OBJECTIVE/BACKGROUND Sleep disturbance is associated with suicidal thoughts and behaviors. The relationship of specific sleep disorders to suicide attempts is less well established. Whether treating sleep disorders reduces suicide attempts remains controversial. METHODS Suicide attempts, treatment utilization, and psychiatric diagnoses were extracted from electronic medical records and a suicide attempt database from the U.S. Department of Veterans Affairs. The sample (N = 60,102) consisted of patients with any record of suicide attempt in FY13-14 and a 1:1 case-control of patients with no record of attempt, who were propensity score-matched based on age, gender, and prior year mental health treatment utilization. Associations among sleep disorders and suicide attempt were examined via logistic regression. Covariates included depression, anxiety, posttraumatic stress disorder (PTSD), bipolar, schizophrenia, substance use disorder (SUD), medical comorbidity, and obesity. RESULTS Insomnia (OR = 5.62; 95% CI, 5.39-5.86), nightmares (odds ratio, OR = 2.49; 95% confidence interval, CI, 2.23-2.77), and sleep-related breathing disorders (OR = 1.37; 95% CI, 1.27-1.48) were positively associated with suicide attempt after accounting for age, gender, treatment utilization, and comorbid sleep disorders. Furthermore, when controlling for depression, anxiety, PTSD, bipolar, schizophrenia, substance use disorder (SUD), medical comorbidity, and obesity, insomnia (OR = 1.51, 95% CI, 1.43-1.59) remained positively associated with suicide attempt nightmares (OR = 0.96; 95% CI, 0.85-1.09) nor sleep-related breathing disorders (OR = 0.87, 95% CI = 0.79-0.94). Additionally, sleep medicine visits 180 days prior to index date were associated with decreased likelihood of suicide attempt for individuals with sleep disorders (OR = 0.86; 95% CI, 0.79-0.94). CONCLUSION Insomnia is associated with suicide attempt among veterans. Sleep medicine visits were associated with a reduced risk of suicide attempt in sleep disordered patients. The assessment and treatment of sleep disorders should be considered in context of strategies to augment suicide prevention efforts.

中文翻译：

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睡眠，自杀行为以及睡眠药物的保护作用。

目的/背景睡眠障碍与自杀的思想和行为有关。特定睡眠障碍与自杀企图之间的关系尚不十分清楚。治疗睡眠障碍是否能减少自杀企图仍存在争议。方法从美国退伍军人事务部的电子病历和自杀未遂数据库中提取自杀未遂，治疗利用和精神病学诊断。样本（N = 60,102）包括13-14财年有任何自杀未遂记录的患者和1：1病例对照的无自杀未遂记录的患者，这些患者根据年龄，性别和以前的意愿进行了得分匹配一年的心理健康治疗利用率。通过逻辑回归分析了睡眠障碍和自杀未遂之间的关联。协变量包括抑郁，焦虑，创伤后应激障碍（PTSD），躁郁症，精神分裂症，物质使用障碍（SUD），合并症和肥胖。结果失眠（OR = 5.62; 95％CI，5.39-5.86），噩梦（比值比，OR = 2.49; 95％置信区间，CI，2.23-2.77）和与睡眠有关的呼吸障碍（OR = 1.37; 95％ CI，1.27-1.48）在考虑了年龄，性别，治疗利用和合并性睡眠障碍后与自杀未遂呈正相关。此外，在控制抑郁症，焦虑症，PTSD，双相情感障碍，精神分裂症，药物滥用障碍（SUD），医学合并症和肥胖症时，失眠（OR = 1.51，95％CI，1.43-1.59）仍与自杀未遂噩梦正相关（ OR = 0.96； 95％CI，0.85-1.09）或与睡眠相关的呼吸障碍（OR = 0.87，95％CI = 0.79-0.94）。此外，索引日期前180天进行睡眠医学就诊与睡眠障碍患者自杀未遂的可能性降低相关（OR = 0.86； 95％CI，0.79-0.94）。结论失眠与退伍军人自杀企图有关。睡眠药物就诊与睡眠障碍患者自杀未遂风险降低有关。应当在加强自杀预防工作的策略中考虑睡眠障碍的评估和治疗。