수면 오지각이 불면증 심각도에 미치는 영향: 우울의 매개 효과 = The Mediating Effect of Depression in the Relationship between Sleep Misperception and Insomnia Severity among Insomnia Patients

다국어 초록 (Multilingual Abstract)

Objectives: Sleep misperception is the underestimation of perceived total sleep time compared to actual total sleep time. It is observed in approximately 50% of patients with insomnia. Insomnia patients with sleep misperception report significantly higher depression than those without sleep misperception. Depression is one of the most consistent risk factors for predicting insomnia. Therefore, this study attempted to confirm the mediating effect of depression in exacerbating insomnia. Methods: This study included 77 male and female aged 18–40 years who met diagnostic criteria for insomnia disorder based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Depression and insomnia severity were measured using self-report questionnaires, and actigraphy data were collected for 1 week. The sleep misperception index was calculated using the sleep diary and actigraphy. Results: The Pearson correlation analysis was performed to examine the relationships between sleep misperception, insomnia, and depression.
Sleep misperception was positively associated with depression (r=0.399, p<0.01). There was also a significant positive correlation between depression and insomnia severity (r=0.591, p<0.01). However, there was no significant correlation between sleep misperception and insomnia severity (r=0.210, p=0.07). Depression was found to have a full mediating effect on the relationship between sleep disturbance and severity of insomnia (n=77, B=6.1688, 95% confidence interval=2.9960, 10.4562). Conclusions: This study verified the mediating effect of depression on the relationship between sleep misperception and insomnia severity. The results highlight the importance of considering depression and sleep misperception in insomnia treatment.

참고문헌 (Reference)

1 조영일, "임상 연구에서 조절효과 및 매개효과의 비교 및 통합: 개념 정의 및 통계 모형" 한국임상심리학회 34 (34): 1113-1131, 2015

2 Bastien CH, "Validation of the Insomnia Severity Index as an outcome measure for insomnia research" 2 : 297-307, 2001

3 조용원, "Validation of a Korean Version of the Insomnia Severity Index" 대한신경과학회 10 (10): 210-215, 2014

4 Lambiase MJ, "Utility of actiwatch sleep monitor to assess waking movement behavior in older women" 46 : 2301-2307, 2014

5 Vgontzas AN, "Usefulness of polysomnographic studies in the differential diagnosis of insomnia" 82 : 47-60, 1995

6 Eaton WW, "The use of psychological testing for treatment planning and outcomes assessment" Lawrence Erlbaum 363-377, 2004

7 Baron RM, "The moderator-mediator variable distinction in social psychological research : conceptual, strategic, and statistical considerations" 51 : 1173-1182, 1986

8 Edinger JD, "The distribution and clinical significance of sleep time misperceptions among insomniacs" 18 : 232-239, 1995

9 Sivertsen B, "The bidirectional association between depression and insomnia : the HUNT study" 74 : 758-765, 2012

10 Ancoli-Israel S, "The SBSM guide to actigraphy monitoring : clinical and research applications" 13 (13): S4-S38, 2015

11 Edinger JD, "Subtyping primary insomnia : is sleep state misperception a distinct clinical entity" 7 : 203-214, 2003

12 Kay DB, "Subjective-objective sleep discrepancy among older adults : associations with insomnia diagnosis and insomnia treatment" 24 : 32-39, 2015

13 Bayley K, "Subjective-objective discrepancies among patients with sleep complaints in the patient-centered medical home" 2018

14 Fernandez-Mendoza J, "Sleep misperception and chronic insomnia in the general population : role of objective sleep duration and psychological profiles" 73 : 88-97, 2011

15 Vanable PA, "Sleep latency and duration estimates among sleep disorder patients: variability as a function of sleep disorder diagnosis, sleep history, and psychological characteristics" 23 : 71-79, 2000

16 Williams JM, "Sleep discrepancy, sleep complaint, and poor sleep among older adults" 68 : 712-720, 2013

17 Carskadon MA, "Self-reports versus sleep laboratory findings in 122drug-free subjects with complaints of chronic insomnia" 133 : 1382-1388, 1976

18 Armitage R, "Relationship between objective and subjective sleep measures in depressed patients and healthy controls" 5 : 97-102, 1997

19 Riemann D, "Primary insomnia : a risk factor to develop depression" 76 : 255-259, 2003

20 Rezaie L, "Paradoxical insomnia and subjective-objective sleep discrepancy : a review" 40 : 196-202, 2018

21 Lee S, "PS223. Validation of the Korean version of Center for Epidemiologic Studies Depression scale-Revised" 19 (19): 81-82, 2016

22 Te Lindert BHW, "Optimizing actigraphic estimates of polysomnographic sleep features in insomnia disorder" 43 : zsaa090-, 2020

23 Weiss BL, "Once more : the inaccuracy of non-EEG estimations of sleep" 130 : 1282-1285, 1973

24 Manconi M, "Measuring the error in sleep estimation in normal subjects and in patients with insomnia" 19 : 478-486, 2010

25 Marino M, "Measuring sleep : accuracy, sensitivity, and specificity of wrist actigraphy compared to polysomnography" 36 : 1747-1755, 2013

26 Salin-Pascual RJ, "Long-term study of the sleep of insomnia patients with sleep state misperception and other insomnia patients" 149 : 904-908, 1992

27 MacKinnon DP, "Introduction to statistical mediation analysis" Lawrence Erlbaum Associates 2008

28 Vgontzas AN, "Insomnia with objective short sleep duration: the most biologically severe phenotype of the disorder" 17 : 241-254, 2013

29 Baglioni C, "Insomnia as a predictor of depression : a meta-analytic evaluation of longitudinal epidemiological studies" 135 : 10-19, 2011

30 Tsuchiyama K, "Discrepancy between subjective and objective sleep in patients with depression" 57 : 259-264, 2003

31 American Psychiatric Association, "Diagnostic and Statistical Manual of Mental Disorders(DSM-5®)" American Psychiatric Pub 2013

32 Bliwise DL, "Depression as a confounding variable in the estimation of habitual sleep time" 49 : 471-477, 1993

33 McCall C, "Comparison of actigraphy with polysomnography and sleep logs in depressed insomniacs" 21 : 122-127, 2012

34 Staner L, "Comorbidity of insomnia and depression" 14 : 35-46, 2010

35 Matthews CE, "Best practices for using physical activity monitors in population-based research" 44 : S68-S76, 2012

36 Tang NK, "Altering misperception of sleep in insomnia : behavioral experiment versus verbal feedback" 74 : 767-776, 2006

37 Means MK, "Accuracy of sleep perceptions among insomnia sufferers and normal sleepers" 4 : 285-296, 2003

38 Harvey AG, "A cognitive model of insomnia" 40 : 869-893, 2002

39 Harvey AG, "(Mis)perception of sleep in insomnia : a puzzle and a resolution" 138 : 77-101, 2012