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Psychiatry Research Dec 2019Apart from possibly distinguishing the different clinical causes of insomnia, this article explores the subjective and objective sleep differences amongst primary... (Comparative Study)
Comparative Study
Apart from possibly distinguishing the different clinical causes of insomnia, this article explores the subjective and objective sleep differences amongst primary insomnia, major depression with insomnia and general anxiety disorder with insomnia. Subjective sleep and objective sleep of the participants were evaluated by using the Pittsburgh sleep quality index and polysomnography, respectively. We found that major depression with insomnia exhibited higher daytime dysfunction than primary insomnia; showed significantly higher values of rapid eye movement (REM) periods, time of REM sleep and percentage of REM stage; and presented lower percentage of non-rapid eye movement stage compared with primary insomnia and general anxiety disorder with insomnia (p < 0.05). General anxiety disorder with insomnia showed lower awakening number (AN) than primary insomnia, and other objective and subjective sleep values of general anxiety disorder with insomnia and primary insomnia showed no significant difference (p > 0.05). Our findings showed that major depression with insomnia increased active REM sleep and severe daytime function, which could alert clinicians to the risk of depression. Major depression with insomnia and primary insomnia may be categorically different. However, general anxiety disorder with insomnia and primary insomnia might be a continuum of a disease rather than be categorically distinct.
Topics: Adult; Anxiety Disorders; Depressive Disorder, Major; Female; Humans; Male; Middle Aged; Polysomnography; Sleep; Sleep Initiation and Maintenance Disorders; Sleep, REM
PubMed: 31474379
DOI: 10.1016/j.psychres.2019.112514 -
The Journal of Clinical Psychiatry Sep 2018This analysis characterizes the individual-level and population-level burden of insomnia in relation to other medical conditions and describes the comorbidity of...
OBJECTIVE
This analysis characterizes the individual-level and population-level burden of insomnia in relation to other medical conditions and describes the comorbidity of insomnia with other medical conditions, including the dependence of these comorbidities on pain, life events, and mental disorders.
METHODS
Information from 34,712 adults in the National Epidemiologic Survey on Alcohol and Related Conditions-III (2012-2013) was analyzed. Quality-adjusted life-years (QALYs) were measured with the SF-6D, a 6-dimensional health state classification derived from the Short-Form-12, version 2.
RESULTS
In the last 12 months, 27.3% of adults reported insomnia. The US annual loss of QALYs associated with insomnia (5.6 million; 95% CI, 5.33-5.86 million) was significantly larger than that associated with any of the other 18 medical conditions assessed, including arthritis (4.94 million; 95% CI, 4.62-5.26 million), depression (4.02 million; 95% CI, 3.87-4.17 million), and hypertension (3.63 million; 95% CI, 3.32-3.93 million). After control for demographic factors, all conditions examined from obesity (adjusted odds ratio [aOR] = 1.25) to mania (aOR = 5.04) were associated with an increased risk of insomnia. Further controlling for pain, stressful life events, and mental disorders decreased the odds of the co-occurrence of insomnia with these conditions. The decrease in insomnia comorbidity associated with pain was greatest for fibromyalgia (31.8%) and arthritis (20.1%); the decrease in insomnia comorbidity associated with life events was greatest for mania (13.4%) and drug use disorders (11.2%); and the decrease in insomnia comorbidity associated with mental disorders was greatest for peptic ulcer disease (11.2%) and liver diseases (11.1%).
CONCLUSIONS
Insomnia is prevalent and associated with substantial population-level burden in self-assessed health. The co-occurrence of insomnia with common medical conditions is differentially related to pain and to a lesser extent to stressful life events and mental disorders.
Topics: Adolescent; Adult; Aged; Comorbidity; Disease; Female; Health Surveys; Humans; Life Change Events; Male; Mental Disorders; Middle Aged; Pain; Quality of Life; Quality-Adjusted Life Years; Sleep Initiation and Maintenance Disorders; United States; Young Adult
PubMed: 30256547
DOI: 10.4088/JCP.17m12020 -
International Psychogeriatrics Apr 2016Insomnia increases in prevalence with age, is strongly associated with depression, and has been identified as a risk factor for suicide in several studies. The aim of...
BACKGROUND
Insomnia increases in prevalence with age, is strongly associated with depression, and has been identified as a risk factor for suicide in several studies. The aim of this study was to determine whether insomnia severity varies between those who have attempted suicide (n = 72), those who only contemplate suicide (n = 28), and those who are depressed but have no suicidal ideation or attempt history (n = 35).
METHODS
Participants were middle-aged and older adults (age 44-87, M = 66 years) with depression. Insomnia severity was measured as the sum of the early, middle, and late insomnia items from the Hamilton Rating Scale for Depression. General linear models examined relations between group status as the independent variable and insomnia severity as the dependent variable.
RESULTS
The suicide attempt group suffered from more severe insomnia than the suicidal ideation and non-suicidal depressed groups (p < 0.05). Differences remained after adjusting for potential confounders including demographics, cognitive ability, alcohol dependence in the past month, severity of depressed mood, anxiety, and physical health burden. Moreover, greater insomnia severity in the suicide attempt group could not be explained by interpersonal difficulties, executive functioning, benzodiazepine use, or by the presence of post-traumatic stress disorder.
CONCLUSIONS
Our results suggest that insomnia may be more strongly associated with suicidal behavior than with the presence of suicidal thoughts alone. Accordingly, insomnia is a potential treatment target for reducing suicide risk in middle-aged and older adults.
Topics: Adult; Aged; Aged, 80 and over; Case-Control Studies; Cross-Sectional Studies; Depression; Female; Humans; Male; Middle Aged; Pennsylvania; Severity of Illness Index; Sleep Initiation and Maintenance Disorders; Suicidal Ideation; Suicide, Attempted
PubMed: 26552935
DOI: 10.1017/S104161021500174X -
Sleep Medicine Reviews Oct 2015Cognitive behavioral therapy for insomnia (CBT-I) is effective for treatment of primary insomnia. There has been no synthesis of studies quantifying this effect on... (Meta-Analysis)
Meta-Analysis Review
Cognitive behavioral therapy for insomnia (CBT-I) is effective for treatment of primary insomnia. There has been no synthesis of studies quantifying this effect on insomnia comorbid with medical and psychiatric disorders using rigorous selection criteria. The objective of this study was to quantify the effect of CBT-I in studies including patients with medical or psychiatric disorders. Studies were identified from 1985 through February 2014 using multiple databases and bibliography searches. Inclusion was limited to randomized controlled trials of CBT-I in adult patients with insomnia diagnosed using standardized criteria, who additionally had a comorbid medical or psychiatric condition. Twenty-three studies including 1379 patients met inclusion criteria. Based on weighted mean differences, CBT-I improved subjective sleep quality post-treatment, with large treatment effects for the insomnia severity index and Pittsburgh sleep quality index. Sleep diaries showed a 20 min reduction in sleep onset latency and wake after sleep onset, 17 min improvement in total sleep time, and 9% improvement in sleep efficiency post-treatment, similar to findings of meta-analyses of CBT-I in older adults. Treatment effects were durable up to 18 mo. Results of actigraphy were similar to but of smaller magnitude than subjective measures. CBT-I is an effective, durable treatment for comorbid insomnia.
Topics: Adult; Cognitive Behavioral Therapy; Comorbidity; Female; Humans; Male; Mental Disorders; Middle Aged; Sleep Initiation and Maintenance Disorders; Treatment Outcome
PubMed: 25645130
DOI: 10.1016/j.smrv.2014.11.007 -
Sleep Nov 2022To examine the longitudinal association between probable insomnia status and both subjective and objective memory decline in middle-aged and older adults.
STUDY OBJECTIVES
To examine the longitudinal association between probable insomnia status and both subjective and objective memory decline in middle-aged and older adults.
METHODS
26 363 participants, ≥45 years, completed baseline and follow-up (3 years after baseline) self-reported evaluations of sleep and memory, and neuropsychological testing in the following cognitive domains: memory, executive functions, and psychomotor speed. Participants were categorized as having probable insomnia disorder (PID), insomnia symptoms only (ISO), or no insomnia symptoms (NIS), based on sleep questionnaires. Participants were further grouped based on their sleep change over time. Prospective odds of self-reported memory worsening were assessed using logistic regression, and associations between insomnia and cognitive performance were assessed via linear mixed-effects modeling, adjusted for demographic, lifestyle, and medical factors.
RESULTS
An increased odds (OR 1.70; 95% CI 1.29-2.26) of self-reported memory worsening was observed for NIS participants at baseline who developed PID at follow-up compared to those who developed ISO or remained NIS. Additionally, participants whose sleep worsened from baseline to follow-up (i.e. transitioned from NIS to ISO, ISO to PID, or NIS to PID) displayed increased odds (OR 1.22; 95% CI 1.10-1.34) of subjective memory worsening at follow-up compared to those who remained insomnia-free or improved their sleep. There were no significant associations between the development of PID or worsening sleep and performance on neuropsychological tests.
CONCLUSIONS
These findings of an increased odds for subjective memory decline in middle-aged and older adults with insomnia disorder suggest insomnia may be an important target for early interventions addressing age-related cognitive decline.
Topics: Middle Aged; Humans; Aged; Sleep Initiation and Maintenance Disorders; Longitudinal Studies; Prospective Studies; Cognition; Canada; Aging; Memory Disorders
PubMed: 35877203
DOI: 10.1093/sleep/zsac176 -
The Primary Care Companion For CNS... May 2020To assess insomnia and its health correlates among elderly primary care patients in India.
OBJECTIVE
To assess insomnia and its health correlates among elderly primary care patients in India.
METHODS
A multicenter, cross-sectional survey was administered to 1,770 elderly primary care patients from 71 government primary health centers in Kerala, India, from May to December 2016. Insomnia was evaluated using the Insomnia Severity Index. Basic demographics and information about medical illness were collected. Study instruments included the Patient Health Questionnaire-Somatic, Anxiety, and Depression Symptoms; Alcohol Use Disorders Identification Test; Fagerström Test for Nicotine Dependence; 12-item World Health Organization Disability Assessment Schedule; and World Health Organization Quality of Life-BREF.
RESULTS
Valid responses were received from 1,574 (89%) patients, of whom the mean age was 68.6 years and 55.5% were women. Clinical insomnia was reported by 11.8%, whereas 30.4% had subclinical insomnia. Primary care attendees with subclinical as well as clinical insomnia had increased odds of being older and female and having chronic medical illness compared with those without insomnia. Patients with clinical insomnia had increased odds of common mental disorders (anxiety, depression, and somatization) and greater disability compared with the subclinical or no insomnia groups. Those with subclinical insomnia had poor satisfaction with life compared to those with no insomnia.
CONCLUSIONS
Insomnia in the elderly is frequent in primary care patients in India and has multiple negative health correlates. This study reiterates the need for more awareness with regard to detection and management of insomnia in the elderly population.
Topics: Age Factors; Aged; Aged, 80 and over; Chronic Disease; Comorbidity; Cross-Sectional Studies; Female; Humans; India; Male; Mental Disorders; Middle Aged; Primary Health Care; Sex Factors; Sleep Initiation and Maintenance Disorders
PubMed: 32441494
DOI: 10.4088/PCC.19m02581 -
Sleep Mar 2023Insomnia may be a modifiable risk factor for later-life cognitive impairment. We investigated: (1) which insomnia symptoms are associated with subsequent cognitive...
STUDY OBJECTIVES
Insomnia may be a modifiable risk factor for later-life cognitive impairment. We investigated: (1) which insomnia symptoms are associated with subsequent cognitive functioning across domains; (2) whether insomnia-cognition associations are mediated by mental and physical health; and (3) whether these associations are modified by gender.
METHODS
Participants included 2595 adults ages 51-88 at baseline (Mage=64.00 ± 6.66, 64.5% women) in the Health and Retirement Study. The frequency of insomnia symptoms (difficulty initiating sleep, night time awakenings, early awakenings, and feeling unrested upon awakening) at baseline (2002) were quantified using a modified Jenkins Sleep Questionnaire. Cognition was assessed in 2016 via the Harmonized Cognitive Assessment Protocol and operationalized with factor scores corresponding to five domains. Depressive symptoms and vascular conditions in 2014 were assessed via self-report. Structural equation models estimated total, indirect, and direct effects of insomnia symptoms on subsequent cognition through depressive symptoms and vascular diseases, controlling for baseline sociodemographic and global cognition.
RESULTS
Frequent difficulty initiating sleep was associated with poorer episodic memory, executive function, language, visuoconstruction, and processing speed 14 years later (-0.06 ≤ β ≤ -0.04; equivalent to 2.2-3.4 years of aging). Depressive symptoms explained 12.3%-19.5% of these associations and vascular disease explained 6.3%-14.6% of non-memory associations. No other insomnia symptoms were associated with cognition, and no associations were modified by gender.
CONCLUSIONS
Difficulty initiating sleep in later life may predict future cognitive impairment through multiple pathways. Future research with longitudinal assessments of insomnia, insomnia treatments, and cognition is needed to evaluate insomnia as a potential intervention target to optimize cognitive aging.
Topics: Adult; Humans; Female; Middle Aged; Aged; Aged, 80 and over; Male; Sleep Initiation and Maintenance Disorders; Depression; Cognition; Executive Function; Sleep
PubMed: 36309871
DOI: 10.1093/sleep/zsac262 -
Journal of Sleep Research Aug 2015Longitudinal studies that have examined the association of insomnia with incident depression using objective sleep measures are very limited. The aim of this study was...
Longitudinal studies that have examined the association of insomnia with incident depression using objective sleep measures are very limited. The aim of this study was to examine the predictive role of the severity of insomnia for incident depression in a general population sample using psychometric and polysomnographic data. From a random, general population sample of 1741 individuals of the Penn State Adult Cohort, 1137 adults without depression were followed up with a structured telephone interview after 7.5 years. All subjects completed a full medical evaluation, 1-night polysomnogram and Multiphasic Minnesota Personality Inventory at baseline. The incidence of depression was 15%. Poor sleep (odds ratio = 1.5, P = 0.001) and insomnia (odds ratio = 1.9, P = 0.031) were significantly associated with incident depression. The odds of incident depression were highest (odds ratio = 2.2, P = 0.019) in insomnia with objective short sleep duration and independent of Multiphasic Minnesota Personality Inventory Ego Strength scores, an index of poor coping resources. The persistence of insomnia and worsening of poor sleep into insomnia significantly increased the odds of incident depression (odds ratios ranged from 1.8 to 6.3), whereas their full remission did not (odds ratio ranged from 1.2 to 1.8). Insomnia with short sleep duration is associated with incident depression independent of poor coping resources, whereas the association of insomnia with normal sleep duration with incident depression was mediated by poor coping resources. Persistence and worsening of poor sleep or insomnia, but not their full remission, are significant predictors of incident depression. These data suggest that there is a significant relationship between the severity of insomnia and incident depression.
Topics: Cohort Studies; Depression; Female; Humans; Incidence; Male; Middle Aged; Odds Ratio; Pennsylvania; Personality; Polysomnography; Sleep; Sleep Initiation and Maintenance Disorders; Time Factors
PubMed: 25728794
DOI: 10.1111/jsr.12285 -
Sleep Jan 2020To examine economic aspects of insomnia and insomnia medication treatment among a nationally representative sample of older adult Medicare beneficiaries.
STUDY OBJECTIVES
To examine economic aspects of insomnia and insomnia medication treatment among a nationally representative sample of older adult Medicare beneficiaries.
METHODS
Using a random 5% sample of Medicare administrative data (2006-2013), insomnia was defined using International Classification of Disease, Version 9, Clinical Modification diagnostic codes. Treatment was operationalized as one or more prescription fills for an US Food and Drug Administration (FDA)-approved insomnia medication following diagnosis, in previously untreated individuals. To evaluate the economic impact of insomnia treatment on healthcare utilization (HCU) and costs in the year following insomnia diagnosis, a difference-in-differences approach was implemented using generalized linear models.
RESULTS
A total of 23 079 beneficiaries with insomnia (M age = 71.7 years) were included. Of these, 5154 (22%) received one or more fills for an FDA-approved insomnia medication following insomnia diagnosis. For both treated and untreated individuals, HCU and costs increased during the 12 months prior to diagnosis. Insomnia treatment was associated with significantly increased emergency department visits and prescription fills in the year following insomnia diagnosis. After accounting for pre-diagnosis differences between groups, no significant differences in pre- to post-diagnosis costs were observed between treated and untreated individuals.
CONCLUSIONS
These results advance previous research into economics of insomnia disorder by evaluating the impact of medication treatment and highlighting important differences between treated and untreated individuals. Future studies should seek to understand why some individuals diagnosed with insomnia receive treatment but others do not, to identify clinically meaningful clusters of older adults with insomnia, and to explore the economic impact of insomnia and insomnia treatment among subgroups of individuals with insomnia, such as those with cardiovascular diseases, mood disorders, and neurodegenerative disease.
Topics: Aged; Aged, 80 and over; Cardiovascular Diseases; Female; Humans; Male; Medicare; Middle Aged; Mood Disorders; Neurodegenerative Diseases; Patient Acceptance of Health Care; Sleep Initiation and Maintenance Disorders; United States
PubMed: 31418027
DOI: 10.1093/sleep/zsz192 -
BMC Psychiatry Feb 2021Epidemiological studies of insomnia in the Middle East remain scarce. The present study aimed to estimate the prevalence of insomnia and explore its associations in the...
BACKGROUND
Epidemiological studies of insomnia in the Middle East remain scarce. The present study aimed to estimate the prevalence of insomnia and explore its associations in the general population of Qatar. With almost 100 nationalities, Qatar is one of the most culturally diverse, richest, and fastest developing countries in the Arabian Peninsula.
METHODS
A probability sample of community-dwelling adults were surveyed in February of 2019. A total of 1611 respondents completed face-to-face interviews in Arabic or English. Logistic regression modeled associations with insomnia, our dependent variable, as defined by a score of ≤16 on the eight-item Sleep Condition Indicator or according to criteria for insomnia in the Diagnostic & Statistical Manual of Mental Disorders, fifth edition or DSM-5.
RESULTS
Approximately, 5.5% of the sample screened positive for insomnia and the 30-day prevalence of those who met all the DSM-5 criteria for insomnia disorder was 3.0%. In addition, 2.0% of the sample screened positive for depression and 3.4% for anxiety in the past 2 weeks. Multivariable analysis showed the following were significantly associated with insomnia: Arab ethnicity, young age, unemployment, being married, having less than high school education, fair or poor health, anxiety, and depression.
CONCLUSIONS
Insomnia prevalence was in the lower range of previously reported DSM-defined estimates from developed Western countries. Our findings highlight the need for raising awareness and improving sleep hygiene in potential risk groups such as younger adults and those of Arab ethnicity, in addition to incorporating insomnia screening in the provision of mental health services.
Topics: Adult; Diagnostic and Statistical Manual of Mental Disorders; Humans; Middle East; Prevalence; Qatar; Sleep Initiation and Maintenance Disorders
PubMed: 33557765
DOI: 10.1186/s12888-020-03035-8