Burden Of Insomnia Research Articles

Insomnia and Related Factors During the Delta Wave of the COVID-19 Pandemic in the Kingdom of Bahrain: A Cross-Sectional Study.

This study aims to estimate the prevalence of insomnia and related risk factors during the Delta wave of the COVID-19 pandemic in the Kingdom of Bahrain. An analytical cross-sectional study included 646 individuals from the general population aged 18 years and over, living in the Kingdom of Bahrain during the Delta wave of the pandemic. Data were collected by an anonymous online questionnaire using the snowball-sampling technique between June and August 2021. We used the Insomnia Severity Index (ISI) and the generalized anxiety disorder scale (GAD-7) to measure the level of insomnia and anxiety, respectively. A total of 646 individuals participated in the study. Most of the participants were females (86%). The mean age was 38.7 ± 12.7 years (age range 18-89) and around half of the participants were 35 years or older. Clinical insomnia was reported by 20% [95% CI, 16.9-20.0] of the participants, and 50.1% [95% CI, 46.2-50.1] had subclinical insomnia according to ISI. The proportion of insomnia was significantly higher among females, healthcare workers, participants with lower educational levels, a lower or decreased monthly income during the pandemic, or participants who reported anxiety symptoms (all P < 0.01). Scales of anxiety and insomnia revealed a high correlation (r2 = 0.347, P< 0.01). The logistic regression model confirmed that factors independently associated with insomnia are female gender (OR=1.94, 95% CI, 1.00-3.76, P < 0.050) as well as presence of anxiety (GAD-7 score ≥ 5) [OR=12.98, 95% CI, 5.61-30.00, P < 0.001]. The burden of insomnia was significant among the general population in the Kingdom of Bahrain during the Delta wave of the COVID-19 pandemic despite the low severity of this variant. Mental health programs are a high priority during the pandemic and afterward. Detection of insomnia could be used to treat some mental health problems at an early stage.

Burden of insomnia among cancer patients undergoing treatment: A retrospective claims database analysis.

e18816 Background: Almost half of all cancer patients have trouble sleeping, usually insomnia or other sleep-wake disorders. Cancer treatment can exacerbate sleep problems. This study evaluated all-cause healthcare resource utilization (HCRU) and costs in cancer patients undergoing treatment who also have insomnia relative to a matched cohort of cancer patients undergoing treatment who do not have insomnia. Methods: This retrospective study used the IBM MarketScan Commercial and Medicare Supplemental Databases (Jan 2014-Dec 2019) to identify patients: (1) age ≥18 years; (2) with ≥1 ICD-9/ICD-10 codes for insomnia OR with ≥2 prescriptions for zolpidem immediate release (IR) OR trazodone ≤150mg OR benzodiazepine; (3) with ≥12 months of continuous enrollment pre-/post-index date (earliest diagnosis or medication fill date); (4) with ≥2 ICD-9/ICD-10 codes for any cancer; and (5) ≥1 claim for oncology treatment. Patients with sleep disorders other than insomnia were excluded. The resulting patients (“insomnia cohort”) were 1:1 matched on age, sex and Elixhauser Comorbidity Index (ECI) score to patients with cancer undergoing treatment without insomnia or other sleep disorders (“control cohort”). HCRU and costs were reported per patient per month (PPPM). Generalized linear models were used to compare adjusted outcomes between cohorts. Results: For each cohort, 7,132 patients (mean age 60.8 years, 69.5% female, 13.6 ECI score) were identified. In adjusted analyses, significantly more patients in the insomnia cohort had at least one inpatient visit per month, inpatient stays were significantly longer, and mean outpatient visits were significantly higher (all p &lt; 0.001) relative to the control cohort. The insomnia cohort had higher mean number of emergency department (ED) visits (p &lt; 0.05); however, mean number of inpatient visits was not significantly different between cohorts. Adjusted analyses also showed significantly higher mean total PPPM costs for the insomnia cohort than the control cohort ($4,864 and $3,302, respectively; mean ratio = 1.47; p &lt; 0.0001). Mean PPPM costs for inpatient visits, ED visits, and outpatient costs were also higher for the insomnia cohort (p &lt; 0.001). Conclusions: Cancer patients undergoing treatment who have insomnia had more intensive HCRU and higher costs relative to those without insomnia. These results suggest that better managing insomnia in this population may have a beneficial impact on both patients and payers.

Burden of Insomnia and Sleep Disturbances and the Impact of Sleep Treatments in Patients with Probable or Possible Alzheimer's Disease: A Structured Literature Review.

Background:Sleep disturbances are frequent in Alzheimer’s disease (AD).Objective:To summarize the impact of sleep disturbances on AD patients and their caregivers and the effects of currently available sleep therapies.Methods:Published studies (January 1985–March 2020) assessing the burden associated with insomnia/sleep disturbances in the AD population and insomnia treatment effects were identified by searching PubMed, Embase, and Cochrane Library and screened against inclusion criteria.Results:58 studies assessing patient and caregiver burden, institutionalization, and insomnia treatments in AD patients with sleep disturbances were identified. Sleep disturbances were associated with worse cognition, functional ability, and behavioral and neuropsychological functioning. Health status and quality of life of both patients and caregivers were reduced in the presence of sleep disturbances. Sleep disturbances were also associated with institutionalization. Although significant associations between sleep problems and clinical outcomes were apparent, there was generally no control for other influencing factors (e.g., cognitive status). Bright light and behavioral therapies as well as drugs showed some promise in AD patients, but studies were primarily small and limited data were available, particularly in regard to the effect on associated clinical burden.Conclusion:Sleep disturbances are a significant problem for AD patients and caregivers, associated with behavioral and psychological problems and cognitive decline. However, they remain poorly characterized and under-researched. As the global population is aging and AD is on thes rise, data from larger, prospective trials are required to fully understand the clinical correlates of sleep disturbances and the impact insomnia treatments can have.

A comparative study between rheumatoid arthritis and osteoarthritis regarding association of insomnia with disease status

BackgroundSleep disturbance is closely related to inflammation and pain. Good sleep quality is essential for patients’ psychological and physical states as well as their quality of life. The aim of this study was to detect how insomnia as a major sleep disturbance could add to the disease burden in rheumatoid arthritis (RA) and osteoarthritis patients (OA) and to determine the predictor parameters in each of them in order to orient the rheumatologist to this unnoticed symptom that could adversely affect the patients’ life. This study included: 20 RA patients, 20 primary knee OA patients together with 20 healthy controls. RA disease activity was assessed by the disease activity score (DAS-28). All participants were assessed for sleep disturbances by the Athens Insomnia Scale, quality of life (QoL) using the short form QoL (SF-36 QoL) scale, depression by the Beck depression inventory (BDI), and functional disability by the Health Assessment Questionnaire Disability Index (HAQ-DI). OA patients were assessed by the Knee OA Flare Up Score (KOFUS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Radiological evaluation for RA patients was done by the Simple Erosion Narrowing Score, while the Kellgren and Lawrence (K-L) radiological grading system was used for OA patients.ResultsInsomnia was found in 75% of the studied RA patients, 25% of the studied OA patients and none of the healthy control with significant difference (P < 0.001). Significant correlations of the insomnia scale with the number of tender and swollen joints (r = 0.66, 0.76 respectively and p = 0.001 both), DAS-28 (r = 0.71, P < 0.001), anti-CCP antibodies titre (r = 0.53, p = 0.02) and the BDI (r = 0.65, p = 0.002) among RA patients were found. Correlations among OA patients occurred with morning stiffness duration (r = 0.69, P = 0.001), number of affected joints (r = 0.81, P = 0.001), the BDI scale (r = 0.51, P = 0.02), the WOMAC index (r = 0.57, P = 0.009), the KOFUS score (r = 0.76, p < 0.001) and the K-L score (r = 0.67, P = 0.001). Linear regression analysis indicated that the predictors for insomnia in RA were DAS-28 and the BDI, while in OA were the number of affected joints and the KOFUS score.ConclusionsInsomnia is a disease burden especially in RA patients being one of the leading causes of depression and is greatly affected by the disease activity. In general the burden of insomnia is much less in OA except in severe cases with markedly affected joints. Rheumatologists should be aware of this disorder that could affect patients’ health, mood, and functional activity.

Insomnia and circadian sleep disorders in ovarian cancer: Evaluation and management of underestimated modifiable factors potentially contributing to morbidity.

Ovarian cancer is the leading cause of gynaecological cancer deaths and the seventh most commonly diagnosed cancer among women worldwide, so that, as it is related to substantial and increasing disease burden, the management of ovarian cancer survivors should be a priority. Such issues involve prevention and management of emotional distress, anxiety/depressive symptoms, and maintenance of quality of life from initial diagnosis to post-treatment. Within this framework, sleep disturbances, in particular insomnia, are emerging as modifiable determinants of mental health, also contributing to substantial morbidity among cancer, including ovarian cancer. To this aim we conducted a systematic review according to PRISMA guidelines on prevalence and management of insomnia and circadian sleep disorders in ovarian cancer, while selecting 22 papers. Insomnia was evaluated in ovarian cancer and, while circadian sleep disturbances were poorly assessed in ovarian cancer, insomnia increased from 14% to 60% of patients. Insomnia was associated with cancer-related comorbid conditions such as emotional distress, anxiety/depressive symptoms and low quality of life. Despite this evidence, no studies have been conducted about insomnia treatment in ovarian cancer. The burden of insomnia and circadian sleep disorders in patients with ovarian cancer still needs to be addressed, and requires a call to action for the evaluation and management of these potential modifiable factors that might contribute to ovarian cancer morbidity.

Prevalence, Impact, and Burden of Insomnia and Discussing It With Patients.

Insomnia is the most prevalent sleep-wake disorder, with about one in ten individuals meeting diagnostic criteria. Associated with significant impairment in daytime function, insomnia has a vast societal burden and impact on public health. To arrive at an accurate diagnosis of insomnia disorder, clinicians should conduct an effective interview with patients to assess the complaint and sleep history and use assessment tools as part of the evaluation.

Burden of Insomnia and Associated Risk Factors in People Living with HIV/AIDS in a Tertiary Hospital in Sub-Saharan Africa

Burden of Insomnia and Associated Risk Factors in People Living with HIV/AIDS in a Tertiary Hospital in Sub-Saharan Africa

The burden of insomnia in Japan.

ObjectivesSeveral studies have suggested that patients who experience insomnia report a number of significant impairments. However, despite this literature, fewer studies have focused on the burden of insomnia among patients in Japan. The objective of the current study is to extend this work in Japan to further understand the effect of insomnia on health-related quality of life (hrQOL). Further, another objective is to understand general predictors of hrQOL among patients with insomnia.MethodsData from the 2012 Japan National Health and Wellness Survey, an annual, cross-sectional study of adults aged 18 years or older, were used (N=30,000). All National Health and Wellness Survey respondents were categorized based on the incidence of self-reported insomnia diagnosis and prescription medication usage (clinical insomniacs under treatment versus [vs] good sleepers without insomnia or insomnia symptoms). Comparisons among different groups were made using multiple regression models controlling for demographics and health history.ResultsClinical insomniacs (n=1,018; 3.4%) reported significantly worse hrQOL compared with good sleepers (n=20,542) (mental component summary: 34.2 vs 48.0; physical component summary: 48.0 vs 52.8; health utilities: 0.61 vs 0.76; all P<0.05). Health behaviors (smoking, exercise, alcohol use) and comorbidities were the strongest predictors of health utilities for clinical insomniacs. For all three clinical insomniac subgroups of interest, those with a physical comorbidity but not a psychiatric one, those with a psychiatric comorbidity but not a physical one, and those without either a physical or psychiatric comorbidity, large decrements in health utilities were observed for respondents who did not engage in any positive health behaviors (0.61, 0.57, 0.64, respectively) relative to good sleepers (0.78). However, the gap in health utility scores between these subgroups and good sleepers diminishes with an increasing number of positive health behaviors (eg, clinical insomniacs with a physical comorbidity but not a psychiatric comorbidity performing all three positive health behaviors =0.67 vs good sleepers =0.78).DiscussionA significant burden remains for those with insomnia who are treated. Given the particularly low levels of hrQOL among treated insomnia patients who have poor health behavior profiles and have psychiatric comorbidities, physicians should place particular emphasis on these patients who are most in need of intervention. Improved treatments may help to address the unmet needs of these patient populations.

The burden of insomnia on individual function and healthcare consumption in Australia

To determine the extent to which insomnia poses an independent burden on individual function and healthcare use in Australia. Cross-sectional data from 8,841 respondents and representative of the Australian population aged 16 to 85 in the 2007 National Mental Health and Wellbeing Survey were analysed. Insomnia was defined as 'sleeping only in short bursts and being awake most of the night' during the past week. This measure was validated against common epidemiological indicators of insomnia. Associations between insomnia, disability and healthcare consumption were explored using multivariate logistic regression. Insomnia was reported by 5.6% of adults and was associated with older age, female gender, pain and psychological distress. Controlling for these and other a priori confounders, insomnia was associated with greater odds of (Adjusted Odds Ratio; 95% CI): disability days (1.62; 1.20-2.18), difficulties in daily activities (1.60; 1.10-2.31), life dissatisfaction (2.34; 1.11-4.93), use of sleep medication (1.78; 1.12-2.82) and a higher number of visits to general practitioners (1.57; 1.06-2.33). Insomnia was not significantly associated with the use of medications for mental health (1.17; 0.82-1.67), hospital admissions (1.31; 0.82-1.67), the use of complementary and alternative medicine (1.10; 0.73-1.67) or unmet need for healthcare (1.22; 0.84-1.77). One in twenty adult Australians experience a level of insomnia that is independently associated with impairments in functioning and increased use of healthcare. Increasing public and clinician awareness of the impact of insomnia, and promotion of available insomnia treatments may be warranted.

032 THE AMERICA INSOMNIA SURVEY: AN EPIDEMIOLOGICAL STUDY OF INSOMNIA IN SUBJECTS WITH VARIOUS COMORBIDITIES AND/OR CONDITIONS

Introduction: The prevalence of insomnia as a disorder is not well defined. Little is known about the number and patterns of night-time and daytime symptoms, their severity and chronicity, or the associations among those features. Most epidemiological studies of insomnia have failed to either systematically use diagnostic criteria or study insomnia subtypes (onset, maintenance [night-time wakening and waking too early], non-restorative sleep) in sufficient detail and have not documented the relative or joint effects of insomnia subtypes on daytime functioning. The night-time and daytime symptoms as well as the disease burden of primary insomnia and comorbid insomnia have not been compared. Methods: The American Insomnia Survey (AIS) telephone questionnaire (approximately 40 minutes) has been administered to 11812 respondents from the HealthCore Integrated Research Database™ consisting of a representative sample of subscribers from 14 geographically dispersed US health plans, which allows responses to be linked with medical and pharmacy claims data. The aim is to investigate associations between insomnia and relevant outcomes, including reported daytime impairment, accidents, injuries, lost productivity, and health care utilization. We also examine prevalence and burden of insomnia in subsamples defined by presence of comorbidities identified by ICD‐9 codes on medical claims, including COPD, osteoarthritis, hypertension, obstructive sleep apnea, neuropathic pain, diabetes, and GERD. Results: This presentation describes AIS methods, instrument development and rationale for choice of scales within the instrument, validation against clinician diagnostic interviews, and planned analyses. Overall, and for each comorbidity controlled for severity, we evaluate prevalence and incremental predictive effects of insomnia and its subtypes on functioning among patients. Analyses include examination of diagnostic thresholds for insomnia based on symptom clustering, severity, and correlates with daytime impairment. The study also includes specific analyses of respondents aged over 65 years, a clearly identified population with an increased prevalence of insomnia . Conclusion: The AIS is a recently completed, large scale, rigorous survey designed to examine the prevalence and impairments associated with insomnia and insomnia subtypes in the USA. First results are reported at the satellite symposium entitled THE AMERICAN INSOMNIA SURVEY: METHODS AND RESULTS, Tuesday 10 November 2009, WASM 2009, Sao Paulo, Brazil.

Chronic Insomnia and Its Negative Consequences for Health and Functioning of Adolescents: A 12-Month Prospective Study

Purpose To estimate prevalence and chronicity of insomnia and the impact of chronic insomnia on health and functioning of adolescents. Methods Data were collected from 4175 youths 11–17 at baseline and 3134 a year later sampled from managed care groups in a large metropolitan area. Insomnia was assessed by youth-reported DSM-IV symptom criteria. Outcomes are three measures of somatic health, three measures of mental health, two measures of substance use, three measures of interpersonal problems, and three of daily activities. Results Over one-fourth reported one or more symptoms of insomnia at baseline and about 5% met diagnostic criteria for insomnia. Almost 46% of those who reported one or more symptoms of insomnia in Wave 1 continued to be cases at Wave 2 and 24% met DSM-IV symptom criteria for chronic insomnia (cases in Wave 1 were also cases in Wave 2). Multivariate analyses found chronic insomnia increased subsequent risk for somatic health problems, interpersonal problems, psychological problems, and daily activities. Significant odds ( p < .05) ranged from 1.6 to 5.6 for poor outcomes. These results are the first reported on chronic insomnia among youths, and corroborate, using prospective data, previous findings on correlates of disturbed sleep based on cross-sectional studies. Conclusions Insomnia is both common and chronic among adolescents. The data indicate that the burden of insomnia is comparable to that of other psychiatric disorders such as mood, anxiety, disruptive, and substance use disorders. Chronic insomnia severely impacts future health and functioning of youths. Those with chronic insomnia are more likely to seek medical care. These data suggest primary care settings might provide a venue for screening and early intervention for adolescent insomnia.

Emerging pharmacotherapeutic agents for insomnia: a hypnotic panacea?

The burden of insomnia has had a significant effect not only on the socioeconomic matrix, but also the medical terrain, as signified by the increased morbidity and mortality of its associated psychiatric and organic sequelae. To this end, a plethora of pharmacotherapeutic agents have been recently introduced that address the vital need to combat insomnia and prevent the perpetuation in its chronic form. The previously and currently dispensed barbiturates and benzodiazepines, respectively, have paved the way for newer agents that are purported to be just as effective, or even more so, with a favourable profile in all domains of sleep. In assessing both published clinical studies and unpublished reports conducted on these emerging agents, this article profiles the most contemporary, therapeutic options in lieu of older hypnotics, over-the-counter medications and supplements. Furthermore, this paper aims to indicate both the future course of hypnotics and the developments currently in progress.

Insights into the Public Health Burden of Insomnia

A QUICK SEARCH OF PUBMED WITH THE TERM INSOM-NIA YIELDS MORE THAN 8000 SCIENTIFIC CITATIONS, THE VAST MAJORITY OF WHICH WERE published after 1980. One might think that this amount of scientific and academic attention would have produced rather significant progress toward understanding insomnia. Yet we continue to struggle with the most basic of questions about the definition, prevalence, patho-physiology, and consequences of and treatments for this disorder (symptom? illness? complaint? syndrome? condition?). One need only to read the 2003 National Sleep Disorders Research Plan

An international survey of insomnia: under-recognition and under-treatment of a polysymptomatic condition

ABSTRACTBackground: Due to its high prevalence, considerable impact on well-being, and high medical and societal costs, insomnia represents an important healthcare challenge. Despite this, the prevalence of this condition is under-recognized and many sufferers do not receive adequate treatment.Objective: This international survey investigated the prevalence and characteristics of insomnia in the general population in France, Italy, Japan and the USA to better understand why insomnia is under-recognized and under-treated.Research design and methods: Type, frequency, natural history of night- and day-time symptoms, and attitudes of people regarding the nature and treatment of insomnia was quantitatively assessed from a representative sample of the general population aged > 18 years in each of the four countries. A survey of an extensive series of standardized 10–15‐min interviews was conducted over the telephone by professional interviewers.Results: Insomnia was reported by 37.2% of respondents in France and Italy, 6.6% in Japan, and 27.1% in the USA. The mean number of symptoms reported per patient was two, with sleep maintenance insomnia the most predominant symptom (73%), followed by difficulty falling asleep (61%), and poor sleep quality (48%). Daytime fatigue and impaired concentration and attention were the most commonly reported next-day symptoms as a result of poor sleep. The majority of individuals with sleep problems reported being ‘somewhat’ or ‘very’ bothered by their symptoms, and reported that their sleep problems impacted on their daily quality of life either ‘somewhat’ or ‘a lot’. Among individuals with a history of insomnia, the rate of reporting insomnia symptoms to physicians was generally low and of those who did consult a physician, few were prescribed any medication.Conclusions: The results of this study suggest that in Europe, Japan and the USA, the burden of insomnia on sufferers is considerable. Many respondents took no action to alleviate their insomnia symptoms despite the poor sleep impacting on their daily quality of life either ‘somewhat’ or ‘a lot’.