The Long-term Effect of Insomnia on Work Disability The HUNT-2 Historical Cohort Study

Department of Clinical Psychology, University of Bergen, Bergen, Hordaland, Norway
American Journal of Epidemiology (Impact Factor: 5.23). 07/2006; 163(11):1018-24. DOI: 10.1093/aje/kwj145
Source: PubMed


Chronic insomnia is common in the general population. Its effect on functioning and disability is usually attributed to an
underlying condition, so the diagnosis of insomnia does not qualify for award of a disability pension in the United States
or Europe. The aim of this study was to investigate whether insomnia, defined according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, contributed to long-term work disability. Using a historical cohort design, the authors gathered baseline
data from a population-based Norwegian health study of 37,308 working-age people not claiming a disability pension through
1995–1997. The outcome was subsequent award of a disability pension (18–48 months after the health screening) as registered
by the National Insurance Administration. Insomnia was a strong predictor of subsequent permanent work disability (adjusted
odds ratio = 3.90, 95% confidence interval: 3.20, 4.76). Sociodemographic and shift-work characteristics had little confounding
effect (adjusted odds ratio = 3.69, 95% confidence interval: 3.00, 4.53), and this association remained significant after
adjustment for psychiatric and physical morbidity and for health-related behaviors (adjusted odds ratio = 1.75, 95% confidence
interval: 1.40, 2.20). This study suggests that insomnia should receive increased attention as a robust predictor of subsequent
work disability.

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Available from: Simon Øverland, Jan 22, 2014
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    • "The two most common medico-legal causes of disability pension (DP) are musculoskeletal and mental disorders (OECD, 2010). Non-medical risk factors of DP include female gender and higher age (OECD, 2010), low socio-economic status (Bruusgaard et al., 2010; Leinonen et al., 2011), smoking (Husemoen et al., 2004; Neovius et al., 2010), low leisure-time physical activity (Robroek et al., 2013), high body mass index (Neovius et al., 2010; Robroek et al., 2013), sleep problems (Sivertsen et al., 2006; Lallukka et al., 2011), high physical workload (Labriola et al., 2009; Lahelma et al., 2012) and adverse psychosocial factors at work (Sinokki et al., 2010; Lahelma et al., 2012; Mäntyniemi et al., 2012; Canivet et al., 2013). Pain is a leading symptom of most musculoskeletal disorders. "
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    ABSTRACT: Musculoskeletal pain at several sites (multisite pain) is more common than single-site pain. Little is known on its effects on disability pension (DP) retirement. A nationally representative sample comprised 4071 Finns in the workforce aged 30 to 63. Data (questionnaire, interview, clinical examination) were gathered in 2000-2001 and linked with national DP registers for 2000-2011. Pain during the preceding month in 18 locations was combined into four sites (neck, upper limbs, low back, lower limbs). Hazard ratios (HR) of DP were estimated by Cox regression. The HR of any DP (n = 477) was 1.6 (95% confidence interval 1.2-2.1) for one, 2.5 (1.9-3.3) for two, 3.1 (2.3-4.3) for three and 5.6 (4.0-7.8) for four pain sites, when adjusted for age and gender. When additionally adjusted for clinically assessed chronic diseases, the HRs varied from 1.4 (1.0-1.8) to 3.5 (2.5-4.9), respectively. When further adjusted for physical and psychosocial workload, education, body mass index, smoking, exercise and sleep disorders, the HRs were 1.3 (0.9-1.7), 1.6 (1.2-2.2), 1.8 (1.3-2.5) and 2.5 (1.8-3.6). The number of pain sites was especially strong in predicting DPs due to musculoskeletal diseases (HRs in the full model; 3.1 to 4.3), but it also predicted DPs due to other somatic diseases (respective HRs 1.3 to 2.3); pain in all four sites was also predictive of DPs due to mental disorders (full model HR 2.2). The number of pain sites independently predicted DP retirement. Employees with multisite pain may need specific support to maintain their work ability. © 2014 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation - EFIC®.
    Full-text · Article · Aug 2015 · European journal of pain (London, England)
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    • "Disturbed sleep is shown to be a factor that predicts sickness absence [7] [8] [9]. Westerlund et al. [10] investigated work-related sleep disturbance in Sweden between 1993 and 1995, finding not only that sleep disturbances related to work is associated with sickness absence, but also that the number of people experiencing sleep disturbances increases over the period. "
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    ABSTRACT: Background: Musculoskeletal pain is one of the most common causes of sickness absence. Sleep disturbances are often co-occurring with pain, but the relationship between sleep and pain is complex. Little is known about the importance of self-reported sleep, when predicting sickness absence among persons with musculoskeletal pain. This study aims to study the association between self-reported sleep quality and sickness absence 5 years later, among individuals stratified by presence of lower back pain (LBP) and neck and shoulder pain (NSP). Methods: The cohort (n = 2286) in this 5-year prospective study (using data from the MUSIC-Norrtälje study) was stratified by self-reported pain into three groups: no LBP or NSP, solely LBP or NSP, and oncurrent LBP and NSP. Odds ratios (ORs) for the effect of self-reported sleep disturbances at baseline on sickness absence (> 14 consecutive days), 5 years later, were calculated. Results: Within all three pain strata, individuals reporting the most sleep problems showed a significantly higher OR for all-cause sickness absence, 5 years later. The group with the most pronounced sleep problems within the concurrent LBP and NSP stratum had a significantly higher OR (OR 2.00; CI 1.09-3.67) also for long-term sickness absence (> 90days) 5 years later, compared to the group with the best sleep. Conclusions: Sleep disturbances predict sickness absence among individuals regardless of co-existing features of LBP and/or NSP. The clinical evaluation of patients should take possible sleep disturbances into account in the planning of treatments. © 2015 the Nordic Societies of Public Health.
    Full-text · Article · Feb 2015 · Scandinavian Journal of Public Health
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    • "Anxiety and depression have been identified as predictors of disability pension (Mykletun et al., 2006; Knudsen et al., 2010; Karpansalo et al., 2005). Insomnia also increases the risk of disability retirement (Sivertsen et al., 2006) and, compared to depression, has important and independent role in the process of disability retirement (Overland et al., 2008). Other risk factors of disability retirement are poor somatic health and functioning, health related risk behavior, low socioeconomic status, work and family related psychosocial factors, including stressful life events, and life dissatisfaction (Harkonmäki, 2007). "
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    ABSTRACT: Background Disturbed sleep is associated with mood disorders. Both depression and insomnia may increase the risk of disability retirement. The longitudinal links between insomnia, depression and work incapacity are poorly known. Methods We examined association of self-reported sleep quality with incident symptoms of depression and disability retirement due to depressive disorders in a longitudinal population-based sample of twins (n=12,063 individuals). These adults were categorized by their sleep quality in 1975 and 1981, excluding individuals with depressed mood in 1975/1981. The outcomes were the Beck Depression Inventory (BDItot) and its subscale Negative Attitudes Towards Self (BDINATS) in 1990 as dichotomized measures, and the incidence of disability retirement due to depressive disorder during 1991–2004. Results Onset of poor sleep between 1975 and 1981 predicted incident depression (BDItot OR=4.5, 95%CI: 2.7-7.4, BDINATS OR=2.0, 95%CI: 1.4-2.7), while persistent poor sleep showed somewhat weaker effects (BDItot; OR=2.5, 95%CI: 1.0-6.0, BDINATS OR=1.9, 95%CI: 1.1-3.3). Among those with few recent stressful life events, onset of poor sleep predicted strongly depression (BDINATS OR=9.5, 95%CI: 3.7-24.2). Likewise onset of poor sleep by 1981 increased the risk of disability retirement due to depression (OR=2.9, 95%CI: 1.8-4.9) with a similar risk among those with persistent poor sleep (OR=2.7, 95%CI: 1.3-5.7). Limitations Lack of baseline diagnostic interviews; sleep quality based on self-report. Conclusions Poor sleep is of importance in etiology of depression and disability retirement due to depression. This emphasizes the importance of early detection and treatment of sleep disturbances.
    Full-text · Article · Oct 2014 · Journal of Affective Disorders
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