Roth T, Coulouvrat C, Hajak G, Lakoma MD, Sampson NA, Shahly V et al. 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. Biol Psychiatry 69: 592-600

Sleep Disorders and Research Center, Henry Ford Health System, Detroit, Michigan, USA.
Biological psychiatry (Impact Factor: 10.26). 12/2010; 69(6):592-600. DOI: 10.1016/j.biopsych.2010.10.023
Source: PubMed


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.

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    • "According to their responses to these items, approximately 13.6% (n = 305) of the entire sample met DSM-5 criteria for insomnia. This rate is relatively consistent with previously reported population estimates of insomnia (Ohayon, 2002; Roth et al, 2011), thus is likely to be representative of sleep problems in the general population. "
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    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. Keywords
    Full-text · Article · Mar 2015
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    • "Insomnia is a remarkably prevalent disorder. Depending on the definition used, it affects 6–20% of the general population [1] [2] [3] [4] [5]. As a result, sleep dissatisfaction counts among the most common health complaints in primary care [6] and the associated healthcare expenditures, in addition to the costs of sleep aids and absenteeism at work, contribute to a considerable economic burden [7] [8]. "
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    ABSTRACT: Les techniques d’imagerie cérébrale ont permis des avancées considérables dans l’étude du sommeil chez l’humain. Cependant, les études par imagerie cérébrale dans l’insomnie primaire demeurent peu nombreuses, particulièrement en regard de la prévalence importante de ce trouble du sommeil dans la population générale. Cette revue examine la contribution des études d’imagerie cérébrale fonctionnelle et structurelle à la compréhension de l’insomnie primaire. Les études d’imagerie fonctionnelle au cours du sommeil appuient la théorie de l’hyperactivation dans l’insomnie. D’autres études fonctionnelles ont révélé des altérations dans le traitement cérébral des processus cognitifs et émotionnels dans l’insomnie primaire. Les résultats des études structurelles suggèrent des modifications neuroanatomiques, particulièrement dans l’hippocampe, le cortex cingulaire antérieur et le cortex orbitofrontal. Cependant, ces résultats ne sont pas concordants d’une étude à l’autre. Quelques études spectroscopiques ont révélé des altérations dans les niveaux de neurotransmetteurs, ainsi que des changements bioénergétiques dans l’insomnie primaire. Le manque de concordance entre les résultats d’imagerie cérébrale en insomnie pourrait être lié à l’hétérogénéité des différentes populations cliniques étudiées, ainsi qu’à la diversité des techniques d’imagerie et d’analyse employées. La neuroimagerie constitue une voie d’exploration prometteuse de l’insomnie, mais la poursuite des avancées dans ce domaine nécessite de réunir de plus grands échantillons, de reproduire et confirmer les résultats existants, tout en développant l’utilisation de nouvelles modalités.
    Full-text · Article · Oct 2014 · Pathologie Biologie
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    • "Insomnia is the most prevalent of all sleep disorders, with 25% of the adult population reporting sleep difficulties and 6–10% fulfilling diagnostic criteria for a chronic insomnia disorder [1] [2] [3]. Chronic insomnia can have detrimental consequences in a variety of domains, including mental and cardiovascular health, cognitive functioning, work productivity, and quality of life [4]. "
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    ABSTRACT: Objectives To examine the speed and trajectory of changes in sleep/wake parameters during short-term treatment of insomnia with cognitive–behavioral therapy (CBT) alone versus CBT combined with medication; and to explore the relationship between early treatment response and post-treatment recovery status. Methods Participants were 160 adults with insomnia (mean age, 50.3 years; 97 women, 63 men) who underwent a six-week course of CBT, singly or combined with 10 mg zolpidem nightly. The main dependent variables were sleep onset latency, wake after sleep onset, total sleep time, sleep efficiency, and sleep quality, derived from sleep diaries completed daily by patients throughout the course of treatment. Results Participants treated with CBT plus medication exhibited faster sleep improvements as evidenced during the first week of treatment compared to those receiving CBT alone. Optimal sleep improvement was reached on average after only one week for the combined treatment compared to two to three weeks for CBT alone. Early treatment response did not reliably predict post-treatment recovery status. Conclusions Adding medication to CBT produces faster sleep improvement than CBT alone. However, the magnitude of early treatment response is not predictive of final response after the six-week therapy. Additional research is needed to examine mechanisms involved in this early treatment augmentation effect and its impact on long-term outcome.
    Full-text · Article · Jun 2014 · Sleep Medicine
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