Insomnia and its relationship to health-care utilization, work absenteeism, prductivity and accidents

Ecole de Psychologie, Université Laval, Quebec, Canada G1K 0A6.
Sleep Medicine (Impact Factor: 3.15). 09/2008; 10(4):427-38. DOI: 10.1016/j.sleep.2008.04.005
Source: PubMed


To document and provide a micro analysis of the relationship between insomnia and health problems, health-care use, absenteeism, productivity and accidents.
A population-based sample of 953 French-speaking adults from Québec, Canada. Participants were categorized as having insomnia syndrome (SYND) or insomnia symptoms (SYMPT) or as good sleepers (GS). They completed questionnaires on sleep, health, use of health-care services and products, accidents, work absences and reduced work productivity. Data were also obtained from the Québec-government-administered health insurance board on selected variables (e.g., consultations with health-care professionals, diagnoses).
There were significantly more individuals in the SYND group relative to the GS group reporting at least one chronic health problem (83% vs. 53%; OR: 2.78) and who had consulted a health-care professional in the past year (81% vs. 60%; OR: 2.8). There were also higher proportions of individuals in the SYND group than in the GS group who had used prescription medications (57% vs. 30.7%; OR: 2.8), most notably to treat insomnia, mood and anxiety disorders, or who had used over-the-counter products (75.6% vs. 62.0%; OR: 1.8) and alcohol as a sleep aid (17.8% vs. 3.9%; OR: 4.6). In terms of daytime function, 25.0% of the SYND had been absent from work relative to 17.1% of GS (OR: 1.7), 40.6% reported having experienced reduced productivity compared to 12.3% of GS (OR: 4.8) and non-motor-vehicle accidents occurred at higher rates in the SYND group (12.5% vs. 6.4% for GS; OR: 2.4). No differences were found for hospitalisations or motor-vehicle accidents. Most of the associations remained significant even after controlling for psychiatric comorbidity. Rates for the SYMPT group were situated between SYND and GS on all major dependent variables. Furthermore, insomnia and fatigue were perceived as contributing significantly to accidents, absences and decreased work productivity, regardless of insomnia status.
This study indicates that insomnia is associated with significant morbidity in terms of health problems and health-care utilization, work absenteeism and reduced productivity, and risk of non-motor-vehicle accidents. Future studies should evaluate whether treating insomnia can reverse this morbidity.

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Available from: Charles M Morin, May 12, 2015
    • "Based on the Diagnostic and Statistical Manual of Mental Disorder (DSM) criteria [7], around 6% of people experience insomnia, with 34.5% found to be classified as poor sleepers [8]. Within the general population, poor sleep has been associated with an increased risk of poor health [9], absenteeism from work, and increased risk of accidents [10] [11] [12]. Following a TBI, the effects of poor sleep can be even more profound, exacerbating symptoms and impeding the ability to perform well at work or engage in rehabilitation [13] [14] [15] [16] [17]. "
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    ABSTRACT: Sleep quality affects all aspects of daily functioning, and it is vital for facilitating recovery from illness and injury. Sleep commonly becomes disrupted following moderate to severe brain injury, yet little is known about the prevalence of sleep disruption over time and how it impacts on recovery following mild injury. This was a longitudinal study of 346 adults who experienced a mild brain injury (aged ≥16 years) identified within a population-based incidence sample in New Zealand. The prevalence of sleep difficulties was assessed at baseline (within two weeks), one, six and 12 months, alongside other key outcomes. One year post injury, 41.4% of people were identified as having clinically significant sleep difficulties, with 21.0% at a level indicative of insomnia. Poor sleep quality at baseline was significantly predictive of poorer post-concussion symptoms, mood, community integration, and cognitive ability one year post injury. The prevalence of insomnia following mild traumatic brain injury (TBI) was more than three times the rate found in the general population. Of those completing a sleep assessment at six and 12 months, 44.9% of the sample showed improvements in sleep quality, 16.2% remained stable, and 38.9% worsened. Screening for sleep difficulties should occur routinely following a mild brain injury to identify adults potentially at risk of poor recovery. Interventions to improve sleep are needed to facilitate recovery from injury, and to prevent persistent sleep difficulties emerging. Copyright © 2015 Elsevier B.V. All rights reserved.
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    • "It has become clear that insomnia is not merely a symptom of psychiatric disorders, but contributes also to the risk of future relapse or the development of new onset mood, anxiety, and substance use disorders, as well as to the severity of psychiatric symptoms [22]. Disturbed sleep has also been associated with increased frequency of violent acts as well as domestic violence, work and vehicle accidents, increased work absenteeism [23] [24] [25] [26]. The observed associations between poor sleep and obesity, diabetes, depression, aggressive and delinquent behaviors concern children and adolescents, too [27] [28] [29] [30]. "
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    ABSTRACT: Environmental noise, especially that caused by transportation means, is viewed as a significant cause of sleep disturbances. Poor sleep causes endocrine and metabolic measurable perturbations and is associated with a number of cardiometabolic, psychiatric and social negative outcomes both in adults and children. Nocturnal environmental noise also provokes measurable biological changes in the form of a stress response, and clearly affects sleep architecture, as well as subjective sleep quality. These sleep perturbations are similar in their nature to those observed in endogenous sleep disorders. Apart from these measurable effects and the subjective feeling of disturbed sleep, people who struggle with nocturnal environmental noise often also suffer the next day from daytime sleepiness and tiredness, annoyance, mood changes as well as decreased well-being and cognitive performance. But there is also emerging evidence that these short-term effects of environmental noise, particularly when the exposure is nocturnal, may be followed by long-term adverse cardiometabolic outcomes. Nocturnal environmental noise may be the most worrying form of noise pollution in terms of its health consequences because of its synergistic direct and indirect (through sleep disturbances acting as a mediator) influence on biological systems. Duration and quality of sleep should thus be regarded as risk factors or markers significantly influenced by the environment and possibly amenable to modification through both education and counseling as well as through measures of public health. One of the means that should be proposed is avoidance at all costs of sleep disruptions caused by environmental noise.
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    • "However, it is also well documented that sleep disorders such as insomnia have specific consequences that are independent of the context in which they appear. In the context of shift work, therefore , it may not be easy to parcel out the contributions of shift work per se and SWD (including insomnia), as these variables can be expected to produce similar symptoms, such as depression and anxiety [22], higher risk of motor vehicle accidents [4], work absenteeism, impaired work performance, and increased risk of work-related accidents [23] [24] [25] [26]. Insomnia might also aggravate symptoms associated with the work schedule. "
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    ABSTRACT: Background Shift work disorder involves insomnia and/or excessive sleepiness associated with the work schedule. The present study examined the impact of insomnia on the perceived physical and psychological health of adults working on night and rotating shift schedules compared to day workers. Methods A total of 418 adults (51% women, mean age 41.4 years), including 51 night workers, 158 rotating shift workers, and 209 day workers were selected from an epidemiological study. An algorithm was used to classify each participant of the two groups (working night or rotating shifts) according to the presence or absence of insomnia symptoms. Each of these individuals was paired with a day worker according to gender, age, and income. Participants completed several questionnaires measuring sleep, health, and psychological variables. Results Night and rotating shift workers with insomnia presented a sleep profile similar to that of day workers with insomnia. Sleep time was more strongly related to insomnia than to shift work per se. Participants with insomnia in the three groups complained of anxiety, depression, and fatigue, and reported consuming equal amounts of sleep-aid medication. Insomnia also contributed to chronic pain and otorhinolaryngology problems, especially among rotating shift workers. Work productivity and absenteeism were more strongly related to insomnia. Conclusion The present study highlights insomnia as an important component of the sleep difficulties experienced by shift workers. Insomnia may exacerbate certain physical and mental health problems of shift workers, and impair their quality of life.
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