Insomnia is a major challenge to human health at present. A clear diagnosis of insomnia is very important for health assessment. The World Federation of Societies of Biological Psychiatry Working Group on Sleep Disorders has reached consensus on the value of physiological measurement tools and biomarkers in the diagnosis of insomnia. Based on this consensus, this paper interprets it in order to provide relevant help for clinical practice and scientific research.
Citation： MA Lan, SHI Jing. Interpretation of consensus statement of the WFSBP on potential biomarkers for diagnosing insomnia. Chinese Journal of Evidence-Based Medicine, 2024, 24(7): 845-852. doi: 10.7507/1672-2531.202309129 Copy
| 1. | Collins PY, Patel V, Joestl SS, et al. Grand challenges in global mental health. Nature, 2011, 475(7354): 27-30. |
| 2. | Sateia MJ, Doghramji K, Hauri PJ, et al. Evaluation of chronic insomnia. An American Academy of Sleep Medicine review. Sleep, 2000, 23(2): 243-308. |
| 3. | Chesson AJ, Hartse K, Anderson WM, et al. Practice parameters for the evaluation of chronic insomnia. An American Academy of Sleep Medicine report. Standards of practice committee of the American Academy of Sleep Medicine. Sleep, 2000, 23(2): 237-241. |
| 4. | Buysse DJ, Reynolds CF, Monk TH, et al. The pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res, 1989, 28(2): 193-213. |
| 5. | Soldatos CR, Dikeos DG, Paparrigopoulos TJ. Athens insomnia scale: validation of an instrument based on ICD-10 criteria. J Psychosom Res, 2000, 48(6): 555-560. |
| 6. | Kessler RC, Coulouvrat C, Hajak G, et al. Reliability and validity of the brief insomnia questionnaire in the America insomnia survey. Sleep, 2010, 33(11): 1539-1549. |
| 7. | Spoormaker VI, Verbeek I, van den Bout J, et al. Initial validation of the SLEEP-50 questionnaire. Behav Sleep Med, 2005, 3(4): 227-246. |
| 8. | Roth T, Zammit G, Kushida C, et al. A new questionnaire to detect sleep disorders. Sleep Med, 2002, 3(2): 99-108. |
| 9. | Morin CM, Stone J, Trinkle D, et al. Dysfunctional beliefs and attitudes about sleep among older adults with and without insomnia complaints. Psychol Aging, 1993, 8(3): 463-467. |
| 10. | Morin CM, Vallières A, Ivers H. Dysfunctional beliefs and attitudes about sleep (DBAS): validation of a brief version (DBAS-16). Sleep, 2007, 30(11): 1547-1554. |
| 11. | Smith S, Trinder J. Detecting insomnia: comparison of four self-report measures of sleep in a young adult population. J Sleep Res, 2001, 10(3): 229-235. |
| 12. | Carney CE, Edinger JD, Morin CM, et al. Examining maladaptive beliefs about sleep across insomnia patient groups. J Psychosom Res, 2010, 68(1): 57-65. |
| 13. | Crönlein T, Wagner S, Langguth B, et al. Are dysfunctional attitudes and beliefs about sleep unique to primary insomnia. Sleep Med, 2014, 15(12): 1463-1467. |
| 14. | Hertenstein E, Nissen C, Riemann D, et al. The exploratory power of sleep effort, dysfunctional beliefs and arousal for insomnia severity and polysomnography-determined sleep. J Sleep Res, 2015, 24(4): 399-406. |
| 15. | Harvey CJ, Gehrman P, Espie CA. Who is predisposed to insomnia: a review of familial aggregation, stress-reactivity, personality and coping style. Sleep Med Rev, 2014, 18(3): 237-247. |
| 16. | Broomfield NM, Espie CA. Towards a valid, reliable measure of sleep effort. J Sleep Res, 2005, 14(4): 401-407. |
| 17. | Kales A, Caldwell AB, Soldatos CR, et al. Biopsychobehavioral correlates of insomnia. II. Pattern specificity and consistency with the Minnesota multiphasic personality inventory. Psychosom Med, 1983, 45(4): 341-356. |
| 18. | van de Laar M, Leufkens T, Bakker B, et al. Phenotypes of sleeplessness: stressing the need for psychodiagnostics in the assessment of insomnia. Psychol Health Med, 2017, 22(8): 902-910. |
| 19. | Križan Z, Hisler G. Personality and sleep: neuroticism and conscientiousness predict behaviourally recorded sleep years later. Eur J Pers, 2019, 33(2): 133-153. |
| 20. | Stephan Y, Sutin AR, Bayard S, et al. Personality and sleep quality: Evidence from four prospective studies. Health Psychol, 2018, 37(3): 271-281. |
| 21. | Gray EK, Watson D. General and specific traits of personality and their relation to sleep and academic performance. J Pers, 2002, 70(2): 177-206. |
| 22. | Duggan KA, Friedman HS, McDevitt EA, et al. Personality and healthy sleep: the importance of conscientiousness and neuroticism. PLoS One, 2014, 9(3): e90628. |
| 23. | Lundh L, Broman J, Hetta J, et al. Perfectionism and Insomnia. Scandi J Behav Ther, 1994, 23(1): 3-18. |
| 24. | Jansson-Frojmark M, Harvey AG, Lundh LG, et al. Psychometric properties of an insomnia-specific measure of worry: the anxiety and preoccupation about sleep questionnaire. Cogn Behav Ther, 2011, 40(1): 65-76. |
| 25. | Johann AF, Hertenstein E, Kyle SD, et al. Perfectionism and polysomnography-determined markers of poor sleep. J Clin Sleep Med, 2017, 13(11): 1319-1326. |
| 26. | Regen W, Kyle SD, Nissen C, et al. Objective sleep disturbances are associated with greater waking resting-state connectivity between the retrosplenial cortex/ hippocampus and various nodes of the default mode network. J Psychiatry Neurosci, 2016, 41(5): 295-303. |
| 27. | Terzano MG, Parrino L, Smerieri A. Neurophysiological basis of insomnia: role of cyclic alternating patterns. Rev Neurol, 2001, 157(11 Pt 2): S62-S66. |
| 28. | Chouvarda I, Mendez MO, Rosso V, et al. Cyclic alternating patterns in normal sleep and insomnia: structure and content differences. IEEE Trans Neural Syst Rehabil Eng, 2012, 20(5): 642-652. |
| 29. | Spiegelhalder K, Regen W, Feige B, et al. Increased EEG sigma and beta power during NREM sleep in primary insomnia. Biol Psychol, 2012, 91(3): 329-333. |
| 30. | Colombo MA, Ramautar JR, Wei Y, et al. Wake high-density electroencephalographic spatiospectral signatures of insomnia. Sleep, 2016, 39(5): 1015-1027. |
| 31. | Riedner BA, Goldstein MR, Plante DT, et al. Regional patterns of elevated alpha and high-frequency electroencephalographic activity during nonrapid eye movement sleep in chronic insomnia: a pilot study. Sleep, 2016, 39(4): 801-812. |
| 32. | Buysse DJ, Germain A, Hall ML, et al. EEG spectral analysis in primary insomnia: NREM period effects and sex differences. Sleep, 2008, 31(12): 1673-1682. |
| 33. | Svetnik V, Snyder ES, Ma J, et al. EEG spectral analysis of NREM sleep in a large sample of patients with insomnia and good sleepers: effects of age, sex and part of the night. J Sleep Res, 2017, 26(1): 92-104. |
| 34. | Schwabedal JT, Riedl M, Penzel T, et al. Alpha-wave frequency characteristics in health and insomnia during sleep. J Sleep Res, 2016, 25(3): 278-286. |
| 35. | Smith MT, Perlis ML, Chengazi VU, et al. Neuroimaging of NREM sleep in primary insomnia: a Tc-99-HMPAO single photon emission computed tomography study. Sleep, 2002, 25(3): 325-335. |
| 36. | Nofzinger EA, Buysse DJ, Germain A, et al. Functional neuroimaging evidence for hyperarousal in insomnia. Am J Psychiatry, 2004, 161(11): 2126-2128. |
| 37. | Kay DB, Karim HT, Soehner AM, et al. Sleep-wake differences in relative regional cerebral metabolic rate for glucose among patients with insomnia compared with good sleepers. Sleep, 2016, 39(10): 1779-1794. |
| 38. | Kay DB, Karim HT, Soehner AM, et al. Subjective-objective sleep discrepancy is associated with alterations in regional glucose metabolism in patients with insomnia and good sleeper controls. Sleep, 2017, 40(11): zsx155. |
| 39. | Harvey AG, Tang NK. (Mis)perception of sleep in insomnia: a puzzle and a resolution. Psychol Bull, 2012, 138(1): 77-101. |
| 40. | Baglioni C, Regen W, Teghen A, et al. Sleep changes in the disorder of insomnia: a meta-analysis of polysomnographic studies. Sleep Med Rev, 2014, 18(3): 195-213. |
| 41. | Altena E, Van Der Werf YD, Sanz-Arigita EJ, et al. Prefrontal hypoactivation and recovery in insomnia. Sleep, 2008, 31(9): 1271-1276. |
| 42. | Drummond SP, Walker M, Almklov E, et al. Neural correlates of working memory performance in primary insomnia. Sleep, 2013, 36(9): 1307-1316. |
| 43. | Stoffers D, Altena E, van der Werf YD, et al. The caudate: a key node in the neuronal network imbalance of insomnia? Brain, 2014, 137(Pt 2): 610-620. |
| 44. | Leerssen J, Wassing R, Ramautar JR, et al. Increased hippocampal-prefrontal functional connectivity in insomnia. Neurobiol Learn Mem, 2019, 160: 144-150. |
| 45. | Tahmasian M, Noori K, Samea F, et al. A lack of consistent brain alterations in insomnia disorder: an activation likelihood estimation meta-analysis. Sleep Med Rev, 2018, 42: 111-118. |
| 46. | Smith MT, McCrae CS, Cheung J, et al. Use of actigraphy for the evaluation of sleep disorders and circadian rhythm sleep-wake disorders: an American academy of sleep medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med, 2018, 14(7): 1209-1230. |
| 47. | Wichniak A, Jankowski KS, Skalski M, et al. Treatment guidelines for circadian rhythm sleep-wake disorders of the polish sleep research society and the section of biological psychiatry of the polish psychiatric association. Part I. Physiology, assessment and therapeutic methods. Psychiatr Pol, 2017, 51(5): 793-814. |
| 48. | Natale V, Plazzi G, Martoni M. Actigraphy in the assessment of insomnia: a quantitative approach. Sleep, 2009, 32(6): 767-771. |
| 49. | Natale V, Léger D, Martoni M, et al. The role of actigraphy in the assessment of primary insomnia: a retrospective study. Sleep Med, 2014, 15(1): 111-115. |
| 50. | Broman JE, Hetta J. Electrodermal activity in patients with persistent insomnia. J Sleep Res, 1994, 3(3): 165-170. |
| 51. | Bonnet MH, Arand DL. Heart rate variability in insomniacs and matched normal sleepers. Psychosom Med, 1998, 60(5): 610-615. |
| 52. | de Zambotti M, Covassin N, Sarlo M, et al. Nighttime cardiac sympathetic hyper-activation in young primary insomniacs. Clin Auton Res, 2013, 23(1): 49-56. |
| 53. | Farina B, Dittoni S, Colicchio S, et al. Heart rate and heart rate variability modification in chronic insomnia patients. Behav Sleep Med, 2014, 12(4): 290-306. |
| 54. | Stein PK, Pu Y. Heart rate variability, sleep and sleep disorders. Sleep Med Rev, 2012, 16(1): 47-66. |
| 55. | Billman GE. The LF/HF ratio does not accurately measure cardiac sympatho-vagal balance. Front Physiol, 2013, 4: 26. |
| 56. | Fang SC, Huang CJ, Yang TT, et al. Heart rate variability and daytime functioning in insomniacs and normal sleepers: preliminary results. J Psychosom Res, 2008, 65(1): 23-30. |
| 57. | Lack LC, Gradisar M, Van Someren EJ, et al. The relationship between insomnia and body temperatures. Sleep Med Rev, 2008, 12(4): 307-317. |
| 58. | Te Lindert BHW, Van Someren EJW. Skin temperature, sleep, and vigilance. Handb Clin Neurol, 2018, 156: 353-365. |
| 59. | Morris M, Lack L, Dawson D. Sleep-onset insomniacs have delayed temperature rhythms. Sleep, 1990, 13(1): 1-14. |
| 60. | Lushington K, Dawson D, Lack L. Core body temperature is elevated during constant wakefulness in elderly poor sleepers. Sleep, 2000, 23(4): 504-510. |
| 61. | Gradisar M, Lack L, Wright H, et al. Do chronic primary insomniacs have impaired heat loss when attempting sleep. Am J Physiol Regul Integr Comp Physiol, 2006, 290(4): R1115-R1121. |
| 62. | Chapman JL, Comas M, Hoyos CM, et al. Is metabolic rate increased in insomnia disorder. a systematic review. Front Endocrinol (Lausanne), 2018, 9: 374. |
| 63. | Vgontzas AN, Bixler EO, Lin HM, et al. Chronic insomnia is associated with nyctohemeral activation of the hypothalamic-pituitary-adrenal axis: clinical implications. J Clin Endocrinol Metab, 2001, 86(8): 3787-3794. |
| 64. | Mikoteit T, De Witte M, Holsboer-Trachsler E, et al. Sleep stage related heart rate variability distinguishes between insomnia and normal sleep. Pharmacopsychiatry, 2019, 52(2): 14149. |
| 65. | Backhaus J, Junghanns K, Hohagen F. Sleep disturbances are correlated with decreased morning awakening salivary cortisol. Psychoneuroendocrinology, 2004, 29(9): 1184-1191. |
| 66. | Seelig E, Keller U, Klarhöfer M, et al. Neuroendocrine regulation and metabolism of glucose and lipids in primary chronic insomnia: a prospective case-control study. PLoS One, 2013, 8(4): e61780. |
| 67. | Zhang J, Lam SP, Li SX, et al. A community-based study on the association between insomnia and hypothalamic-pituitary-adrenal axis: sex and pubertal influences. J Clin Endocrinol Metab, 2014, 99(6): 2277-2287. |
| 68. | Fernandez-Mendoza J, Vgontzas AN, Calhoun SL, et al. Insomnia symptoms, objective sleep duration and hypothalamic-pituitary-adrenal activity in children. Eur J Clin Invest, 2014, 44(5): 493-500. |
| 69. | D'Aurea C, Poyares D, Piovezan RD, et al. Objective short sleep duration is associated with the activity of the hypothalamic-pituitary-adrenal axis in insomnia. Arq Neuropsiquiatr, 2015, 73(6): 516-519. |
| 70. | van Neijenhof RJGP, van Duijn E, Van Den Berg JF, et al. Subjective insomnia symptoms and sleep duration are not related to hypothalamic-pituitary-adrenal axis activity in older adults. J Sleep Res, 2018, 27(1): 40-46. |
| 71. | Lattova Z, Keckeis M, Maurovich-Horvat E, et al. The stress hormone system in various sleep disorders. J Psychiatr Res, 2011, 45(9): 1223-1228. |
| 72. | Riemann D, Klein T, Rodenbeck A, et al. Nocturnal cortisol and melatonin secretion in primary insomnia. Psychiatry Res, 2002, 113(1-2): 17-27. |
| 73. | Slavish DC, Graham-Engeland JE, Engeland CG, et al. Insomnia symptoms are associated with elevated C-reactive protein in young adults. Psychol Health, 2018, 33(11): 1396-1415. |
| 74. | Giese M, Unternährer E, Hüttig H, et al. BDNF: an indicator of insomnia. Mol Psychiatry, 2014, 19(2): 151-152. |
| 75. | Parthasarathy S, Vasquez MM, Halonen M, et al. Persistent insomnia is associated with mortality risk. Am J Med, 2015, 128(3): 268-275. |
| 76. | Fan TT, Chen WH, Shi L, et al. Objective sleep duration is associated with cognitive deficits in primary insomnia: BDNF may play a role. Sleep, 2019, 42(1): y192. |
- 1. Collins PY, Patel V, Joestl SS, et al. Grand challenges in global mental health. Nature, 2011, 475(7354): 27-30.
- 2. Sateia MJ, Doghramji K, Hauri PJ, et al. Evaluation of chronic insomnia. An American Academy of Sleep Medicine review. Sleep, 2000, 23(2): 243-308.
- 3. Chesson AJ, Hartse K, Anderson WM, et al. Practice parameters for the evaluation of chronic insomnia. An American Academy of Sleep Medicine report. Standards of practice committee of the American Academy of Sleep Medicine. Sleep, 2000, 23(2): 237-241.
- 4. Buysse DJ, Reynolds CF, Monk TH, et al. The pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res, 1989, 28(2): 193-213.
- 5. Soldatos CR, Dikeos DG, Paparrigopoulos TJ. Athens insomnia scale: validation of an instrument based on ICD-10 criteria. J Psychosom Res, 2000, 48(6): 555-560.
- 6. Kessler RC, Coulouvrat C, Hajak G, et al. Reliability and validity of the brief insomnia questionnaire in the America insomnia survey. Sleep, 2010, 33(11): 1539-1549.
- 7. Spoormaker VI, Verbeek I, van den Bout J, et al. Initial validation of the SLEEP-50 questionnaire. Behav Sleep Med, 2005, 3(4): 227-246.
- 8. Roth T, Zammit G, Kushida C, et al. A new questionnaire to detect sleep disorders. Sleep Med, 2002, 3(2): 99-108.
- 9. Morin CM, Stone J, Trinkle D, et al. Dysfunctional beliefs and attitudes about sleep among older adults with and without insomnia complaints. Psychol Aging, 1993, 8(3): 463-467.
- 10. Morin CM, Vallières A, Ivers H. Dysfunctional beliefs and attitudes about sleep (DBAS): validation of a brief version (DBAS-16). Sleep, 2007, 30(11): 1547-1554.
- 11. Smith S, Trinder J. Detecting insomnia: comparison of four self-report measures of sleep in a young adult population. J Sleep Res, 2001, 10(3): 229-235.
- 12. Carney CE, Edinger JD, Morin CM, et al. Examining maladaptive beliefs about sleep across insomnia patient groups. J Psychosom Res, 2010, 68(1): 57-65.
- 13. Crönlein T, Wagner S, Langguth B, et al. Are dysfunctional attitudes and beliefs about sleep unique to primary insomnia. Sleep Med, 2014, 15(12): 1463-1467.
- 14. Hertenstein E, Nissen C, Riemann D, et al. The exploratory power of sleep effort, dysfunctional beliefs and arousal for insomnia severity and polysomnography-determined sleep. J Sleep Res, 2015, 24(4): 399-406.
- 15. Harvey CJ, Gehrman P, Espie CA. Who is predisposed to insomnia: a review of familial aggregation, stress-reactivity, personality and coping style. Sleep Med Rev, 2014, 18(3): 237-247.
- 16. Broomfield NM, Espie CA. Towards a valid, reliable measure of sleep effort. J Sleep Res, 2005, 14(4): 401-407.
- 17. Kales A, Caldwell AB, Soldatos CR, et al. Biopsychobehavioral correlates of insomnia. II. Pattern specificity and consistency with the Minnesota multiphasic personality inventory. Psychosom Med, 1983, 45(4): 341-356.
- 18. van de Laar M, Leufkens T, Bakker B, et al. Phenotypes of sleeplessness: stressing the need for psychodiagnostics in the assessment of insomnia. Psychol Health Med, 2017, 22(8): 902-910.
- 19. Križan Z, Hisler G. Personality and sleep: neuroticism and conscientiousness predict behaviourally recorded sleep years later. Eur J Pers, 2019, 33(2): 133-153.
- 20. Stephan Y, Sutin AR, Bayard S, et al. Personality and sleep quality: Evidence from four prospective studies. Health Psychol, 2018, 37(3): 271-281.
- 21. Gray EK, Watson D. General and specific traits of personality and their relation to sleep and academic performance. J Pers, 2002, 70(2): 177-206.
- 22. Duggan KA, Friedman HS, McDevitt EA, et al. Personality and healthy sleep: the importance of conscientiousness and neuroticism. PLoS One, 2014, 9(3): e90628.
- 23. Lundh L, Broman J, Hetta J, et al. Perfectionism and Insomnia. Scandi J Behav Ther, 1994, 23(1): 3-18.
- 24. Jansson-Frojmark M, Harvey AG, Lundh LG, et al. Psychometric properties of an insomnia-specific measure of worry: the anxiety and preoccupation about sleep questionnaire. Cogn Behav Ther, 2011, 40(1): 65-76.
- 25. Johann AF, Hertenstein E, Kyle SD, et al. Perfectionism and polysomnography-determined markers of poor sleep. J Clin Sleep Med, 2017, 13(11): 1319-1326.
- 26. Regen W, Kyle SD, Nissen C, et al. Objective sleep disturbances are associated with greater waking resting-state connectivity between the retrosplenial cortex/ hippocampus and various nodes of the default mode network. J Psychiatry Neurosci, 2016, 41(5): 295-303.
- 27. Terzano MG, Parrino L, Smerieri A. Neurophysiological basis of insomnia: role of cyclic alternating patterns. Rev Neurol, 2001, 157(11 Pt 2): S62-S66.
- 28. Chouvarda I, Mendez MO, Rosso V, et al. Cyclic alternating patterns in normal sleep and insomnia: structure and content differences. IEEE Trans Neural Syst Rehabil Eng, 2012, 20(5): 642-652.
- 29. Spiegelhalder K, Regen W, Feige B, et al. Increased EEG sigma and beta power during NREM sleep in primary insomnia. Biol Psychol, 2012, 91(3): 329-333.
- 30. Colombo MA, Ramautar JR, Wei Y, et al. Wake high-density electroencephalographic spatiospectral signatures of insomnia. Sleep, 2016, 39(5): 1015-1027.
- 31. Riedner BA, Goldstein MR, Plante DT, et al. Regional patterns of elevated alpha and high-frequency electroencephalographic activity during nonrapid eye movement sleep in chronic insomnia: a pilot study. Sleep, 2016, 39(4): 801-812.
- 32. Buysse DJ, Germain A, Hall ML, et al. EEG spectral analysis in primary insomnia: NREM period effects and sex differences. Sleep, 2008, 31(12): 1673-1682.
- 33. Svetnik V, Snyder ES, Ma J, et al. EEG spectral analysis of NREM sleep in a large sample of patients with insomnia and good sleepers: effects of age, sex and part of the night. J Sleep Res, 2017, 26(1): 92-104.
- 34. Schwabedal JT, Riedl M, Penzel T, et al. Alpha-wave frequency characteristics in health and insomnia during sleep. J Sleep Res, 2016, 25(3): 278-286.
- 35. Smith MT, Perlis ML, Chengazi VU, et al. Neuroimaging of NREM sleep in primary insomnia: a Tc-99-HMPAO single photon emission computed tomography study. Sleep, 2002, 25(3): 325-335.
- 36. Nofzinger EA, Buysse DJ, Germain A, et al. Functional neuroimaging evidence for hyperarousal in insomnia. Am J Psychiatry, 2004, 161(11): 2126-2128.
- 37. Kay DB, Karim HT, Soehner AM, et al. Sleep-wake differences in relative regional cerebral metabolic rate for glucose among patients with insomnia compared with good sleepers. Sleep, 2016, 39(10): 1779-1794.
- 38. Kay DB, Karim HT, Soehner AM, et al. Subjective-objective sleep discrepancy is associated with alterations in regional glucose metabolism in patients with insomnia and good sleeper controls. Sleep, 2017, 40(11): zsx155.
- 39. Harvey AG, Tang NK. (Mis)perception of sleep in insomnia: a puzzle and a resolution. Psychol Bull, 2012, 138(1): 77-101.
- 40. Baglioni C, Regen W, Teghen A, et al. Sleep changes in the disorder of insomnia: a meta-analysis of polysomnographic studies. Sleep Med Rev, 2014, 18(3): 195-213.
- 41. Altena E, Van Der Werf YD, Sanz-Arigita EJ, et al. Prefrontal hypoactivation and recovery in insomnia. Sleep, 2008, 31(9): 1271-1276.
- 42. Drummond SP, Walker M, Almklov E, et al. Neural correlates of working memory performance in primary insomnia. Sleep, 2013, 36(9): 1307-1316.
- 43. Stoffers D, Altena E, van der Werf YD, et al. The caudate: a key node in the neuronal network imbalance of insomnia? Brain, 2014, 137(Pt 2): 610-620.
- 44. Leerssen J, Wassing R, Ramautar JR, et al. Increased hippocampal-prefrontal functional connectivity in insomnia. Neurobiol Learn Mem, 2019, 160: 144-150.
- 45. Tahmasian M, Noori K, Samea F, et al. A lack of consistent brain alterations in insomnia disorder: an activation likelihood estimation meta-analysis. Sleep Med Rev, 2018, 42: 111-118.
- 46. Smith MT, McCrae CS, Cheung J, et al. Use of actigraphy for the evaluation of sleep disorders and circadian rhythm sleep-wake disorders: an American academy of sleep medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med, 2018, 14(7): 1209-1230.
- 47. Wichniak A, Jankowski KS, Skalski M, et al. Treatment guidelines for circadian rhythm sleep-wake disorders of the polish sleep research society and the section of biological psychiatry of the polish psychiatric association. Part I. Physiology, assessment and therapeutic methods. Psychiatr Pol, 2017, 51(5): 793-814.
- 48. Natale V, Plazzi G, Martoni M. Actigraphy in the assessment of insomnia: a quantitative approach. Sleep, 2009, 32(6): 767-771.
- 49. Natale V, Léger D, Martoni M, et al. The role of actigraphy in the assessment of primary insomnia: a retrospective study. Sleep Med, 2014, 15(1): 111-115.
- 50. Broman JE, Hetta J. Electrodermal activity in patients with persistent insomnia. J Sleep Res, 1994, 3(3): 165-170.
- 51. Bonnet MH, Arand DL. Heart rate variability in insomniacs and matched normal sleepers. Psychosom Med, 1998, 60(5): 610-615.
- 52. de Zambotti M, Covassin N, Sarlo M, et al. Nighttime cardiac sympathetic hyper-activation in young primary insomniacs. Clin Auton Res, 2013, 23(1): 49-56.
- 53. Farina B, Dittoni S, Colicchio S, et al. Heart rate and heart rate variability modification in chronic insomnia patients. Behav Sleep Med, 2014, 12(4): 290-306.
- 54. Stein PK, Pu Y. Heart rate variability, sleep and sleep disorders. Sleep Med Rev, 2012, 16(1): 47-66.
- 55. Billman GE. The LF/HF ratio does not accurately measure cardiac sympatho-vagal balance. Front Physiol, 2013, 4: 26.
- 56. Fang SC, Huang CJ, Yang TT, et al. Heart rate variability and daytime functioning in insomniacs and normal sleepers: preliminary results. J Psychosom Res, 2008, 65(1): 23-30.
- 57. Lack LC, Gradisar M, Van Someren EJ, et al. The relationship between insomnia and body temperatures. Sleep Med Rev, 2008, 12(4): 307-317.
- 58. Te Lindert BHW, Van Someren EJW. Skin temperature, sleep, and vigilance. Handb Clin Neurol, 2018, 156: 353-365.
- 59. Morris M, Lack L, Dawson D. Sleep-onset insomniacs have delayed temperature rhythms. Sleep, 1990, 13(1): 1-14.
- 60. Lushington K, Dawson D, Lack L. Core body temperature is elevated during constant wakefulness in elderly poor sleepers. Sleep, 2000, 23(4): 504-510.
- 61. Gradisar M, Lack L, Wright H, et al. Do chronic primary insomniacs have impaired heat loss when attempting sleep. Am J Physiol Regul Integr Comp Physiol, 2006, 290(4): R1115-R1121.
- 62. Chapman JL, Comas M, Hoyos CM, et al. Is metabolic rate increased in insomnia disorder. a systematic review. Front Endocrinol (Lausanne), 2018, 9: 374.
- 63. Vgontzas AN, Bixler EO, Lin HM, et al. Chronic insomnia is associated with nyctohemeral activation of the hypothalamic-pituitary-adrenal axis: clinical implications. J Clin Endocrinol Metab, 2001, 86(8): 3787-3794.
- 64. Mikoteit T, De Witte M, Holsboer-Trachsler E, et al. Sleep stage related heart rate variability distinguishes between insomnia and normal sleep. Pharmacopsychiatry, 2019, 52(2): 14149.
- 65. Backhaus J, Junghanns K, Hohagen F. Sleep disturbances are correlated with decreased morning awakening salivary cortisol. Psychoneuroendocrinology, 2004, 29(9): 1184-1191.
- 66. Seelig E, Keller U, Klarhöfer M, et al. Neuroendocrine regulation and metabolism of glucose and lipids in primary chronic insomnia: a prospective case-control study. PLoS One, 2013, 8(4): e61780.
- 67. Zhang J, Lam SP, Li SX, et al. A community-based study on the association between insomnia and hypothalamic-pituitary-adrenal axis: sex and pubertal influences. J Clin Endocrinol Metab, 2014, 99(6): 2277-2287.
- 68. Fernandez-Mendoza J, Vgontzas AN, Calhoun SL, et al. Insomnia symptoms, objective sleep duration and hypothalamic-pituitary-adrenal activity in children. Eur J Clin Invest, 2014, 44(5): 493-500.
- 69. D'Aurea C, Poyares D, Piovezan RD, et al. Objective short sleep duration is associated with the activity of the hypothalamic-pituitary-adrenal axis in insomnia. Arq Neuropsiquiatr, 2015, 73(6): 516-519.
- 70. van Neijenhof RJGP, van Duijn E, Van Den Berg JF, et al. Subjective insomnia symptoms and sleep duration are not related to hypothalamic-pituitary-adrenal axis activity in older adults. J Sleep Res, 2018, 27(1): 40-46.
- 71. Lattova Z, Keckeis M, Maurovich-Horvat E, et al. The stress hormone system in various sleep disorders. J Psychiatr Res, 2011, 45(9): 1223-1228.
- 72. Riemann D, Klein T, Rodenbeck A, et al. Nocturnal cortisol and melatonin secretion in primary insomnia. Psychiatry Res, 2002, 113(1-2): 17-27.
- 73. Slavish DC, Graham-Engeland JE, Engeland CG, et al. Insomnia symptoms are associated with elevated C-reactive protein in young adults. Psychol Health, 2018, 33(11): 1396-1415.
- 74. Giese M, Unternährer E, Hüttig H, et al. BDNF: an indicator of insomnia. Mol Psychiatry, 2014, 19(2): 151-152.
- 75. Parthasarathy S, Vasquez MM, Halonen M, et al. Persistent insomnia is associated with mortality risk. Am J Med, 2015, 128(3): 268-275.
- 76. Fan TT, Chen WH, Shi L, et al. Objective sleep duration is associated with cognitive deficits in primary insomnia: BDNF may play a role. Sleep, 2019, 42(1): y192.