Abstract
STUDY OBJECTIVES: In the present study, factors associated with sleep perception were identified by comparing clinical characteristics and polysomnographic variables between insomnia patients with negative and positive sleep state misperception (NSSM and PSSM, respectively). METHODS: Self-reported and objective sleep measures were retrospectively collected, including the Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory, and a questionnaire on "morning feeling" after nocturnal polysomnography in 150 patients with insomnia. Based on the misperception index (MI), participants were classified into NSSM (MI > 0, n = 115) and PSSM (MI < 0, n = 35) groups. RESULTS: The PSSM group had more N3 sleep on nocturnal polysomnography than the NSSM group (P = .002). The NSSM group showed a higher PSQI score (P < .001), longer self-reported sleep-onset latency (SOL) (P = .001), and a greater SOL discrepancy (P = .001). Self-reported feelings of tiredness and morning awakenings in the morning were higher in the NSSM group (P = .029 and P = .038). The MI negatively correlated with a proportion of N3 sleep (P = .005) and positively correlated with PSQI (P < .001), morning awakenings (P = .01), self-reported SOL (P < .001), and SOL discrepancy (P < .001) in patients with insomnia. Multiple regression analysis showed that N3 sleep, PSQI, and morning awakenings were significantly associated with MI in patients with insomnia. CONCLUSIONS: The proportion of slow-wave sleep and self-reported measures may be associated with perception of sleep in patients with insomnia. Objective and self-reported characteristics of patients with insomnia should be carefully evaluated and managed because they may influence the perception of sleep. CITATION: Yoon G, Lee MH, Oh SM, Choi J-W, Yoon SY, Lee YJ. Negative and positive sleep state misperception in patients with insomnia: factors associated with sleep perception. J Clin Sleep Med. 2022;18(7):1789-1795.