Sleep Misperception and Associated Factors in Patients With Anxiety-Related Disorders and Complaint of Insomnia: A Retrospective Study

Yingjie Liang; Xu Zhao; Changyong Zhang; Guangya Liu; Baili Lu; Li Han; Fang Tong; Xinyu Luo; Chuang Hu; Hui Liu

doi:10.3389/fneur.2022.836949

Sleep Misperception and Associated Factors in Patients With Anxiety-Related Disorders and Complaint of Insomnia: A Retrospective Study

Front Neurol. 2022 Apr 7:13:836949. doi: 10.3389/fneur.2022.836949. eCollection 2022.

Authors

Yingjie Liang^{1

2}, Xu Zhao^{1

2}, Changyong Zhang³, Guangya Liu⁴, Baili Lu¹, Li Han¹, Fang Tong^{1

2}, Xinyu Luo^{1

2}, Chuang Hu^{1

2}, Hui Liu^{1

2}

Affiliations

¹ Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China.
² Department of Sleep Disorder, Wuhan Hospital for Psychotherapy, Wuhan, China.
³ Department of Psychiatry, Wuhan Wudong Hospital (Wuhan Second Mental Hospital), Wuhan, China.
⁴ Outpatient Office, Wuhan Jinyintan Hospital, Wuhan, China.

Abstract

Purpose: Data on sleep parameters by polysomnography (PSG) in patients with anxiety-related disorders are limited. Although the disturbance and risk factors of sleep misperception have been implicated in psychopathology, its role in anxiety-related disorders remains unclear. This retrospective study aimed to explore the characteristics and sleep parameters in patients with anxiety-related disorders and different sleep perception types, and to explore the associated factors for sleep misperception.

Methods: Patients with anxiety-related disorders who had complaint of insomnia for more than 3 months were collected at Wuhan Mental Health Center between December 2019 and July 2021. Patients underwent a two-night PSG monitoring and completed a self-reported sleep questionnaire. Behaviors were assessed using 30-item Nurses' Observation Scale for Inpatient Evaluation (NOSIE-30). Patients were divided into normal sleep perception (NSP), positive sleep perception abnormality [PSPA; overestimation of total sleep time (TST) >60 min], and negative sleep perception abnormality (NSPA; underestimation of TST >60 min) groups. PSG indicators and NOSIE-30 scores were compared among groups using the one-way analysis of variance and the Kruskal-Wallis test. Multiple linear regression analysis was performed to determine the associated factors for misperception index.

Results: The subjective and objective TST were 5.5 ± 1.9 h and 6.4 ± 1.7 h in 305 patients, respectively. Sixty-nine (22.6%) had PSPA, 80 (26.2%) had NSP, and 156 (51.1%) had NSPA. Subjective TST and objective sleep parameters were significantly different among groups. No statistical differences in NOSIE-30 subscale and total scores were observed among groups. Sex, rapid eye movement (REM)/TST (%), sleep efficiency, number of awakenings, Non-rapid eye movement of stage 2 sleep (NREM)/TST (%), REM spontaneous arousal times, sleep latency, diagnosis, social competence, and manifest psychosis were associated with sleep misperception.

Conclusion: Sleep misperception is common in patients with anxiety-related disorders. Various sleep perception types have different PSG profiles, but similar personal and social behaviors. These data may be helpful to conduct personalized treatment.

Keywords: anxiety-related disorders; misperception index; polysomnography; sleep misperception; total sleep time.