Diagnostic Criteria For Insomnia Research Articles

Prevalence of insomnia in a general adult population cohort using different diagnostic criteria: The seventh survey of the Tromsø study 2015–2016

Insomnia disorder is a subjective complaint of sleep dissatisfaction including both night-time and daytime symptoms. Currently there are three commonly used diagnostic manuals each with their own set of criteria, which is often credited for the wide range in insomnia prevalence reported by population-based studies, especially those with self-reported insomnia. However, there are limited studies directly comparing different criteria and little is known about associations with health outcomes. Thus, the aim of this study was to compare the most commonly used diagnostic criteria for insomnia from the literature and to explore the associations with a range of physical and mental health outcomes. We used data from 21,083 women and men from the seventh survey of the population-based Tromsø Study which included adults aged 40–99 years. A revised version of the Bergen Insomnia Scale was used to define insomnia based on the 4th (revised) and 5th edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR and DSM5), the 10th edition of the International Classification of Diseases (ICD-10), and the 3rd edition of the International Classification of Sleep Disorders (ICSD-3). We found the following prevalence of insomnia: DSM-IV-TR 23.6 %, DSM5 8.5 %, ICD-10 9.9 % and ICSD-3 20.0 %. When looking at each symptom, we found over half the participants classified as having insomnia using the DSM-IV-TR and ICSD-3 criteria did not report having impaired daytime functioning at least three days per week. Overall, participants with DSM5 and ICD-10 insomnia appeared to have worse health profiles, based on a higher percentage meeting the cut-off for possible anxiety or depression, reporting a psychological problem or chronic pain, and using antidepressants, painkillers or sleeping pills. However logistic regression models showed largely the same health factors had the same association with the odds for being classified as having insomnia disorder from each set of criteria. Overall, this study suggests that insomnia prevalence may be overestimated if daytime symptoms are not adequately included in accordance with current guidelines.

Psychometric properties of Indonesian version of sleep condition indicator for screening poststroke insomnia.

No study has examined the psychometric properties of the sleep condition indicator (SCI) for screening poststroke insomnia in the Indonesian population. We aimed to develop the Indonesian version of the sleep condition indicator (ISCI) and to examine its psychometric properties for screening adult patients in late sub-acute and chronic periods after stroke. This was a cross-sectional study with two stages. In the first stage, theEnglish version of the SCI was translated into theISCI using standard procedures. The psychometric properties of theISCI were testedin the second stage. Internal consistency and test-retest reliability of ISCI were used to evaluate reliability. A confirmatory factor analysis (CFA) was performed to test construct validity. To test concurrent and convergent validity, the Indonesian version of the insomnia severity index (ISI-INA), generalized anxiety disorder questionnaire (IGAD-7), and patient health questionnaire (IPHQ-9) were used. A receiver operating characteristic (ROC) analysis was conducted to calculate the optimal cutoff score of the ISCI on the basis of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria for insomnia. A total of 160 adults with a diagnosis of stroke for more than 3 months were included (median age of 58.5 years, 31% met the DSM-5 criteria for insomnia). The ISCI had a satisfactory Cronbach's alpha of 0.89 and test-retest reliability of 0.78. The CFA revealed that the ISCI exhibited a satisfactory model fit and was associated with the ISI-INA, IGAD-7, and IPHQ-9 (r = -0.81, -0.32, and -0.52, respectively; all P < .001). The ROC test revealed that the optimal cutoff point of ≤23 yielded the highest sensitivity (94%) and specificity (97%). The study results revealed that the 8-item ISCI is a reliable and valid screening tool for detecting insomnia symptoms according to the DSM-5 criteria in thechronic period after stroke.

Comparison of polysomnography in people with Alzheimer's disease and insomnia versus non-demented elderly people with insomnia

BackgroundWe used baseline polysomnography (PSG) data obtained during the clinical program development for suvorexant to compare the PSG profiles of people with Alzheimer's disease and insomnia (ADI) versus age-matched elderly individuals with insomnia (EI). MethodsSleep laboratory baseline PSG data from participants age 55–80 years from 2 trials in people with insomnia and a trial in people with ADI were included. ADI participants had dementia of mild-to-moderate severity. Diagnostic criteria for insomnia, exclusion for other sleep problems, PSG recording procedures, and endpoint derivations were similar across the trials. All participants underwent a night of in-laboratory PSG prior to the baseline night to allow for screening/adaptation. Participants in the EI and ADI groups were compared with regard to sleep architecture, sleep micro-structure, and quantitative EEG power spectral endpoints. The analysis was performed on a post hoc basis using propensity score matching to compare sleep parameters separately in women and men while accounting for age group and total sleep time. ResultsA total of 837 EI and 239 ADI participants were included, with the majority in each population (∼65%) being women. Compared to EI, those with ADI had a lower percentage of time spent in slow wave sleep (and a corresponding higher percentage of time spent in the lighter N1 sleep), a lower number of spindles per minute of N2 sleep, and lower absolute EEG power during NREM sleep, particularly in the lower-frequency bands. Trends for lower REM sleep percentage in ADI did not reach statistical significance. ConclusionsOur findings in this large data set, in which the influence of sleep problems was effectively subtracted out (since both groups had insomnia), provide strong confirmatory support of results from previous smaller studies in indicating that AD of mild-to-moderate severity is associated with less slow wave sleep, spindles, and lower-frequency EEG power. Trial registrationClinicalTrials.gov, numbers NCT01097616, NCT01097629, NCT02750306

Prevalence, risk factors and effects of restless legs syndrome in COPD patients.

Restless legs syndrome (RLS), a sensory motor disorder, is commonly seen amongst chronic obstructive pulmonary disease (COPD) patients. We conducted a study to know its prevalence in COPD and analyse the possible cause and effect of RLS. It is an analytical cross-sectional study conducted between July 2016-December 2020.The prevalence of RLS was evaluated in patients of COPD using RLS diagnostic criteria. Spirometry, iron profile and arterial blood gas analysis was performed in all the patients to evaluate the cause of RLS. The effect was evaluated with diagnostic criteria for insomnia and patient health questionnaire (PHQ2) for depression. There were 205 participants with a mean age of 59±8 years, 182 (88.7%) men and 23 (11.2%) women. The mean body mass index (BMI) was 29±3.9 kg/m2. The prevalence of RLS was 31.2%. RLS was more common amongst women compared to men (60.8% vs 27.4%). RLS was more prevalent among hypoxemic (PaO2<60 mm Hg) and hypercapnic (PaCO2>45 mm Hg) patients (p<0.016; p<0.017). The ROC curve plotted between PaO2 and RLS occurrence showed that the patients having PaO2 less than 76 mm of Hg were more prone to develop RLS. RLS patients had a higher incidence of insomnia as compared to those without RLS (68.8% vs 36.8%, p<0.001). COPD with RLS patients had more depressive symptoms with a higher patient health questionnaire 2 (PHQ2) score (35.9% vs 14.2%, p<0.001) compared to non-RLS COPD patients. The multiple regression analysis also confirmed that RLS led to insomnia and depressive symptoms in COPD patients. To conclude, RLS is common in COPD patients. RLS leads to insomnia and depression, thus should be identified and treated.

Особливості лікувальної тактики при коморбідності інсомнії та тривоги: в пошуках безпечної альтернативи бензодіазепінів

У статті подано визначення та сучасні діагностичні критерії інсомнії, висвітлено аспекти спільних патогенетичних механізмів розвитку інсомнії та тривоги. Детально описано підходи до лікування інсомнії. Розглянуто місце Валео-Дорм Дуо — препарату на основі фітофлавоноїду кризину з анксіолітичною дією та мелатоніну в лікуванні пацієнтів із тривогою та інсомнією.

Tactile Processing and Quality of Sleep in Autism Spectrum Disorders.

Individuals with autism spectrum disorders (ASDs) commonly experience problems with the processing of tactile stimuli and poor quality of sleep. The aim of the present study was to analyze whether tactile stimuli modulation (TSM) disorders might be linked to insomnia prevalence in ASD individuals. We hypothesized that sleep disorders in children with ASD may result from improper tactile under/over responsivity. The study included 27 children diagnosed with ASD, aged 6.8 (±2.9 years) with male dominance (n = 22, 81.5%). To evaluate the pattern of TSM we used a clinical interview with a parent, and guided and spontaneous observation of the patients. Sleep disorders were diagnosed using the Athens Insomnia Scale. Of all the children diagnosed with TSM, 20 patients (74.1%) had an over-responsivity pattern and 7 children (25.9%) had an under-responsivity pattern. Of the patients, 11 children (40.7%) met the diagnostic criteria for insomnia. The data indicated a statistical tendency for higher prevalence of insomnia in individuals diagnosed with tactile under-responsivity (p = 0.051). We concluded that under-responsivity toward tactile stimuli may be partly responsible for poor sleep quality in ASD. There is an urgent need to treat sleep and sensory disruptions which may intensify behavioral difficulties in ASD.

0924 Adolescent Perceptions of Insomnia Treatment

Abstract Introduction Approximately 10% of adolescents meet diagnostic criteria for insomnia, which is associated with increased health problems, academic difficulties, and psychological morbidity. Empirical evidence supports cognitive-behavioral treatments for insomnia, yet research suggests adolescent insomnia is undertreated. Thus, the goal of this study was to evaluate adolescent perceptions about insomnia treatment seeking and strategies. Methods Adolescents ages 13-18 years with self-reported insomnia symptoms completed an online survey assessing treatment-seeking behaviors and management strategies. English-speaking participants were recruited using targeted Facebook advertising. Descriptive statistics were used to summarize results. Results Of the 3,014 survey respondents, participants were predominantly female (77%) and white non-Hispanic (71%), with a mean age of 16±1.3 years. Most (87%) met DSM-V diagnostic criteria for insomnia, but only 29% reported seeking professional help for insomnia. Of these, participants reported waiting an average of 1-2 years after symptom onset to seek treatment. Participants most often sought help from a mental health professional (18%) or primary care provider (13%), while &amp;lt;2% saw a sleep specialist. Across adolescents, the most commonly endorsed strategies to manage insomnia symptoms were daytime caffeine consumption (48%), staying out of bed except when trying to sleep (38%), and daily exercise (28%). Nearly half of participants endorsed currently using medications to help with sleep, most commonly melatonin (18%) and antihistamine-based sleep aids (10%). Participants reported greatest preference to take medication (64%), meet individually with a sleep specialist (48%), or use a phone or tablet application (40%) to help with sleep. While 30% of participants felt that sleep researchers should prioritize increasing access to insomnia treatment, 20% encouraged developing new modes for treatment delivery (e.g., online). Conclusion Adolescents with insomnia reported using behavioral and pharmacological strategies to help with sleep, with very few receiving treatment from a sleep specialist. Further research is needed to increase accessibility and acceptability of interventions for adolescent insomnia. Support N/A

0921 Insomnia in Adolescents: Patient-Centered Outcomes and Perspectives

Abstract Introduction An estimated 25-40% of adolescents endorse symptoms of insomnia. While research has demonstrated that insomnia is associated with impaired functioning, little is known regarding which insomnia symptoms or outcomes are most burdensome for adolescents. Patient-centered outcomes (PCO) are clinical and research questions and outcomes that are meaningful to patients. This study is the first to evaluate PCOs in adolescents with insomnia. Methods We conducted an online survey of adolescents in the USA, UK, Canada, Australia, and New Zealand who were 13 - 18 years old and reported experiencing one or more insomnia symptoms. Participants were recruited using targeted advertising on Facebook. Participants reported on insomnia symptom severity, frequency, and duration, help-seeking behavior, areas of insomnia-related impairment, and research priorities. Results Of the N=3034 respondents, 99.3% (n=3014) met inclusion criteria. Participants were predominantly female (77.0%) and white non-Hispanic (70.8%), with a mean age of 16.1 years (SD=1.3). Most (87.5%) met DSM-V diagnostic criteria for insomnia, yet only 29.3% reported seeking professional help. Over half (52.1%) reported a symptom duration of three or more years. Insomnia symptoms reported were sleep initiation difficulties (94.4%), sleep fragmentation (65.3%), premature awakening (54.5%), and difficulty sleeping independently (22.3%). The most burdensome areas of insomnia-related impairment were reported to be mood (72.2%), attentional focus (61.0%), pain (49.7%), worry (46.3%) and sleepiness (38.7%). Adolescents with insomnia most frequently endorsed the following research priorities: causes of insomnia (66.4%), early detection (66.1%), public education about sleep (49.1%) and non-pharmacological treatments (48.3%). Conclusion Adolescents with insomnia report significant insomnia-related distress and impairment, with symptoms often persisting for three or more years. However, adolescents with insomnia often do not seek professional help. Areas perceived as most problematic to adolescents living with insomnia (e.g., mood, focus, pain) should be considered as important outcomes for insomnia researchers. Support This publication was made possible with support from Grant Number UL1TR002529 (A Shekhar, PI) from the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Sciences Award and the Indiana University School of Medicine.

Constructs of sleep disturbance and mental wellbeing in older UK adolescents

Poor sleep quality can have far reaching physical and mental health consequences (Alvaro et al., 2014; Ribeiro et al., 2012). This study explores sleep quality in older adolescents; specifically, whether insomnia constructs have unique patterns of association to depression, anxiety and stress. Data from 16–19-year olds (N=198) recruited from further education colleges were obtained. Sleep quality was assessed using the diagnostic criteria for insomnia (DSM-5), Insomnia Severity Index and self-report. The Depression Anxiety Stress Scale (DASS-21) was used to measure mental health state. A large proportion (42–52 per cent) reported sleep difficulties lasting four weeks or more, with 17 per cent short-sleepers (&lt;7hrs.). Regression analysis indicated 12.1 per cent–17.8 per cent of variance in mental health was explained by sleep quality. Specifically, ‘non-restorative sleep’ and ‘daily impact’ consistently predicted depression, anxiety and stress levels. Interestingly, ‘maintaining sleep’ and ‘early wakings’, were associated with anxiety and stress respectively. Results indicate for a potentially large group of adolescents; sleep quality is poor. The cumulative effect of poor sleep appears particularly detrimental. Results provide preliminary indications that sleep behaviours could provide a means for early identification of mental health concerns. Findings can inform tailored interventions aimed at improving sleep quality in adolescents thereby having clear benefits in relation to both short, and longer term, health outcomes.

The ICSD-3/DSM-5 diagnostic criteria for insomnia reinforce the association between insomnia, anxiety and depression

The ICSD-3/DSM-5 diagnostic criteria for insomnia reinforce the association between insomnia, anxiety and depression

External Validity of the Multicomponent Group Treatment KiSS for School-Aged Children With Insomnia

ABSTRACTBackground: Insomnia is common in school-aged children and often associated with other mental disorders. Here, we investigated the effectiveness and acceptance of the KiSS program in an “all-comer” pediatric insomnia clinic. Participants/Methods: Forty-five families (children: 5–10 years, 57.8% female) were randomly assigned to the multicomponent six-session KiSS treatment (CBT-I, hypnotherapy, and imaginations) or a wait-list control group. A sleep diary was recorded before intervention or waiting time, immediately after, as well as 3, 6, and 12 months postintervention (primary outcome: sleep efficiency, SE; sleep-onset latency, SOL). Results: Sleep improved significantly after the KiSS intervention. Three to 12 months after the intervention, only 1.75% of treated children still met the diagnostic criteria for insomnia. SE improved to 96%, and both SOL (reduced to 23 min) and total sleep time were normalized. All improvements were stable for at least one year after the intervention. KiSS was well accepted (0% dropout during intervention) and well tolerated. Conclusions: Treatment with the multimodal sleep training KiSS leads to positive changes in the sleep of children with insomnia, including a subset of children that presented with comorbid mental disorders. With only three sessions for parents and three sessions for children, the treatment can be readily implemented as a stand-alone treatment or be combined with other interventions. Dismantling studies and studies with an active control group are ongoing.

Derivation of Research Diagnostic Criteria for Insomnia: Report of an American Academy of Sleep Medicine Work Group

Derivation of Research Diagnostic Criteria for Insomnia: Report of an American Academy of Sleep Medicine Work Group