Journal
SLEEP
Volume 34, Issue 8, Pages 997-1011Publisher
OXFORD UNIV PRESS INC
DOI: 10.5665/SLEEP.1150
Keywords
Insomnia; subtypes; comorbidity; perceived health; prevalence; societal burden
Categories
Funding
- Sanofi-Aventis
- Pfizer
- Merck Co.
- Somaxon
- Evotec
- Actelion
- Vanda
- Neurogen
- Ventus
- Respironics
- Jazz Pharmaceuticals
- Astra-Zeneca
- Daimler Benz
- GlaxoSmithKline
- Lundbeck
- Takeda
- UCB
- Volkswagen
- Weinmann
- Sanofi Aventis
- Shire Development Inc.
- Janssen Pharmceutica
- Cephalon
- Glaxo Smith Kline
- Merck
- Neurocrine
- Sanofi
- Schering-Plough
- Sepracor
- Syrex
- TransOral
- Wyeth
- Xenoport
- Analysis Group Inc.
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Study Objectives: To explore the distribution of the 4 cardinal nighttime symptoms of insomnia-difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), early morning awakening (EMA), and nonrestorative sleep (NRS)-in a national sample of health plan members and the associations of these nighttime symptoms with sociodemographics, comorbidity, and perceived health. Design/Setting/Participants: Cross-sectional telephone survey of 6,791 adult respondents. Intervention: None. Measurements/Results: Current insomnia was assessed using the Brief Insomnia Questionnaire (BIQ)-a fully structured validated scale generating diagnoses of insomnia using DSM-IV-TR, ICD-10, and RDC/ICSD-2 inclusion criteria. DMS (61.0%) and EMA (52.2%) were more prevalent than DIS (37.7%) and NRS(25.2%) among respondents with insomnia. Sociodemorgraphic correlates varied significantly across the 4 symptoms. All 4 nighttime symptoms were significantly related to a wide range of comorbid physical and mental conditions. All 4 also significantly predicted decrements in perceived health both in the total sample and among respondents with insomnia after adjusting for comorbid physical and mental conditions. Joint associations of the 4 symptoms predicting perceived health were additive and related to daytime distress/impairment. Individual-level associations were strongest for NRS. At the societal level, though, where both prevalence and strength of individual-level associations were taken into consideration, DMS had the strongest associations. Conclusions: The extent to which nighttime insomnia symptoms are stable over time requires future long-term longitudinal study. Within the context of this limitation, the results suggest that core nighttime symptoms are associated with different patterns of risk and perceived health and that symptom-based subtyping might have value.
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