Advertisement

Schlafmangel und Insomnie

Einfluss auf die körperliche und psychische Gesundheit
  • D. Riemann
  • C. Baglioni
  • K. Spiegelhalder
Leitthema

Zusammenfassung

Die Begriffe „Schlafmangel“ und „Insomnie“ sollten nicht synonym verwendet und nicht verwechselt werden. Als Schlafmangel wird eine Verkürzung der üblichen Schlafdauer eines Menschen bezeichnet, die durch äußere Umstände oder motivationale Faktoren bedingt ist. Bei einer Insomnie liegt hingegen eine für die Betroffenen nicht erklärbare und mit einem Leidensdruck verbundene Störung des Schlafs vor, obwohl die äußeren Umstände nicht gegen einen ausreichend langen Schlaf sprechen. Die meisten Studien zum Thema Schlafmangel untersuchten den Zusammenhang zwischen der Schlafdauer sowie körperlicher und psychischer Gesundheit. Die Längsschnittstudien zeigten dabei, dass Menschen mit einer verkürzten Schlafdauer (< 6 Stunden) ein erhöhtes Risiko für das Auftreten eines metabolischen Syndroms und für kardiovaskuläre Erkrankungen aufweisen. Zudem zeigte sich ein U-förmiger Zusammenhang zwischen der Schlafdauer und Mortalität, das heißt, die Mortalität ist sowohl bei einer verkürzten (< 6 Stunden) als auch bei einer verlängerten Schlafdauer (> 8 Stunden) erhöht. In Bezug auf Insomnien konnten ähnliche, allerdings schwächer ausgeprägte Zusammenhänge gezeigt werden. Zudem sind Insomnien Risikofaktoren für psychische Erkrankungen, insbesondere für Depressionen. Die Befunde legen nahe, dem Thema Schlaf und Schlafstörungen in der ärztlichen Praxis mehr Zeit einzuräumen und diesbezügliche Präventionsmaßnahmen zu stärken.

Schlüsselwörter

Schlafmangel Insomnie Depression Metabolisches Syndrom Herz-Kreislauf-Erkrankungen 

Lack of sleep and insomnia

Impact on somatic and mental health

Abstract

Lack of sleep and insomnia need to be viewed differently. Lack of sleep implies a shortening of the habitual sleep duration due to external circumstances or motivational factors. Insomnia, in contrast, is defined as a sleep disorder due to unknown reasons for the afflicted subjects. People with insomnia suffer from being unable to sleep, in spite of adequate external circumstances. Research on lack of sleep/shortened sleep duration has focused on relationships with somatic and mental health. Longitudinal studies revealed that a shortening of sleep duration (< 6 h) is associated with an increased risk for the metabolic syndrome and cardiovascular diseases. For sleep duration and mortality, a U-shaped relationship was found, indicating that both shortened (< 6 h) and prolonged sleep durations (> 8 h) are associated with increased mortality. Similar, albeit weaker, correlations were described for insomnia and somatic health. In addition, insomnia is a risk factor for the development of mental disorders, especially depression. These relationships suggest that the area of sleep and sleep disorders should be integrated into everyday medical practice and that preventive approaches to somatic and mental disorders should encompass the topic of sleep to a much stronger extent than currently practiced.

Keywords

Lack of sleep Insomnia Depression Metabolic syndrome Cardiovascular disorders 

Notes

Danksagung

Aktuelle Forschungsarbeiten von D. Riemann, K. Spiegelhalder und C. Baglioni zum Thema dieses Artikels werden mit EU-Mitteln gefördert (OPTIMI, GAN 248544; Marie Curie IEF, GAN 235231).

Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: D. Riemann hat im letzten Jahr Mittel zur Durchführung einer „Investigator Initiated Study“ von Sanofi Aventis bekommen. Die beiden anderen Autoren geben keinen Interessenkonflikt an.

Literatur

  1. 1.
    Edinger JD, Bonnet MH, Bootzin RR et al (2004) Derivation of research diagnostic criteria for insomnia: report of an American academy of sleep medicine work group. Sleep 27:1567–1596PubMedGoogle Scholar
  2. 2.
    Peter H, Penzel T, Peter JH (2007) Enzyklopädie der Schlafmedizin. Springer, BerlinGoogle Scholar
  3. 3.
    AASM (2005) International classification of sleep disorder, 2. Aufl. Westchester, IlliniosGoogle Scholar
  4. 4.
    Horne J (1988) Why we sleep. Oxford University Press, OxfordGoogle Scholar
  5. 5.
    Van Dongen HP, Maislin G, Mullington JM, Dinges DF (2003) The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep 26:117–126Google Scholar
  6. 6.
    American Psychiatric Association (1994) Diagnostic and statistical manual, 4. Aufl. American Psychiatric Association, Washington D.CGoogle Scholar
  7. 7.
    NIH, National Institutes of Health State of the Science Conference Statement (2005) Manifestations and management of chronic insomnia in adults, June 13–15. Sleep 28:1049–1057Google Scholar
  8. 8.
    Reynolds CF, Redline S, Morin C et al (2010) The DSM-V sleep-wake disorders nosology: an update and an invitation to the sleep community. Sleep 33:10–11PubMedGoogle Scholar
  9. 9.
    Ohayon M (2002) Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev 6:97–111PubMedCrossRefGoogle Scholar
  10. 10.
    Riemann D, Hajak G (2009) Insomnien: I. Ätiologie, Pathophysiologie und Diagnostik. Nervenarzt 9:1060–1069CrossRefGoogle Scholar
  11. 11.
    Spiegelhalder K, Scholtes C, Riemann D (2010) The association between insomnia and cardiovascular diseases. Nature Sci Sleep 2:71–78CrossRefGoogle Scholar
  12. 12.
    Haynes SN, Adams A, Franzen M (1981) The effects of presleep stress on sleep-onset insomnia. J Abnorm Psychol 90:601–606PubMedCrossRefGoogle Scholar
  13. 13.
    Bonnet MH, Arand DL (1998b) Heart rate variability in insomniacs and matched normal sleepers. Psychosom Med 60:610–615PubMedGoogle Scholar
  14. 14.
    Fox K, Borer JS, Camm AJ et al (2007) Resting heart rate in cardiovascular disease. J Am Coll Cardiol 50:823–830PubMedCrossRefGoogle Scholar
  15. 15.
    Lahiri MK, Kannankeril PJ, Goldberger JJ (2008) Assessment of autonomic function in cardiovascular disease: physiological basis and prognostic implications. J Am Coll Cardiol 51:1725–1733PubMedCrossRefGoogle Scholar
  16. 16.
    Nilsson PM, Nilsson JA, Hedblad B, Berglund G (2001) Sleep disturbance in association with elevated pulse rate for prediction of mortality – consequences of mental strain? J Intern Med 250:521–529PubMedCrossRefGoogle Scholar
  17. 17.
    Jurysta F, Lanquart JP, Sputaels V et al (2009) The impact of chronic primary insomnia on the heart rate – EEG variability link. Clin Neurophysiol 120:1054–1060PubMedCrossRefGoogle Scholar
  18. 18.
    Spiegelhalder K, Fuchs L, Ladwig J et al (2011) Heart rate and heart rate variability in subjectively reported insomnia. J Sleep Res 20:137–145PubMedCrossRefGoogle Scholar
  19. 19.
    Ben-Dov IZ, Kark JD, Ben-Ishay D et al (2007) Blunted heart rate dip during sleep and all-cause mortality. Arch Intern Med 167:2116–2121PubMedCrossRefGoogle Scholar
  20. 20.
    Gangwisch JE, Heymsfield SB, Boden-Albala B et al (2006) Short sleep duration as a risk factor for hypertension: analyses of the first National Health and Nutrition Examination Survey. Hypertension 47:833–839PubMedCrossRefGoogle Scholar
  21. 21.
    Suka M, Yoshida K, Sugimori H (2003) Persistent insomnia is a predictor of hypertension in Japanese male workers. J Occup Health 45:344–350PubMedCrossRefGoogle Scholar
  22. 22.
    Knutson KL, Van Cauter E, Rathouz PJ et al (2009) Association between sleep and blood pressure in midlife: the CARDIA sleep study. Arch Intern Med 169:1055–1061PubMedCrossRefGoogle Scholar
  23. 23.
    Phillips B, Mannino DM (2007) Do insomnia complaints cause hypertension or cardiovascular disease? J Clin Sleep Med 3:489–494PubMedGoogle Scholar
  24. 24.
    Phillips B, Buzkova P, Enright P (2009) Insomnia did not predict incident hypertension in older adults in the cardiovascular health study. Sleep 32:65–72PubMedGoogle Scholar
  25. 25.
    Vgontzas AN, Liao D, Bixler EO et al (2009) Insomnia with objective short sleep duration is associated with a high risk for hypertension. Sleep 32:491–497PubMedGoogle Scholar
  26. 26.
    Lanfranchi PA, Pennestri MH, Fradette L et al (2009) Night time blood pressure in normotensive subjects with chronic insomnia: implications for cardiovascular risk. Sleep 32:760–766PubMedGoogle Scholar
  27. 27.
    Schwartz SW, Cornoni-Huntley J, Cole SR et al (1998) Are sleep complaints an independent risk factor for myocardial infarction? Ann Epidemiol 8:384–392PubMedCrossRefGoogle Scholar
  28. 28.
    Mallon L, Broman JE, Hetta J (2002) Sleep complaints predict coronary artery disease mortality in males: a 12-year follow-up study of a middle-aged Swedish population. J Intern Med 251:207–216PubMedCrossRefGoogle Scholar
  29. 29.
    Schwartz S, Anderson WM, Cole SR et al (1999) Insomnia and heart disease: a review of epidemiologic studies. J Psychosom Res 47:313–333PubMedCrossRefGoogle Scholar
  30. 30.
    Kripke DF, Garfinkel L, Wingard DL et al (2002) Mortality associated with sleep duration and insomnia. Arch Gen Psychiat 59:131–136PubMedCrossRefGoogle Scholar
  31. 31.
    Gallicchio L, Kalesan B (2009) Sleep duration and mortality: a systematic review and meta-analysis. J Sleep Res 18:148–158PubMedCrossRefGoogle Scholar
  32. 32.
    Grandner MA, Hale L, Moore M, Patel NP (2010) Mortality associated with short sleep duration: the evidence, the possible mechanisms and the future. Sleep Med Rev 14:191–203PubMedCrossRefGoogle Scholar
  33. 33.
    Vgontzas A, Liao D, Pejovic S et al (2010) Insomnia with short sleep duration and mortality: the Penn state cohort. Sleep 33:1159–1164PubMedGoogle Scholar
  34. 34.
    Vorona R, Winn MP, Babineau TW et al (2005) Overweight and obese patients in a primary care population report less sleep than patients with a normal body mass index. Arch Intern Med 165:25–30PubMedCrossRefGoogle Scholar
  35. 35.
    Bass J, Turek FW (2005) Sleepless in America – a pathway to obesity and the metabolic syndrome? Arch Intern Med 165:15–16PubMedCrossRefGoogle Scholar
  36. 36.
    Patel S, Hu FB (2008) Short sleep duration and weight gain: a systematic review. Obesity 16:643–653PubMedCrossRefGoogle Scholar
  37. 37.
    Chen X, Beydoun MA, Wang Y (2008) Is sleep duration associated with childhood obesity? A systematic review and meta-analysis. Obesity 16:265–274PubMedCrossRefGoogle Scholar
  38. 38.
    Marshall NS, Glozier N, Grunstein RR (2008) Is sleep duration related to obesity? A critical review of the epidemiological evidence. Sleep Med Rev 12:289–298PubMedCrossRefGoogle Scholar
  39. 39.
    Nielsen LS, Danielsen KV, Sorensen TI (2011) Short sleep duration as a possible cause of obesity: critical analysis of the epidemiological evidence. Obes Rev 12:78–92PubMedCrossRefGoogle Scholar
  40. 40.
    Nilsson PM, Röst M, Engström G et al (2004) Incidence of diabetes in middle-aged men is related to sleep disturbances. Diabetes Care 27:2464–2469PubMedCrossRefGoogle Scholar
  41. 41.
    Mallon L, Broman JE, Hetta J (2005) High incidence of diabetes in men with sleep complaints or short sleep duration. Diabetes Care 28:2762–2767PubMedCrossRefGoogle Scholar
  42. 42.
    Hayashino Y, Fukuhara S, Suzukamo Y et al (2007) Relation between sleep quality and quantity, quality of life, and risk of developing diabetes in healthy workers in Japan: the high risk and population strategy for occupational health promotion. BMC Public Health 7:129–137PubMedCrossRefGoogle Scholar
  43. 43.
    Vgontzas AN, Liao D, Pejovic S et al (2009) Insomnia with objective short sleep duration is associated with type 2 diabetes: a population-based study. Diabetes Care 32:1980–1985PubMedCrossRefGoogle Scholar
  44. 44.
    Spiegel K, Leproult R, Cauter E van (1999) Impact of sleep debt on metabolic and endocrine function. Lancet 354:1435–1439PubMedCrossRefGoogle Scholar
  45. 45.
    Spiegel K, Tasali E, Leproult R, Cauter E van (2009) Effects of poor and short sleep on glucose metabolism and obesity risk. Nat Rev Endocr 5:253–261CrossRefGoogle Scholar
  46. 46.
    Riemann D, Berger M, Voderholzer U (2001) Sleep and depression – results from psychobiological studies: an overview. Biol Psychol 57:67–103PubMedCrossRefGoogle Scholar
  47. 47.
    Ford DE, Kamerow DB (1989) Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention? JAMA 262:1479–1484PubMedCrossRefGoogle Scholar
  48. 48.
    Riemann D, Voderholzer U (2003) Primary insomnia: a risk factor to develop depression? J Affect Disord 76:255–259PubMedCrossRefGoogle Scholar
  49. 49.
    Baglioni C, Battagliese G, Feige B et al (im Druck) Insomnia is a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. J Affect DisordGoogle Scholar
  50. 50.
    Riemann D, Perlis ML (2009) The treatments of chronic insomnia: a review of benzo-diazepine receptor agonists and psychological and behavioural therapies. Sleep Med Rev 13:205–214PubMedCrossRefGoogle Scholar
  51. 51.
    Riemann D, Spiegelhalder K, Feige B et al (2010) The hyperarousal concept of insomnia: a review of the concept and its evidence. Sleep Med Rev 14:19–31PubMedCrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag 2011

Authors and Affiliations

  1. 1.Abteilung für Psychiatrie und PsychotherapieUniversitätsklinik FreiburgFreiburgDeutschland

Personalised recommendations