Journal
BIOLOGICAL PSYCHIATRY
Volume 70, Issue 11, Pages 1063-1073Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.biopsych.2011.08.010
Keywords
Comorbidity; days out of role; epidemiology; insomnia; perceived health; role disability
Categories
Funding
- Sanofi-Aventis (SA)
- Merck
- Actelion
- Affectis
- Astra-Zeneca
- BrainLab
- Daimler Benz
- Daimler Benz, Essex
- Daimler Benz, Essex, GlaxoSmithKline
- Lundbeck
- Neurim
- NeuroBiotec
- Neurocrine
- Novartis
- Organon, SA
- Schwarz
- Schwarz, Sepracor
- Takeda
- UCB
- Volkswagen
- Weinmann
- Weinmann, and Wyeth
- Aventis
- Cephalon
- Glaxo Smith Kline
- Pfizer
- Sanofi
- SchoeringPlough
- Sepracor
- Somaxon
- Somnus
- Syrex
- TransOral
- Ventus
- Wyeth
- Xenoport
- Vanda
- Neurogen, SA
- Respironics
- Jazz Pharmaceuticals
- Analysis Group
- Bristol-Myers Squibb
- Eli Lilly and Company
- EPI-Q
- GlaxoSmithKline
- Johnson and Johnson Pharmaceuticals
- Ortho-McNeil Janssen Scientific Affairs
- SA Groupe
- Shire US
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Background: Insomnia is highly prevalent and impairing but also highly comorbid with other chronic physical/mental disorders. Population-based research has yet to differentiate the role impairments uniquely associated with insomnia per se from those due to comorbidity. Methods: A representative sample of 6791 adult subscribers to a large national US commercial health plan was surveyed by telephone about sleep and health. Twenty-one conditions previously found to be comorbid with insomnia were assessed with medical/pharmacy claims data and validated self-report scales. The Brief Insomnia Questionnaire, a fully structured, clinically validated scale, generated insomnia diagnoses according to inclusion criteria of DSM-IV-TR, ICD-10, and Research Diagnostic Criteria/International Classification of Sleep Disorders: Diagnostic and Coding Manual, Second Edition. The World Health Organization Disability Assessment Schedule-II assessed number of days in the past 30 when health problems prevented respondents from conducting their usual daily activities. Regression analyses estimated associations of insomnia with days-out-of-role controlling comorbidity. Results: Insomnia was significantly associated with days-out-of-role (.90 days/month) in a gross model. The association was reduced when controls were introduced for comorbidity (.42 days/month). This net association did not vary with number or type of comorbid conditions but was confined to respondents 35 + years of age. Insomnia was one of the most important conditions studied not only at the individual level, where it was associated with among the largest mean days-out-of-role, but also at the aggregate level, where it was associated with 13.6% of all days-out-of-role. Conclusions: Insomnia has a strong net association with days-out-of-role that does not vary as a function of comorbidity.
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