BACKGROUND: Recent studies indicate that chronic insomnia is associated with the development of certain somatic diseases. Whether it would be associated with the development of an autoimmune disease (AID) was unknown. OBJECTIVE: We aimed to examine the association and quantify the magnitude of risk for AID in individuals suffering from chronic insomnia requiring sleep-inducing pills. DESIGN: This was a population-based, nationwide longitudinal study. PARTICIPANTS: Using a claims data set containing 1 million randomly sampled, insured subjects derived from the National Health Insurance Research Database, we assembled a chronic insomnia group and a 1:3 propensity score-matched comparison group (CP), which were balanced in terms of sex, age, insurance premium, urbanization, alcohol use disorder, smoking-related diagnoses, and morbid obesity. MAIN MEASURES: Person-time data with incidence rate, adjusted hazard ratios (aHR) by the Cox model, AID-free survival functions compared with the log-rank test, and a sensitivity analysis on the time lag effect were presented. Incident AID within the first year of follow-up were excluded. The error rate was controlled using the BenjaminiHochberg procedure. KEY RESULTS: With 39,550 and 129,914 person-years' follow-up for the chronic insomnia and CP groups (n = 5,736 and 17,208), respectively, we found an increased risk for subsequent AID, representing a 70 % increase in the aHR (1.7; 95 % confidence interval [CI], 1.5-1.9, p < 0.0001). A positive association between chronic insomnia and primary Sjögren's syndrome (pSS) was observed (aHR, 1.3; 95 % CI, 1.1-1.6). Sensitivity analysis disclosed that AID risk was even stronger after 5 years of follow-up (aHR, 2.0; 95 % CI, 1.7-2.4). CONCLUSION:Chronic insomnia requiring sleepinducing pills may be associated with a 70 % increased risk for future AID, particularly pSS.KEY WORDS: chronic insomnia; autoimmune disease; population-based study; propensity score matching; Sjögren's syndrome.

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Cognitive warfare—controlling others’ mental states and behaviors by manipulating environmental stimuli—is a significant and ever-evolving issue in global conflict and security, especially during the COVID-19 crisis. In this article, we aim to contribute to the field by proposing a two-dimensional framework to evaluate China's cognitive warfare and explore promising ways of counteracting it. We first define the problem by clarifying relevant concepts and then present a case study of China's attack on Taiwan. Next, based on predictive coding theory from the cognitive sciences, we offer a framework to explain how China's cognitive warfare works and to what extent it succeeds. We argue that this framework helps identify vulnerable targets and better explains some of the conflicting data in the literature. Finally, based on the framework, we predict China's strategy and discuss Taiwan's options in terms of cognitive and structural interventions.

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