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已发表论文
中国慢性失眠成人反常性失眠的患病率、临床相关因素、性别差异及预测因素：一项横断面研究
Authors Wang M, Zhu W, Sun Y, Feng Z, Hou Y, Wang H , Zhou B, Han F, Xiao F
Received 7 October 2025
Accepted for publication 4 January 2026
Published 21 January 2026 Volume 2026:18 570398
DOI https://doi.org/10.2147/NSS.S570398
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Prof. Dr. Ahmed BaHammam
Mengmeng Wang,1,2,* Wenjun Zhu,1,3,* Yunliang Sun,4 Zhaoyan Feng,1 Yanyan Hou,1 Huanhuan Wang,1 Bing Zhou,1 Fang Han,1 Fulong Xiao1
1Division of Sleep Medicine, Peking University People’s Hospital, Beijing, People’s Republic of China; 2Nursing Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China; 3Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China; 4Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Fang Han, Division of Sleep Medicine, Peking University People’s Hospital, Beijing, 100044, People’s Republic of China, Email hanfang1@hotmail.com Fulong Xiao, Division of Sleep Medicine, Peking University People’s Hospital, Beijing, 100044, People’s Republic of China, Email xiaofulong1681@163.com
Objective: This study aimed to determine the prevalence of paradoxical insomnia (PI) in Chinese adults with chronic insomnia, compare clinical and sleep-related characteristics between PI and non-paradoxical insomnia (non-PI) groups, explore gender-specific differences, and identify factors associated with PI, with particular focus on anxiety and depression.
Methods: A total of 862 adults with chronic insomnia were involved. All participants completed 7-day sleep diaries and validated questionnaires, including the Hamilton Depression Rating Scale (HAMD; clinician-rated depression), Hamilton Anxiety Rating Scale (HAMA; clinician-rated anxiety), and Insomnia Severity Index (ISI; subjective insomnia severity). All participants underwent two consecutive nights of polysomnography (PSG), and biochemical testing. Group differences were tested using independent samples t-tests or chi-square tests. Subjective-objective sleep associations were examined using Pearson correlations. Multivariable logistic regression was conducted to identify factors associated with PI.
Results: PI was present in 30.5% of participants (n = 263). Compared with non-PI, the PI group showed a higher proportion of females and exhibited greater depressive symptom severity on the HAMD and somatic anxiety on the HAMA, alongside lower perceived insomnia severity on the ISI (all p < 0.05). Gender-stratified analyses suggested distinct profiles, including higher perceived insomnia severity among females with PI and higher apnea-hypopnea index (AHI) among males with non-PI. In multivariable analyses, older age, male gender, heightened somatic symptoms (one subscale of HAMD), and lower subjective insomnia severity remained independently associated with PI (all p < 0.05).
Conclusion: Nearly one-third of Chinese adults with chronic insomnia meet the criteria for PI. Depression, particularly somatic symptoms, male gender, older age, and lower subjective insomnia severity are key predictors of PI. The findings highlight that incorporating objective sleep assessment and considering gender-specific clinical features may reduce diagnostic misclassification and facilitate more individualized management.
Keywords: paradoxical insomnia, sleep state misperception, depressive symptoms, anxiety, gender differences
1Division of Sleep Medicine, Peking University People’s Hospital, Beijing, People’s Republic of China; 2Nursing Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China; 3Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China; 4Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Fang Han, Division of Sleep Medicine, Peking University People’s Hospital, Beijing, 100044, People’s Republic of China, Email hanfang1@hotmail.com Fulong Xiao, Division of Sleep Medicine, Peking University People’s Hospital, Beijing, 100044, People’s Republic of China, Email xiaofulong1681@163.com
Objective: This study aimed to determine the prevalence of paradoxical insomnia (PI) in Chinese adults with chronic insomnia, compare clinical and sleep-related characteristics between PI and non-paradoxical insomnia (non-PI) groups, explore gender-specific differences, and identify factors associated with PI, with particular focus on anxiety and depression.
Methods: A total of 862 adults with chronic insomnia were involved. All participants completed 7-day sleep diaries and validated questionnaires, including the Hamilton Depression Rating Scale (HAMD; clinician-rated depression), Hamilton Anxiety Rating Scale (HAMA; clinician-rated anxiety), and Insomnia Severity Index (ISI; subjective insomnia severity). All participants underwent two consecutive nights of polysomnography (PSG), and biochemical testing. Group differences were tested using independent samples t-tests or chi-square tests. Subjective-objective sleep associations were examined using Pearson correlations. Multivariable logistic regression was conducted to identify factors associated with PI.
Results: PI was present in 30.5% of participants (n = 263). Compared with non-PI, the PI group showed a higher proportion of females and exhibited greater depressive symptom severity on the HAMD and somatic anxiety on the HAMA, alongside lower perceived insomnia severity on the ISI (all p < 0.05). Gender-stratified analyses suggested distinct profiles, including higher perceived insomnia severity among females with PI and higher apnea-hypopnea index (AHI) among males with non-PI. In multivariable analyses, older age, male gender, heightened somatic symptoms (one subscale of HAMD), and lower subjective insomnia severity remained independently associated with PI (all p < 0.05).
Conclusion: Nearly one-third of Chinese adults with chronic insomnia meet the criteria for PI. Depression, particularly somatic symptoms, male gender, older age, and lower subjective insomnia severity are key predictors of PI. The findings highlight that incorporating objective sleep assessment and considering gender-specific clinical features may reduce diagnostic misclassification and facilitate more individualized management.
Keywords: paradoxical insomnia, sleep state misperception, depressive symptoms, anxiety, gender differences