Prevalence and Perceived Health Associated with Insomnia Based on DSM-IV-TR; International Statistical Classification of Diseases and Related Health Problems, Tenth Revision; and Research Diagnostic Criteria/International Classification of Sleep Disorders, Second Edition Criteria: Results from the America Insomnia Survey
ABSTRACT Although several diagnostic systems define insomnia, little is known about the implications of using one versus another of them.
The America Insomnia Survey, an epidemiological survey of managed health care plan subscribers (n = 10,094), assessed insomnia with the Brief Insomnia Questionnaire, a clinically validated scale generating diagnoses according to DSM-IV-TR; International Statistical Classification of Diseases, Tenth Revision (ICD-10); and Research Diagnostic Criteria/International Classification of Sleep Disorders, Second Edition (RDC/ICSD-2) criteria. Regression analysis examines associations of insomnia according to the different systems with summary 12-item Short-Form Health Survey scales of perceived health and health utility.
Insomnia prevalence estimates varied widely, from 22.1% for DSM-IV-TR to 3.9% for ICD-10 criteria. Although ICD insomnia was associated with significantly worse perceived health than DSM or RDC/ICSD insomnia, DSM-only cases also had significant decrements in perceived health. Because of its low prevalence, 66% of the population-level health disutility associated with overall insomnia and 84% of clinically relevant cases of overall insomnia were missed by ICD criteria.
Insomnia is highly prevalent and associated with substantial decrements in perceived health. Although ICD criteria define a narrower and more severe subset of cases than DSM criteria, the fact that most health disutility associated with insomnia is missed by ICD criteria, while RDC/ICSD-only cases do not have significant decrements in perceived health, supports use of the broader DSM criteria.
SourceAvailable from: Ivan Vargas[Show abstract] [Hide abstract]
ABSTRACT: Greater sleep difficulty following a challenging event, or a vulnerability to stress-related sleep disturbance (i.e., sleep reactivity), is characteristic of insomnia. However, insomnia is rarely observed in isolation; rather it is frequently seen in combination with other problems, such as depression. Despite the link between depression and increased sensitivity to stress, relatively little is known about the role sleep reactivity has in explaining variability in depressive symptoms. Therefore, the current study examined whether sleep reactivity was associated with depressive symptoms, and whether this relationship was mediated by insomnia. We assessed sleep reactivity, insomnia, and depressive symptoms among 2250 young adults (1244 female; M age = 23.1, SD age = 2.97) from the Colorado Longitudinal Twin Study and Community Twin Study. Results indicated that greater sleep reactivity was significantly associated with elevated depressive symptoms, and that this link was partially mediated by insomnia. This is one of the first studies to demonstrate an independent association between sleep reactivity and depressive symptomatology. These findings suggest that a greater sensitivity to stress-related sleep disturbance may also be a predisposing factor to depression, and highlight the need for a better understanding of sleep reactivity, as it may represent a more global vulnerability construct. Keywords03/2015; 1(1). DOI:10.1037/tps0000015
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ABSTRACT: Objectives Sleep disturbances and fatigue are common in patients with multiple sclerosis (MS), but little is known about hypnotic use patterns in MS, or the relationship between these medications and fatigue. The objectives of this study were to investigate the prevalence of prescription and over-the-counter (OTC) hypnotic use among MS patients, and to assess relationships between fatigue severity and hypnotic use among persons with MS. Methods Data on hypnotic use frequency, hypnotic agents of choice, and clinical characteristics were extracted from medical records and a survey dataset from n=190 MS patients who completed questionnaires regarding sleep quality, sleep quantity, nocturnal symptoms, sleepiness (Epworth Sleepiness Scale), obstructive sleep apnea risk (STOP-Bang questionnaire), insomnia (Insomnia Severity Index), and fatigue level (Fatigue Severity Scale - FSS). Results N=89 (47%) endorsed hypnotic use occasionally, frequently, or always. Over-the-counter diphenhydramine-containing products accounted for the majority of utilization, reported by n=47 (25%). Presence of occasional or more frequent hypnotic use correlated with daytime fatigue (Spearman rho=0.28, p=0.0002), but not sleepiness. Regression of FSS scores on hypnotic use confirmed the association [beta (SE) = 0.55 (0.21), p=0.0092] after adjustment for clinical and sleep-related confounds. In separate, similarly adjusted models, use of OTC hypnotics but not prescription hypnotics was independently associated with higher FSS scores [0.54 (0.22), p=0.0159]. An analogous association was observed more specifically for use of diphenhydramine-containing products [0.49 (0.24), p=0.044]. Conclusions Hypnotic use is highly prevalent among MS patients. Carry-over effects from hypnotic agents, and in particular, OTC diphenhydramine-containing products, could contribute to daytime fatigue.Sleep Medicine 09/2014; 16(1). DOI:10.1016/j.sleep.2014.09.006 · 3.10 Impact Factor
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ABSTRACT: The impact of hospitalization on sleep in late-life is underexplored. The current study examined patterns of sleep quality before, during, and following hospitalization, investigated predictors of sleep quality patterns, and examined predictors of classification discordance between two suggested clinical cutoffs used to demarcate poor/good sleep.Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 10/2014; DOI:10.5664/jcsm.4362 · 2.83 Impact Factor