Prevalence and Associations of Insomnia in Lung Transplant Recipients: A Cross-Sectional Study

Abstract

SESSION TITLE: Transplant SESSION TYPE: Original Investigation Slide PRESENTED ON: Monday, October 30, 2017 at 07:30 AM - 08:30 AM PURPOSE: Insomnia is a common disorder and is defined as a persistent difficulty initiating or maintaining sleep, or waking up too early, which occurs despite adequate opportunity for sleep. The sleep disturbance can lead to significant impairment in daytime function and quality of life. There are effective behavioral and pharmacological therapy options for insomnia. Nonetheless, insomnia is often under recognized by clinicians. Although medical disorders and medications known to be associated with insomnia feature commonly amongst lung transplant recipients, the prevalence of insomnia in this population is not known. This study aimed to determine the prevalence and associations of insomnia in lung transplant recipients. METHODS: We conducted a cross-sectional study within a state-wide lung transplant service in Australia. Consecutive patients attending the lung transplant clinic on random days in November and December 2016 were invited to participate in the study if they were more than 4 weeks post-transplant and had no pre-existing diagnosis of a sleep disorder. Participants completed the Insomnia Severity Index (ISI) and Hospital Anxiety and Depression Scale (HADS). Insomnia was defined as an ISI score of ≥15 out of 28. The HADS has a maximum score of 21 for each of the two components, anxiety (HADS A) and depression (HADS D). Medications and lung function data were also recorded. RESULTS: 81 lung transplant recipients participated in the study. The mean age was 57 ± 13 years. 46 of the participants were male. The median time since transplantation was 350 days (interquartile range 128-1228). All patients were on prednisolone at a mean dose of 10.4 ± 4.2 mg. Mean FEV1 was 76 ± 26% of predicted. The mean ISI score was 9.3 ± 7.4, and the prevalence of insomnia, based on an ISI score of ≥15, was 32% (95% confidence interval (CI) 23, 43). The mean HADS A score was 5.4 ± 3.7, and the mean HADS D score was 3.8 ± 3.4. Insomnia was more common amongst female patients (odds ratio (OR) 5.0, 95% CI 1.8, 14.3). In a multivariate analysis, insomnia was associated with the HADS A (OR 1.24, 95% CI 1.06, 1.46) and HADS D scores (OR 1.27, 95% CI 1.05, 1.52), adjusted for age, sex, FEV1 and prednisolone dose. Insomnia was not associated with age, prednisolone dose, time since transplantation, FEV1, 6-minute walk distance, analgesic use, or use of anti-depressant or anti-anxiety medications. CONCLUSIONS: There is a high prevalence of insomnia amongst lung transplant recipients and it is associated with symptoms of anxiety and depression. CLINICAL IMPLICATIONS: Clinicians involved in the care of lung transplant recipients should be aware that insomnia is very common in this patient population, irrespective of prednisolone dose, time since transplantation or lung function. It is important to note that the ISI does not differentiate insomnia from sleep disturbance due to other sleep disorders. Therefore, clinician assessment remains essential. DISCLOSURE: The following authors have nothing to disclose: Shaun Yo, Louise Fuller, Catherine Martin, Matthew Naughton, Gregory Snell, Eli Dabscheck No Product/Research Disclosure Information