上海交通大学学报(医学版), 2023, 43(11): 1436-1444 doi: 10.3969/j.issn.1674-8115.2023.11.012

综述

失眠相关量表汉化及开发现状

罗鑫,, 苑成梅,

上海交通大学医学院附属精神卫生中心临床心理科,上海 200030

Current status of development of Chinese versions of insomnia-related scales

LUO Xin,, YUAN Chengmei,

Department of Clinical Psychology, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China

通讯作者: 苑成梅,电子信箱:yuanchengmei@yeah.net

编委: 吴洋

收稿日期: 2023-06-19   接受日期: 2023-09-15   网络出版日期: 2023-11-28

基金资助: 国家重点研发计划.  2022YFC2503902
上海市科学技术委员会科技创新行动计划.  20Y11906600
上海市申康发展中心重大临床研究项目.  SHDC2020CR4074
上海市卫生健康委员会、上海市中医药管理局中西医协同引导项目.  ZXXXT-202208
上海市精神心理疾病临床医学研究中心项目.  19MC1911100

Corresponding authors: YUAN Chengmei, E-mail:yuanchengmei@yeah.net.

Received: 2023-06-19   Accepted: 2023-09-15   Online: 2023-11-28

作者简介 About authors

罗 鑫(1999—),女,硕士生;电子信箱:xinluoflora@163.com。 E-mail:xinluoflora@163.com

摘要

失眠障碍是最常见的睡眠-觉醒障碍,长期失眠对个体的身心健康有严重的负面影响。选择恰当的测量工具作为失眠的评价指标,对于科研和临床工作者而言尤为重要。国际上已存在多个常用的失眠评估量表,包括匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI)、失眠严重程度指数(Insomnia Severity Index,ISI)等,这些量表广泛应用于评估失眠症状和睡眠质量,为研究者和临床医师提供了可靠的量化工具。除了常规的失眠评估量表,部分量表从睡眠的认知、睡眠卫生、不同人群睡眠情况的角度进行评估。在国内,学者们积极开发适用于中国人群的失眠评估工具,其中也包含针对特殊人群的睡眠评估。此外,还开发了一些具有中医特色的失眠评估量表,以满足国内对于中西医结合治疗的需求。研究者在量表的编制过程中,需要明确量表开发的目的,选择合适的心理测量学方法,并注重量表的可靠性和有效性;同时,开发能够区分失眠亚型的量表,并加强失眠相关量表的多样性。该文对失眠相关量表的汉化及开发现状进行了总结,并对现有量表提出了评价及未来展望。

关键词: 失眠量表 ; 睡眠质量 ; 睡眠-觉醒障碍 ; 失眠评估 ; 睡眠状况

Abstract

Insomnia disorder is the most common sleep-wake disorder, and long-term insomnia has a serious negative impact on the physical and mental health of individuals. It is crucial for researchers and clinicians to select appropriate measurement tools as evaluative indicators for insomnia. There are some commonly used insomnia assessment scales in the world, including Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), etc. These scales are widely used to assess insomnia symptoms and sleep quality, providing researchers and clinicians with reliable quantitative tools. In addition to conventional insomnia assessment scales, some scales evaluate sleep cognition, sleep hygiene, and sleep conditions of different groups of people. Domestic scholars are actively developing sleep assessment tools suitable for the Chinese population, which also include sleep assessment for special groups. In addition, some sleep assessment with traditional Chinese medicine characteristics have also been developed to meet the needs of integrated traditional Chinese and Western medicine treatment. During the process of scale development, researchers should clarify the purpose of scale, select appropriate psychometric methods, and emphasize the reliability and validity of the scale. Furthermore, it is important to develop scales that can differentiate subtypes of insomnia and enhance the diversity of insomnia-related measures. This article summarizes the current situation of development of Chinese versions of insomnia-related scales, and provides evaluation and future prospects for existing scales.

Keywords: insomnia scale ; sleep quality ; sleep-wake disorder ; insomnia assessment ; sleep status

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本文引用格式

罗鑫, 苑成梅. 失眠相关量表汉化及开发现状. 上海交通大学学报(医学版)[J], 2023, 43(11): 1436-1444 doi:10.3969/j.issn.1674-8115.2023.11.012

LUO Xin, YUAN Chengmei. Current status of development of Chinese versions of insomnia-related scales. Journal of Shanghai Jiao Tong University (Medical Science)[J], 2023, 43(11): 1436-1444 doi:10.3969/j.issn.1674-8115.2023.11.012

失眠是指个体在具备充足睡眠机会的条件下,持续经历入睡困难、睡眠维持困难或早醒等问题,常常是焦虑、抑郁等心理问题的症状之一1-2。当这种失眠症状的持续时间达到一定标准,并对日间功能造成损伤时,则演化为失眠障碍。常见的失眠症状评估工具包括客观评估和主观评估两类。客观评估工具以多导睡眠监测仪为主,可以测量患者夜间的睡眠参数,但是无法检测清醒期间大脑活动与失眠日间症状的关系3。量表是最常见的主观评估工具,可以报告客观评估工具无法测量的部分,例如对睡眠质量的主观感知。相比客观评估工具,量表具有简便易行、成本低的优点,更适用于临床筛查和大规模研究4。然而,失眠症状相关的量表种类繁多,测量内容以及适用条件具有一定的差异。因此,选择合适的、具有特异性的量表评估失眠症状尤为重要。

在国内,学者们积极参与汉化国外失眠量表的研究,并自主开发适用于中国人群的失眠评估工具。研究成果将为科学研究和临床实践提供标准化的评估工具,推动睡眠研究的发展和治疗方案的优化。本文对国内外失眠相关评估量表的研究现状进行了总结,并对目前失眠相关量表引进和开发过程中所存在的问题进行了探讨。

1 国际上失眠相关评估量表

国际上用于评估失眠的量表可以分为睡眠质量评估、睡眠-觉醒障碍评估、失眠评估、睡眠认知评估、睡眠卫生评估、特殊人群睡眠质量评估六类(表1)。

表1   国际上常用的失眠相关评估量表

Tab 1  International insomnia-related scales

ClassificationScaleItem/nTimeReliability and validity of Chinese versionReference

Assessment of

sleep quality

PSQI241 month

Cronbach′s α: 0.842.

Test-retest reliability: 0.809 2.

Split-half reliability: r=0.866 1.

PSQI was positively associated with

the score of SDS (r =0.428 9, P<0.01)

and SAS (r =0.416 2, P<0.01)

[5]
SQS281 month

Cronbach′s α was 0.89 among Chinese drivers.

Daytime dysfunction factor significantly

predicted violation involvement and

accident involvement (P=0.001)

[6]
SQQ10Not reported

Cronbach′s α : 0.828.

Test-retest reliability: the ICCs ranged

from 0.738 to 0.764.

SQQ was negatively associated with the score

of NRSS-C (r =-0.645) and SCI-C (r =-0.588)

[7-8]
LSEQ10Not reportedNot reported[9]
Assessment of sleep-wake disordersSDQ1756 monthsNot reported[10-11]

Sleep-50

Questionnaire

501 monthNot reported[12]

Assessment of

insomnia

ISI72 weeks

Cronbach′s α was 0.81 among old people.

Content validity index was 0.94.

Construct validity: ISI-C was positively

associated with the score of PSQI

(r =0.686, P<0.001) and negatively associated

with sleep efficiency (r =-0.583, P<0.001)

[13]
AIS81 month

Test-retest reliability: 0.80.

AIS was positively associated with the score

of Epworth Sleepiness Scale (r =0.44) and

General Health Questionnaire (r =0.51)

[15]
BIS61 monthNot reported[16]
SCI81 month

Cronbach′s α: 0.817.

SCI was negatively associated with the score

of SQQ (r =-0.558, P < 0.001)

[17-19]
MISS3Not reportedNot reported[20]
JSS41 monthNot reported[21]

Sleep cognitive

assessment

DBAS-30301 month

Cronbach′s α: 0.835.

Test-retest reliability: 0.94.

Split-half reliability: 0.81.

DBAS-30 was positively associated with the

score of DBAS-16 (r =0.86), and was negatively

associated with the score of PSQI (r =-0.48)

[24]
GSES71 week

Cronbach′s α was 0.775 among college students.

Test-retest reliability: 0.917.

GSES was positively associated with the score

of PSQI (r =0.405), and was negatively

associated with the score of DBAS-16 (r =-0.439)

[27]
ClassificationScaleItem/nTimeReliability and validity of Chinese versionReference
Sleep hygiene assessmentSHAPS311 weekNot reported[28]
SHI13Not reported

Cronbach′s α was 0.62 among students in

nursing major.

Test-retest reliability: 0.9.

SHI was positively associated with the score of

ISI (r =0.25)

[30]

Assessment of

sleep quality

of different

populations

CSHQ331 month

Cronbach′s α: 0.73.

The consistency between mother and father was 0.89.

Test-retest reliability was 0.85

[31]
SDSC266 months

Cronbach′s α was 0.86 among preschoolers.

Split-half reliability: 0.802

[32]
RCSQ61 d

Cronbach′s α was 0.895 among ICU patients.

Content validity: 0.84.

RCSQ was positively associated with the score

of SMH (r =0.504‒0.856)

[33]
SMH91 dNot reported[34]
VSH83 dNot reported[35]
MOS-SS121 month

Cronbach′s α =0.72‒0.88.

Test-retest reliability ranged from 0.64 to 0.91

[36]

Note: SDS—Self-Rating Depression Scale; SAS—Self-Rating Anxiety Scale; NRSS-C—Chinese Nonrestorative Sleep Scale; ICCs—intraclass correlation coefficients; SCI-C—Chinese Sleep Condition Indicator.

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1.1 睡眠质量评估

睡眠质量量表能够客观地反映患者对失眠症状的主观体验,并提供多维度的评估指标,广泛应用于失眠症状的评估。

国内外使用最为广泛的睡眠质量评估工具是匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI),该量表用来评价健康人群、睡眠障碍患者和伴有睡眠问题的精神疾病患者日间和夜间的睡眠情况。量表前4题可以计算出患者的在床时间、睡眠潜伏期、主观睡眠时间和睡眠效率。中文版PSQI的信度和效度已经过检验,其临界值为7分时,区分患者和健康人的灵敏度和特异度分别是98.3%和90.2%5。与PSQI相比,睡眠质量量表(Sleep Quality Scale,SQS)评价内容更加全面,包含更多关于睡眠后恢复功能、起床困难和因睡眠不良而导致的白天功能障碍的条目6。睡眠品质问卷(Sleep Quality Questionnaire,SQQ)是针对健康人群设计的,能够对有着高风险睡眠问题的个体进行早期的筛查。该量表分为日间嗜睡和睡眠困难2个维度,其中睡眠困难分量表可以用来单独评估失眠,作为结果变量或预测变量使用7。中文版SQQ在删去条目2后具有良好的信度和效度,并具有跨性别、年龄和跨时间的测量不变性8。里兹睡眠评价量表(Leeds Sleep Evaluation Questionnaire,LSEQ)用来评估患者主观睡眠质量在药物治疗前后的变化。在一项跨文化研究中,该量表的4个维度在使用安慰剂和药物治疗的原发性失眠患者中内部一致性为0.78~0.929。然而,该量表主要用于药物实验,不适用于行为学实验。

1.2 睡眠-觉醒障碍评估

有一些量表旨在筛选包括失眠在内的不同睡眠-觉醒障碍。睡眠障碍问卷(Sleep Disorders Questionnaire,SDQ)可以作为睡眠-觉醒相关障碍的辅助诊断工具10。一项荷兰的研究11对145份SDQ的得分进行聚类分析,67%的受试者能够正确地被归为健康、抑郁、失眠、发作性睡病和呼吸暂停组,表明SDQ是辅助诊断睡眠-觉醒障碍的有效工具。然而,该量表共175个条目,限制了其在大范围内的使用。原作者编制了一个45个条目的版本,用于评估睡眠呼吸暂停、发作性睡病、精神病性睡眠障碍和周期性肢体运动障碍。睡眠-50问卷(Sleep-50 Questionnaire)包含9个分量表,用于一般人群、大学生和患者睡眠-觉醒障碍的筛查。英文版睡眠-50问卷的Cronbach′s α系数为0.85,重测系数为0.78(P<0.01),能够预测睡眠呼吸暂停、失眠、发作性睡病、不宁腿或周期性肢体运动障碍、昼夜节律睡眠障碍、睡行症、梦魇、影响睡眠的因素,以及睡眠对于日间功能的影响12

1.3 失眠评估

失眠障碍的诊断通常需要医师主观判断,而相关量表可作为辅助诊断参考。这类量表对于失眠障碍的临床意义有明确的划分界限。

失眠严重指数量表(Insomnia Severity Index,ISI)和阿森斯失眠量表(Athens Insomnia Scale,AIS)侧重评估失眠的严重程度,通过患者对于严重程度的主观描述计分,可将失眠划分为不同程度。ISI能够反映患者睡眠模式的变化、失眠的后果以及与睡眠问题有关的担忧13。AIS的前5个题目可以用于评估夜间睡眠情况。该量表在原发性失眠患者、精神疾病患者和健康人群中被证明是有效的14。中文版ISI和AIS具有良好的心理测量学特性,但中文版ISI和AIS的划界值分别为9分和7分时,灵敏度和特异度最高,与原版的7分和6分均不一致15,可能与测试人群不同有关。

卑尔根失眠量表(Bergen Insomnia Scale,BIS)是根据《精神障碍诊断与统计手册》第四版修订版(Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition,DSM-IV)对失眠障碍的定义编制而成的评估工具16。该量表的前3个问题用于评估入睡困难、睡眠维持困难和早醒,后3个问题用于评估失眠症状对日间功能和情感状态的干扰,更加准确地反映了失眠障碍诊断标准的不同方面。相比之下,睡眠状态指数(Sleep Condition Indicator,SCI)则采用更为详细的时间划分方式,并且在日间功能受损的相关问题中使用了患者主观感受作为评估依据。该量表的条目3和条目7构成简版SCI,可以用于快速筛查17。目前已有繁体中文版、繁体中文简版18和简体中文版193个版本。

此外,最小失眠症状量表(Minimal Insomnia Symptom Scale,MISS)20和詹金斯睡眠量表(Jenkins Sleep Scale,JSS)21均可用于失眠障碍的筛查,其共同特点是条目简单、操作方便,但均未汉化。

1.4 睡眠认知评估

睡眠的三因素模型认为,睡眠由睡眠驱动、生物钟和唤醒系统三部分调控,过度活跃的唤醒系统可能会影响调节睡眠的另外2个过程,其中认知唤醒最为常见22。睡眠信念和态度量表(Dysfunctional Beliefs and Attitudes on Sleep,DBAS)是国内外应用最为广泛的评估失眠相关认知的量表,该量表用于评价失眠相关的信念、态度、期望和归因,可以作为治疗效果的评价指标之一23。量表分为30个条目(Dysfunctional Beliefs and Attitudes on Sleep-30,DBAS-30)和16个条目(Dysfunctional Beliefs and Attitudes on Sleep-16,DBAS-16)2个版本。中文版DBAS-30经过修订,保留了24个条目24,在健康人群和患者中的Cronbach′s α系数分别为0.835和0.78025。过度的认知唤醒会导致睡眠努力,睡眠努力被公认为失眠的维持因素。格拉斯哥睡眠努力度问卷(Glasgow Sleep Effort Scale,GSES)可用来评估个体在睡眠上的努力程度,可以作为矛盾意向法治疗失眠的指导,该疗法通过最大程度减少睡眠努力来改善睡眠26。余金玲27使用中文版GSES作为失眠障碍患者睡眠努力的指标,探究其与客观睡眠质量的关系,结果发现睡眠努力程度能够准确地预测睡眠潜伏期。

1.5 睡眠卫生评估

此外,不良的睡眠卫生习惯也是失眠的影响因素之一。睡眠卫生意识和习惯量表(Sleep Hygiene Awareness and Practice Scale,SHAPS)常用来评估个体对睡眠卫生的了解和实践程度。该量表包括睡眠卫生意识和睡眠卫生习惯两部分28,通常采用3 d/周作为睡眠卫生的临界值。中文版SHAPS常用于大学生睡眠卫生习惯的调查29。与SHAPS相似,睡眠卫生指数(Sleep Hygiene Index,SHI)用于评价不良的睡眠卫生习惯,中文版SHI可以用于预测失眠30

1.6 特殊人群睡眠质量评估

大多数睡眠量表适用于成年人,但儿童的睡眠问题同样值得关注。儿童睡眠量表通常由父母填写,能够反映孩子意识不到的行为,如异态睡眠。常见的儿童睡眠量表有儿童睡眠习惯问卷(Children′s Sleep Habits Questionnaire,CSHQ)和儿童睡眠紊乱量表(Sleep Disturbance Scale for Children,SDSC)。CSHQ用于评价4~12岁儿童典型的睡眠问题31。中文版SDSC在我国儿童中心理测量学特性良好32。CSHQ和SDSC均对儿童的入睡和睡眠持续问题、睡眠呼吸问题、异态睡眠和嗜睡进行了测量。

此外,还有一些针对不同疾病患者睡眠质量评估的量表。查兹-坎贝尔睡眠量表(Richards-Campbell Sleep Questionnaire,RCSQ)采用视觉模拟量表,可以评估重症监护室(ICU)患者前一天的睡眠状况33。St. Mary′s医院睡眠问卷(St. Mary′s Hospital Sleep Questionnaire,SMH)能够评估患者前一天的睡眠参数及主观体验,国内研究多将该量表应用于术后患者睡眠治疗的评估34。维辛氏睡眠量表(Verran and Snyder-Halpern Sleep Scale,VSH)采用视觉模拟评分,在没有睡眠障碍的住院患者中被证明具有良好的信度和效度35。睡眠影响健康的评定量表(Medical Outcomes Study Sleep Scale,MOS-SS)用于癌症疼痛或者其他慢性疼痛患者的睡眠评估,该量表能够粗略地估计睡眠参数,与PSQI相比,多了睡眠不宁的条目36

2 国内失眠相关评估量表

目前,国内自主研发的失眠相关评估量表可以分为睡眠相关评估、失眠评估以及特殊人群睡眠质量评估3类(表2)。

表2   国内失眠相关量表

Tab 2  Domestic insomnia scales

ClassificationInstrumentClinical applicationNorm modelCut-off scoreReference

Assessment

of sleep

SRSS

Used to investigate sleep

in different populations or

as an indicator of efficacy

Yes

A cut-off score ≥23

was diagnosed as

insomnia

[37-38]
CPSDS

For screening and assessment

of sleep disorders in the

general population

NoNot reported[39]

Assessment

of insomnia

SDRS

For assessing the severity

of insomnia

NoNot reported[44]
WIIQ

It can be used as an

alternative to PSQI to assess

the severity of insomnia

No

A cut-off score≥5

was diagnosed as

insomnia

[42]

Insomnia

scale of

TCM

For evaluating the efficacy of

Chinese medicine in the

treatment of insomnia

NoNot reported[45]

Assessment of

sleep quality

of different populations

SQSCMP

For the assessment

of sleep in soldiers

NoNot reported[46]
SSSAS

To assess the ability of soldiers

to adapt and self-adjust to

changes in their sleep

environment

NoNot reported[47]
CMPSDS

For assessing sleep problems

in soldiers

NoNot reported[48]
ISAS

For assessing the sleep of

infants from 0 to 3 months

Yes

The cut-off values for poor and

abnormal sleep were 31 and

34, respectively

[49, 51]

For assessing the sleep of

infants aged 4‒11 months

The cut-off values for poor and

abnormal sleep were 32 and

35, respectively

TSAS

For assessing sleep

in toddlers aged 12‒35

months

Yes

The total score>40 indicated

poor sleep, and >45 indicated

abnormal sleep

[50, 52]

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2.1 睡眠相关评估

国内开发的睡眠相关评估量表中,应用最广泛的是睡眠状况自评量表(Self-Rating Scale of Sleep,SRSS)。该量表由李建明教授编制,一共包括10个条目,用于评估过去1个月内的睡眠情况37。研究者在大学生群体中进行了SRSS信度和效度检验,并根据13 273名健康个体制定了全国常模38。中国睡眠障碍量表(Chinese Military Personnel Sleep Disorders Scale,CPSDS)包含5个因子和1个掩饰分量表39。该量表用于探究睡眠质量与心理承受力等变量的关系,还可以用于睡眠相关障碍的调查40

2.2 失眠评估

国内也有专门评估失眠的量表。汪卫东教授团队参考心理学和中西医对失眠的认识编制了汪氏失眠综合问卷(Wang Insomnia Integrated Questionnaire,WIIQ)41。该问卷为一个半结构化问卷,包括个人信息、睡眠情况、日间情况、发病史、心理因素、个人史、家庭史和期待治疗方式,能够全面地反映失眠的影响因素和睡眠现状。其中,WIIQ的睡眠情况部分可以单独用来评估失眠的严重程度。该部分参考PSQI的量表结构,测量了失眠之前、不服药和服药情况下的主观睡眠参数及其他关于睡眠的评价。量表的评分标准也参考PSQI,如睡眠效率的分界线42。WIIQ的心理因素部分用来评估失眠的心理因素,包括过度要求、控制干预、外归因和依赖4个维度,但该部分并未经过信度和效度检验43

其他相关量表包括睡眠障碍评定量表(Sleep Dysfunction Rating Scale,SDRS),能够区分失眠的不同临床类型44,多用于精神药物治疗前后的疗效评价指标;此外,还有根据中医证候分型辩证要点及中医理论所编制的中医失眠量表(Insomnia Scale of TCM),该量表更接近中国人的生活,可以作为中医药治疗失眠的疗效评价工具45

2.3 特殊人群睡眠质量评估

国内学者也开发了一些针对特殊人群的睡眠量表,尤其是军人群体。2009年发表的中国军人睡眠质量量表(Sleep Quality Scale of Chinese Military Personnel,SQSCMP),不仅包括睡眠量表常见的评估内容,如入睡和睡眠维持问题、日间功能等,还包括个体对睡眠的紧张、担心等情绪状态46。该团队还开发了军人睡眠自适应量表(Soldier Sleep Self-Adaptation Scale,SSSAS),用于评估军人对睡眠环境改变的适应能力和自我调整能力47。其他用于军人人群的量表还有军人睡眠问题测量问卷(Chinese Military Personnel Sleep Disorders Scale,CMPSDS)等48

冯围围等于2021年开发了一套适用于我国3岁以下婴幼儿睡眠状况的评估量表,分别是中国婴儿睡眠状况评估量表(Chinese Infants Sleep Assessment Scales,ISAS)49和中国幼儿睡眠状况评估量表(Chinese Toddler Sleep Assessment Scale,TSAS)50。ISAS分为0~3个月和4~11个月2个版本,TSAS适用于12~35个月的幼儿。以上3个量表条目内容有所不同,但均测量了婴幼儿的睡眠节律、入睡行为、夜醒和睡眠呼吸等情况,并制定了睡眠不良及睡眠异常的全国常模51-52

3 失眠相关评估量表存在的问题及展望

综上所述,随着失眠相关研究的不断进展,相关量表的开发和引进呈现出逐渐增多的趋势。然而,在这个过程中仍存在一些问题,需要进一步完善。

第一,在量表开发之前需要明确其目的。失眠量表通常用于3个主要方面:临床诊断、疗效评估以及科学研究。对于临床诊断量表,应当关注失眠的症状、频率、持续时间、严重程度等方面,并根据这些信息提供参考阈值,用以诊断失眠障碍。此外,量表还应具备良好的灵敏度和特异度,以能够准确区分失眠患者和非失眠患者。对于疗效评估量表,可以设定测量指标,例如总睡眠时间、入睡潜伏期、睡眠效率等,作为评估治疗效果的参考。同时,对每个指标可以设定具体的阈值范围,用于衡量治疗效果的改变。对于科学研究量表,需要涵盖更广泛的睡眠特征和相关因素,用于分析和研究失眠的发病机制、流行病学特征、与其他因素的关联等问题。

第二,在量表开发时,应根据不同的目的选择适合的心理测量学方法。除了进行基本的信度和效度检验之外,还应考虑其他心理测量方法学方面的补充53。如果需要评估失眠治疗效果或干预措施对改善失眠症状的影响,需要测试反应度(如ISAS和TSAS)。如需了解特定人群中失眠症状的分布情况,判断个体是否存在异常等情况时,需要进行常模分析(如SSSAS、ISAS和TSAS)。当需要评估不同人群,如性别、年龄、文化背景等不同的群体在失眠症状上的差异时,可以进行多组比较(如中医失眠量表)。

第三,注重量表的可靠性和有效性。目前,国内一些量表的信度系数较低,例如SRSS的Cronbach′s α系数为0.641 8,ISAS和TSAS的Cronbach′s α系数分别为0.68和0.69,而CPSDS中非运动性异样睡眠因子的Cronbach′s α系数仅为0.395,使用可靠性较低的量表可能导致评估结果的不准确。未来研究者需要根据评估结果,对量表进行修订和改进,这可能包括修改问题项、增加新的项目、改善选项的设计等。修订后的量表需要重新进行信度和效度测试。

第四,开发能够区分失眠亚型的量表。根据ICD-11(International Classification of Diseases,11th Revision)中的分类,失眠障碍被分为慢性失眠障碍、短期失眠障碍和未分类的睡眠减少3类。然而,目前尚无量表能够对失眠障碍的不同亚型进行区分。未来的研究可以考虑将失眠持续时间和近期应激事件等因素纳入考量,以便更好地诊断、治疗和研究失眠障碍的不同亚型。

第五,国内应关注失眠相关量表的多样性。目前,国内缺少针对青少年这一人群失眠相关量表的开发。由于睡眠稳态机制的变化,青少年时期的睡眠时相往往会出现向后推迟的情况,该阶段与婴幼儿时期和成年期的睡眠情况存在一定的差异,而国内尚无自主开发的用于评定青少年失眠障碍的量表。此外,不合理的认知是失眠的主要维持因素之一,但目前国内量表所涉及的范围较为有限,仅限于SSSAS和WIIQ的心理因素部分。未来,国内量表的开发需要更加多元化,以便覆盖更多维度和领域。

作者贡献声明

罗鑫负责论文撰写,苑成梅负责论文修改。2位作者均阅读并同意最终稿件的提交。

AUTHOR's CONTRIBUTIONS

The manuscript was drafted by LUO Xin and revised by YUAN Chengmei. Both authors have read the last version of paper and consented for submission.

利益冲突声明

两位作者声明不存在利益冲突。

COMPETING INTERESTS

Both authors disclose no relevant conflict of interests.

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