in the follow-up study, persistent insomnia combined with mild to moderate depression patients using single benzodiazepines(Laura Si and zolpidem) or benzodiazepines combined with SNRIs(duloxetine) for 1 months and 3 months, bothin sleep quality and anxiety and depression the state is obviously improved, but compared with them, the latter is more effective, especially in the depression status of the more obvious improvement. In the clinical, focusing on attention of persistent insomnia patients occurred depression status and cognitive function situation, the early use of SNRIs antidepressants combined with benzodiazepines, which is to improve the effective approach for the treatment of sleep quality and anxiety and depression, and is worthy of further research and multi center clinical application. |
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