Abstract
The aims of this study were (1) to compare health outcomes (i.e., health-related quality of life [HRQoL], productivity at work, and healthcare resource use visits) between those with insomnia and non-insomnia controls, (2) to compare health outcomes between those treated for insomnia and non-insomnia controls, and (3) to assess the prevalence of side effects of insomnia medications and their relationship with health outcomes. Data from the 2013 US (N = 75,000) and 5EU (N = 62,000) National Health and Wellness Survey (NHWS) were used. The NHWS is a patient-reported survey administered to a demographically representative sample of adults. Those who met DSM-V criteria for insomnia and, separately, those treated for insomnia were compared with equivalently sized control groups who were identified using a propensity score matching method. Outcomes included HRQoL (Short Form 36v2), productivity at work (Work Productivity and Activity Impairment—General Health questionnaire), and healthcare resource use visits in the past 6 months and were analyzed using one-way ANOVAs. Among those with treated insomnia, those with and without side effects were compared on health outcomes using general linear models controlling for confounding variables. Patients with insomnia (n = 4147) and treated insomnia (n = 2860) in the 5EU reported significantly worse HRQoL than controls (health utilities: 0.60 vs. 0.74; 0.60 vs. 0.74, respectively), greater overall work impairment (38.74% vs. 14.86%; 39.50% vs. 15.66%), and more physician visits in the past 6 months (9.10 vs. 4.08; 9.58 vs. 4.11). Similar findings were observed in the US. Among those treated for insomnia, 13.56% and 24.55% in the US and 5EU, respectively, were non-adherent due to side effects. In the US, non-adherence was associated with significantly worse HRQoL (health utilities: 0.60 vs. 0.64, p <.05) and greater overall work impairment (37.71% vs. 29.08%, p <.05), among other significant differences. These relationships were not significant in the 5EU. A significant burden of insomnia was observed in both the US and 5EU, and the association remained even after treatment. Non-adherence due to side effects was common and, in the case of the US, associated with significantly poorer health outcomes.
Highlights
Prior research has suggested that approximately 30% of adults report difficulty falling asleep, difficulty maintaining sleep, or non-restorative sleep [1,2]
The aims of this study were (1) to compare health outcomes between those with insomnia and non-insomnia controls, (2) to compare health outcomes between those treated for insomnia and non-insomnia controls, and (3) to assess the prevalence of side effects of insomnia medications and their relationship with health outcomes
A study by Bolge and colleagues reported that respondents who had been diagnosed with insomnia and experienced their symptoms at least a few times per month reported significantly worse health-related quality of life (HRQoL) and greater impairment in work and leisure activities [3]
Summary
Prior research has suggested that approximately 30% of adults report difficulty falling asleep, difficulty maintaining sleep, or non-restorative sleep [1,2]. Several studies have suggested that patients who experience insomnia and symptoms of insomnia report a number of significant impairments. There are a number of available medications for insomnia which have, in clinical studies, demonstrated significant improvements in sleep latency, total sleep duration, sleep quality, daytime functioning, and physical well-being [6,7,8]. These medications can be associated with both cognitive and psychomotor adverse events such as memory loss or loss of balance [8,9,10,11,12]. It is critical to examine differences in HRQoL, work impairment, activity impairment, and healthcare resource use between those being treated for insomnia and those without insomnia
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