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Consequences of chronic (primary) insomnia: Effects on performance, psychiatric and medical morbidity—An overview

Konsequenzen der chronischen (primären) Insomnie: Auswirkungen auf Leistungsfähigkeit, psychiatrisches und organisches Erkrankungsrisiko

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Summary

Question of the study

Chronic insomnia afflicts approximately 5–10% of the adult population in Western industrialized countries. Insomnia may be secondary, i. e. triggered and/or maintained by psychiatric/organic illnesses or the intake of prescribed/illicit drugs. It can also occur as primary insomnia, due to a psychophysiological hyperarousal process.

This review article aims at analysing the literature on the consequences of chronic primary insomnia to delineate the sequenlae of ‘pure’ insomnia with respect to performance and to psychiatric and medical morbidity.

Methods

Literature review.

Results

Concerning aspects of performance, studies describing the effects of primary insomnia are scarce. Chronic primary insomnia does not seem to lead to increased daytime sleepiness, but rather to the opposite. Neuropsychological consequences seem to be only of a minor nature. No data exist that prove definitively that primary insomnia is accompanied by general psychosocial impairments. Studies dealing with the interplay between primary insomnia and psychiatric disorders, especially depressive disorders, have been published increasingly in recent years. Analysis of the pertinent literature indicates that patients with primary insomnia are at heightened risk of developing a depressive disorder.

With respect to medical morbidity, the picture is less clear: primary insomnia leads to a heightened utilization of health services and an increased frequency of diagnostic and therapeutic interventions, especially the intake of hypnotic drugs. There is no proof yet that primary insomnia is coupled with an increased frequency of cardiovascular diseases or a weakening of immune functions.

Zusammenfassung

Fragestellung

Etwa 5 bis 10% der erwachsenen Bevölkerung in westlichen Industrieländern leiden unter chronischer Insomnie. Insomnie kann sekundär. d. h. durch psychiatrische/organische Erkrankungen oder die Einnahme verschriebener Medikamente/legaler oder illegaler drogen verursacht sein. Insomnie kann jedoch auch als primäre Insomnie vorkommen, wobei hier ein psychophysiologischer Hyperarousal-Prozess ursächlich angesehen wird.

Dieser Übersichtsartikel zielt darauf ab, die Literatur im Hinblick auf die Konsequenzen der chronischen primären Insomnie zu analysieren, um zu bestimmen, welches die Folgen der „reinen” Insomnie im Hinblick auf Leistungsfähigkeit sowie psychiatrische und körperfiche Morbidität sind.

Methodik

Literaturüberblick.

Ergebnisse

Hinsichtlich Aspekten der Leistungsfähigkeit wurden nur wenige Originalstudien durchgeführt, die sich den Effekten der primären Insomnie widmeten. Chronische primäre Insomnie scheint nicht zu erhöhter Tagesschläfrigkeit zu führen, eher zum Gegenteil. Neuropsychologische Konsequenzen scheinen nur in geringem Maße aufzutreten. Es existieren dato keine Daten, die definitiv beweisen, dass die primäre Insomnie mit deutlichen psychosozialen Beeinträchtigungen einhergeht. In den letzten Jahren wurden zunehmend Studien publiziert, die sich mit dem Zusammenhang zwischen der primären Insomnie und psychiatrischen Störungen, insbesondere depressiven Erkrankungen befassen. Die Analyse der relevanten Literatur zeigt an, dass Patienten mit einer primären Insomnie ein erhöhtes Risiko dafür haben, an einer depressiven Störung zu erkranken. Im Hinblick auf die körperliche Morbidität ist das Bild weniger deutlich: die primäre Insomnie führt zu einer erhöhten Inanspruchnahme von Gesundheitsleistungen und zu einer erhöhten Frequenz diagnostischer und therapeutischer Interventionen, insbesondere natürlich im Hinblick auf die Einnahme hypnotischer Medikamente. Bisher gibt es jedoch keinen Beweis, dass die primäre Insomnie mit einer erhöhten Wahrscheinlichkeit kardiovaskulärer Erkrankungen oder einer Abschwächung von Immunfunktionen verbunden ist.

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Riemann, D., Voderholzer, U. Consequences of chronic (primary) insomnia: Effects on performance, psychiatric and medical morbidity—An overview. Somnologie 6, 101–108 (2002). https://doi.org/10.1046/j.1439-054X.2002.02184.x

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