Insomnia In Subjects Research Articles

10-Year Risk for Cardiovascular Disease Associated with COMISA (Co-Morbid Insomnia and Sleep Apnea) in Hypertensive Subjects.

Due to the few studies available, this study aimed to investigate the 10-year risk for cardiovascular disease (CVD) associated with COMISA (co-morbid insomnia and sleep apnea) in hypertensive subjects. Clinical data of 1009 hypertensive subjects extracted from the Sleep Laboratory database were analyzed. Framingham Risk Score ≥ 10% was used as a cut-off to identify hypertensive subjects with high 10-year risk for CVD. The association between 10-year risk for CVD and COMISA was investigated using logistic regression analyses. 65.3% of hypertensive subjects from our sample presented a high 10-year risk for CVD. After controlling for major confounding factors, multivariate logistic regression analyses demonstrated that unlike its components present separately, COMISA was significantly associated with high 10-year risk for CVD in hypertensive subjects (OR 1.88, 95% CI 1.01-3.51). In this study, we have demonstrated that the negative synergy between obstructive sleep apnea syndrome and insomnia disorder seems to play a central role in the 10-year risk for CVD in hypertensive subjects, which seems to indicate that the establishment of a systematic research and an adapted treatment of COMISA could open new perspectives to promote a better cardiovascular outcome in this specific subgroup of patients.

The association of dietary glycemic index and glycemic load with the risk of insomnia in the adult population

BackgroundA dietary pattern with a high glycemic index (GI) and glycemic load (GL) can be a precursor to sleep disorders that link to many chronic diseases. We aimed to assess the association of dietary GI and GL with the risk of insomnia in Iranian adults.MethodsA total of 111 newly diagnosed insomnia cases and 333 controls aged 18–60 years were included in this case–control study. The participants’ dietary intakes were collected using a valid and reliable food frequency questionnaire. The diagnosis of insomnia in subjects was performed by a neurologist using the Insomnia Severity Index (ISI) questionnaire. Multivariable logistic regression models, adjusted for the potential confounders, were used to determine the risk of insomnia according to tertiles of dietary glycemic indices.ResultsThe mean (SD) age and BMI of the study population (78.6% female) were 31.8 (10.0) years and 24.70 (3.62) kg/m2, respectively. The median (IQR) of dietary GI and GL in subjects was 62.7 (57.0–68.6) and 213.5(167.4–268.5), respectively. Based on the multivariable-adjusted model, after controlling for age, sex, physical activity, obesity, smoking, socioeconomic score, general health questionnaire (GHQ) score, and dietary energy intake, the odds of insomnia were increased across tertiles of dietary GL[(OR:2.72,95%CI:1.10–6.70),(Ptrend = 0.017)], however, no significant association was observed between high GI diet and insomnia risk [(OR:1.38,95%CI:0.77–2.47),(Ptrend = 0.298)].ConclusionsOur results revealed that greater adherence to dietary pattern with high GL could be increased the odds of insomnia in Iranian adults.

The role of baseline insomnia in moderating the hypnotic properties of quetiapine

IntroductionThe primary aim of this study was to investigate the effect of quetiapine on insomnia and alcohol craving (craving) in subjects with co-occurring insomnia and AUD. MethodsInsomnia was assessed with the Insomnia Severity Index (ISI) and craving with the Penn Alcohol Craving Scale (PACS, primary) and Obsessive-Compulsive Drinking Scale (OCDS, secondary). A multivariable model adjusted for covariates (N = 123) evaluated the relationship between craving (PACS and OCDS total scores) and insomnia (ISI total score). To simultaneously assess the effects of treatment arm allocation and insomnia status, subjects (N = 115) were stratified into 4 groups, quetiapine-insomnia(N = 38), quetiapine-No insomnia(N = 19), placebo-insomnia(N = 38), and placebo-No insomnia(N = 20). Linear mixed-effects regression models adjusted for covariates compared the trajectories of ISI, PACS, and OCDS total scores across 12 weeks of treatment and at post-treatment follow-up at week 24, between the four groups. ResultsThe ISI total score was positively associated with the PACS (p = 0.006) and OCDS (p = 0.001) total scores in the multivariable models. In the longitudinal analysis, when compared to the three other groups, subjects with insomnia treated with quetiapine showed a marked reduction in their insomnia scores with a return of insomnia after stopping treatment. There was no significant difference between the groups for the PACS and OCDS total score trajectories. DiscussionAlthough craving is associated with insomnia, treatment with quetiapine may improve insomnia but not craving in patients with co-occurring AUD and insomnia.

Abstract P205: Use Of A Noninvasive, Closed-loop, Allostatic, Neurotechnology Reduced Blood Pressure And Improved Sleep In Heterogeneous Cohort

Introduction: Elevated blood pressure is a major modifiable risk for cardiovascular disease. Disturbed central control of cardiovascular regulation due to trauma, stress, anxiety or other causes can lead to rise in blood pressure. High-resolution, relational, resonance-based, electroencephalic mirroring (HIRREM®) is a noninvasive, closed-loop, allostatic, acoustic stimulation neurotechnology using software algorithms to identify specific brain frequencies, and translate them in real time into audible tones, to support self-optimization of brain rhythms. Objective: To evaluate the benefits of adding this nontraditional therapy on BP and symptoms of insomnia in subjects with normal or controlled BP, who are enrolled in an IRB-approved open label feasibility study evaluating HIRREM for diverse neuropsychological disorders. Methods: 236 participants (105 female), mean (SD) age 43.1 (16.5), received 15.7 (4.8) HIRREM sessions over 22.6 (18.2) days, (9.3 (3.4) days with sessions). Brachial BP and insomnia score (ISI) were collected before, and 14.0 (14.0) days after HIRREM completion. Paired t-tests were performed. Results: Before HIRREM, participants were divided in the following groups based on ACC/AHA 2017 BP guidelines, normal n=78, elevated n=36, stage 1 n=50, stage 2 n=57, stage 3 n=14 and crisis n=2. There were no changes in medications throughout the study duration. The use of HIRREM was associated with significant reduction in systolic BP (from 126.1 (19.0) to 123.5 (17.0) mmHg, p=0.007), and diastolic BP (from 75.3 (10.6) to 73.0 (9.0) mmHg, p<0.001), with no change in heart rate. Many participants moved to lower BP stage after V2 with the number of participants within normal BP at V2 increasing from 78 to 88. ISI score decreased from 13.2 (7.2) to 6.7 (5.6), p<0.0001. This change met the clinically meaningful drop in ISI of 6 points or more. Conclusion: These data provide evidence of significant benefits of adding a closed-loop therapy for blood pressure reduction and improving sleep. Further studies are indicated to better define the role of this promising intervention to improve sleep, depression, anxiety, and cardiovascular outcomes.

Insomnia is associated with worry, cognitive avoidance and low academic engagement in Argentinian university students during the COVID-19 social isolation

ABSTRACT An increment in mental health problems related to social isolation strategies was evinced in several populations, however few investigations address this problem in students. This study aimed to analyze the relationship between insomnia, worry, coping strategies, and academic engagement in subjects pursuing a university degree in Argentina during the first month of compulsory social isolation against the COVID-19 pandemic. Self-report online questionnaires were administered to 584 participants: Insomnia Severity Index, Penn State Worry Questionnaire, Coping Responses Inventory, Utrecht Work Engagement Scale for Students. Demographic data was recorded. Statistics included bivariate and multivariate techniques. Prevalences of 45% for subthreshold insomnia, 23% for moderate insomnia, and 4% for severe insomnia were found. The severe insomnia group presented higher levels of worry and cognitive avoidance strategies. Insomnia was also associated with daytime concerns. The group without insomnia was more vigorous in their academic engagement. Being physically active was associated with lower sleep problems. Insomnia prevalence is high in socially isolated university students. Cognitive avoidance coping strategies are associated with worry, which leads to an alert state that makes sleep difficult. These findings should be taken into account by academic institutions to define their pedagogic strategies.

The Natural History of Insomnia: the incidence of acute insomnia and subsequent progression to chronic insomnia or recovery in good sleeper subjects.

The primary aim of the present study was to estimate the incidence per annum of acute insomnia and to what extent those that develop acute insomnia recover good sleep or develop chronic insomnia. Unlike prior studies, a dense-sampling approach was used here (i.e. daily diaries) and this allowed for a more precise detection of acute insomnia and the follow-on states (the transitions to either recovery or chronic insomnia). Good sleeper subjects (n = 1,248; 67% female) that were at least 35 years old participated in this prospective study on the natural history of insomnia. Subjects were recruited nationwide and completed online assessments for 1 year. The online measures consisted primarily of daily sleep diaries, as well as weekly/bi-weekly and monthly measures of sleep, stress, and psychological and physical health. The 1-year incidence rate of acute insomnia was 27.0% (n = 337). The incidence rate of chronic insomnia was 1.8% (n = 23). Of those that developed acute insomnia, 72.4% (n = 244) went on to recover good sleep. 19.3% (n = 65) of the acute insomnia sample continued to experience persistent poor sleep, but did not meet criteria for chronic insomnia. The incidence rate of acute insomnia (3 or more nights a week for between 2 and 12 weeks) is remarkably high. This said, most incident cases resolve within a few days to weeks. Incident chronic insomnia only occurs in about 2 in 100 individuals.

PREDICTORS OF INSOMNIA IN INDIVIDUALS WITH MILD COGNITIVE IMPAIRMENT

Insomnia is a common disorder that affects up to 40% of people age 65 and older. Untreated insomnia can decrease quality of life, increase healthcare use, and exacerbate cognitive problems. Individuals with cognitive impairment experience more sleep disorders than those without cognitive concerns, yet little is known about insomnia and mild cognitive impairment (MCI). Our objective was to examine predictors of insomnia in persons with MCI (PwMCI). Using data from the National Alzheimer’s Coordinating Center Uniform Data Set, a cross-sectional study of older PwMCI was conducted. Independent sample t-tests and contingency tables with chi-square tests of independence were used to examine differences between PwMCI with and without insomnia. Multivariate binary logistic modeling was performed. The total sample (N=1543) was comprised of 234 (15.1%) with clinician-reported insomnia and 1309 (84.9%) without insomnia. PwMCI and insomnia were more likely to be younger, take more medications, and smoke cigarettes (p.05). Three variables significantly predicted insomnia in PwMCI subjects in a multivariate model: active depression (OR 1.66, 95%CI 1.21, 2.27), active anxiety (OR 2.16, 95%CI 1.57, 2.99) and arthritis (OR 1.78, 95%CI 1.33, 2.39). Differences in predictors of insomnia in PwMCI highlight the need for geriatric and mental health specialists to provide specialized care to this population. Future studies should examine conversion of PwMCI with insomnia to dementia and the compounding effects of insomnia on cognition.

Randomized, Placebo-Controlled Trial of Ferrous Sulfate to Treat Insomnia in Children With Autism Spectrum Disorders

BackgroundInsomnia and low iron stores are common in children with autism spectrum disorders, and low iron stores have been associated with sleep disturbance. MethodsWe performed a randomized placebo-controlled trial of oral ferrous sulfate to treat insomnia in children with autism spectrum disorders and low normal ferritin levels. Twenty participants who met inclusion criteria and whose insomnia did not respond to sleep education were randomized to 3 mg/kg/day of ferrous sulfate (n = 9) or placebo (n = 11) for three months. ResultsIron supplementation was well tolerated, and no serious adverse events were reported. Iron supplementation improved iron status (+18.4 ng/mL active versus −1.6 ng/mL placebo, P = 0.044) but did not significantly improve the primary outcome measures of sleep onset latency (−11.0 minutes versus placebo, 95% confidence interval −28.4 to 6.4 minutes, P = 0.22) and wake time after sleep onset (−7.7 minutes versus placebo, 95% confidence interval −22.1 to 6.6 min, P = 0.29) as measured by actigraphy. Iron supplementation was associated with improvement in the overall severity score from the Sleep Clinical Global Impression Scale (−1.5 points versus placebo, P = 0.047). Changes in measures of daytime behavior did not differ between groups. ConclusionThis trial demonstrated no improvement in primary outcome measures of insomnia in subjects treated with ferrous sulfate compared with placebo. Interpretation was limited by low enrollment.

0905 Reduced Sleep Duration Moderates Alcohol Use in Risky Situations in a Treatment Seeking Sample

Increased alcohol consumption has been linked to insufficient sleep duration and insomnia in subjects with/without alcohol use disorder (AUD). However, little information exists on the underlying reasons for alcohol consumption in those with insufficient sleep duration and insomnia symptoms in those with AUD. The primary aim of this investigation was to evaluate the association between alcohol consumption situations and habitual sleep duration in patients with alcohol use disorder. We analyzed baseline cross-sectional data from a treatment study of AUD patients (N=182). The Inventory of Drug-Taking Situations (IDTS) was used to assess reasons for alcohol consumption over the past year. Habitual sleep duration over the last 4 weeks was assessed using questions 4 from the Pittsburgh Sleep Quality Index. Alcohol consumption was assessed using the Time Line Follow Back interview. Linear regression analyses were used to assess the relationships between the IDTS reasons and sleep-related variables. Significant associations were further assessed in multivariable models adjusted for alcohol consumption, age, race and gender. The mean age was 42.2 years (SD=11.2), 67.3% were male and 93.7% were Caucasian. The mean habitual sleep duration was 5.9 hours (SD=1.5) with 39.9% reporting short sleep duration (<6 hours/night). About 34.4% (N=64) subjects reported difficulty falling asleep within 30 minutes in the 4 weeks. They drank on 49% (SD=27) of the days at baseline and nearly all of these drinking days were heavy drinking days [mean of 45(SD=27.5)]. Bivariate analyses demonstrated significant associations between IDTS reason-2 (physical discomfort) (β=-3.3; p=0.004) as well as IDTS reason-4 (difficulty with personal control) and sleep duration (β=-3.4; p=0.01). In multivariable models adjusted for covariates, sleep duration remained a significant predictor for IDTS item 2 (β= -2.4, t=-2.0; p=0.04) and item 4 (β=-3.1; p=0.04). A significant proportion of treatment seeking patients with AUD report short sleep duration and difficulty initiating sleep. Insufficient sleep duration appears to moderate alcohol use in situations of loss of control and discomfort and may be a risk factor for maintaining alcohol consumption. None

Insomnia symptoms predict emotional dysregulation, impulsivity and suicidality in depressive bipolar II patients with mixed features

IntroductionInsomnia symptoms are very common in Bipolar Disorder. Our aim was to assess the potential association between insomnia, emotion dysregulation and suicidality in subjects with Bipolar Disorder. MethodsSeventy-seven subjects with Bipolar Disorder type II with a depressive episode with mixed features were recruited. Patients were assessed with SCID-DSM-5, the Insomnia Severity Index (ISI), the Difficulties in Emotion Regulation Scale (DERS), the Scale for Suicide Ideation (SSI) while evaluating manic and depressive symptoms. ResultsSubjects with insomnia symptoms compared to those without showed higher scores in the DERS scale and subscales, including impulsivity, and in the SSI scale. Insomnia symptoms significantly predicted the severity of depressive symptoms, emotion dysregulation, and suicidality in subjects with bipolar disorder. In particular, insomnia was related to difficulties in some areas of emotion regulation including impulsivity. Emotion dysregulation significantly mediated the association between insomnia and depressive symptoms (Z = 2.9, p = 0.004). Furthermore, emotional impulsivity mediated the association between insomnia symptoms and suicidality (Z = 2.2, p = 0.03). ConclusionIn our study, subjects with bipolar disorder suffering from insomnia experienced a greater severity of depressive symptoms and suicidality compared to subjects without insomnia. Insomnia was associated with emotion dysregulation, impulsivity and suicidality. Further research is necessary to investigate if these latter features may benefit from early insomnia treatment in subjects with bipolar disorder.

Prevalence and risk factors of moderate to severe obstructive sleep apnea syndrome in insomnia sufferers: a study on 1311 subjects

BackgroundSeveral studies have investigated the prevalence and risk factors of insomnia in subjects with obstructive sleep apnea syndrome. However, few studies have investigated the prevalence and risk factors for obstructive sleep apnea syndrome in insomnia sufferers. Thus, the aim of this study was to examine the prevalence and risk factors of moderate to severe obstructive sleep apnea syndrome in a large sample of insomnia sufferers.MethodsData from 1311 insomnia sufferers who were recruited from the research database of the sleep laboratory of the Erasme Hospital were analysed. An apnea-hypopnea index of ≥15 events per hour was used as the cut-off score for moderate to severe obstructive sleep apnea syndrome. Logistic regression analyses were conducted to examine clinical and demographic risk factors of moderate to severe obstructive sleep apnea syndrome in insomnia sufferers.ResultsThe prevalence of moderate to severe obstructive sleep apnea syndrome in our sample of insomnia sufferers was 13.88%. Multivariate logistic regression analysis revealed that male gender, snoring, excessive daytime sleepiness, lower maintenance insomnia complaint, presence of metabolic syndrome, age ≥ 50 & <65 years, age ≥ 65 years, BMI ≥ 25 & <30 kg/m2, BMI >30 kg/m2, and CRP >7 mg/L were significant risk factors of moderate to severe obstructive sleep apnea syndrome in insomnia sufferers.ConclusionModerate to severe obstructive sleep apnea syndrome is a common pathology in insomnia sufferers. The identification of these different risk factors advances a new perspective for more effective screening of moderate to severe obstructive sleep apnea syndrome in insomnia sufferers.

Associations of impaired sleep quality, insomnia, and sleepiness with epilepsy: A questionnaire-based case-control study.

The purpose of this study was to document the frequency of sleep problems including poor sleep quality, excessive daytime sleepiness, and insomnia in subjects with epilepsy compared with healthy controls and to determine the factors associated with these sleep disturbances. We recruited 180 patients with epilepsy (age: 43.2 ± 15.6 years, men: 50.0%) and 2836 healthy subjects (age: 44.5 ± 15.0 years, men: 49.8%). Sleep and the anxiety/mood profiles were measured using the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Insomnia Severity Index, Goldberg Anxiety Scale, and Patient Health Questionnaire-9 depression scale. Associations of sleep problems with epilepsy and other factors were tested by multiple logistic regression analysis, adjusted for age, gender, body mass index, alcohol intake, smoking, perceived sleep insufficiency, and habitual snoring. Sleep disturbances were more common in the group with epilepsy than in the controls (53.3% vs. 25.5%; p<0.001). Poor sleep quality, excessive daytime sleepiness, and insomnia were significantly associated with epilepsy (odds ratio [95% confidence interval]: 3.52 [2.45-5.05], 2.10 [1.41-3.12], 5.91 [3.43-10.16], respectively). Depressive mood, anxiety, and perceived sleep insufficiency contributed to the presence of sleep disturbances. In the group with epilepsy, seizure remission for the past year related to a lower frequency of insomnia, whereas age, sex, type of epilepsy, and number of antiepileptic drugs were not correlated with sleep problems. Epilepsy was significantly associated with the higher frequency of sleep disturbances, which supports the importance of screening sleep problems in patients with epilepsy and providing available intervention.

Insomnia in alcohol dependent subjects is associated with greater psychosocial problem severity

IntroductionAlthough psychosocial problems are commonly associated with both alcohol misuse and insomnia, very little is known about the combined effects of insomnia and current alcohol dependence on the severity of psychosocial problems. The present study evaluates whether the co-occurrence of insomnia and alcohol dependence is associated with greater psychosocial problem severity. MethodsAlcohol dependent individuals (N=123) were evaluated prior to participation in a placebo-controlled medication trial. The Short Index of Problems (SIP), Addiction Severity Index (ASI), Insomnia Severity Index (ISI), and Time Line Follow Back (TLFB), were used to assess psychosocial, employment, and legal problems; insomnia symptoms; and alcohol consumption, respectively. Bivariate and multivariate analyses were used to evaluate the relations between insomnia and psychosocial problems. ResultsSubjects' mean age was 44years (SD=10.3), 83% were male, and their SIP sub-scale scores approximated the median for normative data. A quarter of subjects reported no insomnia; 29% reported mild insomnia; and 45% reported moderate-severe insomnia. The insomnia groups did not differ on alcohol consumption measures. The ISI total score was associated with the SIP total scale score (β=0.23, p=0.008). Subjects with moderate–severe insomnia had significantly higher scores on the SIP total score, and on the social and impulse control sub-scales, and more ASI employment problems and conflicts with their spouses than others on the ASI. ConclusionIn treatment-seeking alcohol dependent subjects, insomnia may increase alcohol-related adverse psychosocial consequences. Longitudinal studies are needed to clarify the relations between insomnia and psychosocial problems in these subjects.

Safety analysis of zolpidem in elderly subjects 80 years of age or older: adverse event monitoring in Japanese subjects

Objectives: Prescriptions of non-benzodiazepine sedative hypnotics, e.g. zolpidem, for insomnia in elderly subjects 80 years of age or older have markedly increased in the USA. However, a meta-analysis of the risks and benefits of hypnotics in older people reported the benefits associated with hypnotics use are outweighed by the risks. This study aimed to investigate the safety of zolpidem administration in extremely old elderly.Methods: The prevalence of adverse reactions to zolpidem was investigated in a subpopulation of participants in the Drug Event Monitoring project of the Japan Pharmaceutical Association. A total of 1011 (316 males and 695 females) zolpidem users, including 261 (25.8%) subjects 80 years of age or older without cognitive or mental complications, were eligible for the analysis.Results: The elderly and female patients were prescribed significantly lower doses of zolpidem than their counterparts. Adverse symptoms after the last prescription were reported by 60 (5.9%) subjects. The most common symptoms were impaired balance and/or falls (1.8%) and morning drowsiness (1.3%). The multiple logistic regression analyses showed that subjects 80 years of age or older were at lower risk of adverse symptoms (odds ratio 0.39, 95% confidence intervals: 0.17–0.88).Conclusion: Our findings in a real-world clinical setting suggest that low-dose zolpidem can be safely prescribed to subjects 80 years of age or older without cognitive or mental complications.

A single-dose, randomized, double-blind, double dummy, placebo and positive-controlled, five-way cross-over study to assess the pharmacodynamic effects of lorediplon in a phase advance model of insomnia in healthy Caucasian adult male subjects.

A 5-h phase advance model of insomnia was used to evaluate the efficacy of lorediplon, a new non-benzodiazepine hypnotic. Thirty-five male, healthy subjects were included in a five-way randomized cross-over study. During each of the periods, sleep was recorded, and residual effects were measured. All subjects received lorediplon 1, 5, and 10 mg, placebo, and zolpidem 10 mg (i.e., active control). Polysomnographic evaluation revealed that lorediplon (5 and 10 mg) significantly decreased wake after sleep onset (WASO) and increased total sleep time. Analysis by quarters of the night showed a progressive increasing effectiveness of lorediplon 10 mg across the first three quarters. Lorediplon increased non-rapid eye movement slow wave sleep and stage N2 sleep in the second and third quarters. The magnitude of these effects was dose related, with minimal effects seen with 1 mg. No residual effects were observed 13 h post dose. Lorediplon demonstrated a dose-dependent improvement in sleep, whereas zolpidem showed a more sustained WASO effect. No next-day hangover effects were observed. These sleep effects are also consistent with the pharmacokinetic profile of lorediplon. These results warrant clinical trials in patients with insomnia.

Validation of the Japanese version of the Ford Insomnia Response to Stress Test and the association of sleep reactivity with trait anxiety and insomnia

ObjectiveOur study was conducted to validate the Japanese version of the Ford Insomnia Response to Stress Test (FIRST-J) and to clarify the association of the measure with trait anxiety and insomnia in healthy subjects and insomnia patients. MethodsWe studied 161 healthy subjects and 177 insomnia patients who completed the FIRST-J, Pittsburgh Sleep Quality Index (PSQI), Athens Insomnia Scale (AIS), and State-Trait Anxiety Inventory-Trait (STAI). The healthy subjects and the insomnia patients were classified, respectively, into two groups with high FIRST-J and low FIRST-J scores (divided by the median value of healthy subjects). ResultsCronbach α coefficients of the FIRST-J in the insomnia patients and healthy subjects were 0.89 and 0.87, respectively. Factor analysis revealed that the FIRST-J had a single-factor structure. The FIRST-J score significantly correlated with all other measures in the healthy subjects, though the score only correlated with the score of the STAI in the insomnia patients. The healthy subjects with high FIRST-J scores showed higher scores of the AIS and STAI than those with low FIRST-J scores. Furthermore, insomnia patients had a higher total score of the FIRST-J than the healthy subjects. ConclusionsThe FIRST-J is an important tool for assessing vulnerability to insomnia.

The association of insomnia with gastroesophageal reflux symptoms in biopsy-proven nonalcoholic fatty liver disease

It is suggested that nonalcoholic fatty liver disease (NAFLD), including nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH), can be associated with insomnia and gastro-esophageal reflux disease (GERD). The relationship between GERD and insomnia in subjects with biopsy-proven NAFLD was investigated. This study enrolled 123 patients with biopsy-proven NAFLD. Insomnia was assessed by the Athens Insomnia Scale (AIS), a self-assessment psychometric instrument designed to quantify sleep difficulty based on ICD-10 criteria; AIS scores ≥ 6 were considered positive for insomnia. GERD symptoms were evaluated using a frequency scale for the symptoms of GERD (FSSG); FSSG scores ≥ 8 were considered positive. Logistic regression models were used to evaluate the association of insomnia with GERD, after adjusting for potential confounders. Thirteen patients with GERD were treated with the proton pump inhibitor rabeprazole (RPZ; 10 mg/day), for 12 weeks. Of the 123 patients, 76 (62%) were female and 87 (71%) were obese, with 34 (28%) having AIS scores ≥ 6 and 31 (25%) having FSSG scores ≥ 8. Liver biopsy revealed that 40 patients (33%) had NAFL and 83 (67%) had NASH. FSSG and AIS scores were similar in the two groups. HOMA-IR, FSSG scores and γGT (GGT) concentrations were significantly higher in insomniacs than in non-insomniacs. Logistic regression analysis demonstrated that FSSG score and GGT concentration were independently associated with insomnia. RPZ treatment resulted in significantly reductions in both AIS and FSSG scores. Nearly 30% of patients with biopsy-proven NAFLD had insomnia, which was related to GGT and GERD and could be relieved by RPZ treatment.

Prevalence and polysomnographic correlates of insomnia comorbid with medical disorders.

To determine the prevalence and polysomnographic correlates of insomnia in subjects with self-reported medical disorders. Prospective cross-sectional study. Community-based sample of 3282 men and women aged 18 to 65 years old, with a subset who underwent polysomnography. Self-reported measures of sleep habits and current health, and polysomnographic sleep variables. The prevalence of insomnia was 21.4%. The adjusted odds of insomnia were 2.2 times as high in persons with any medical disorders as in those without medical disorders. Specifically, odds of insomnia were higher in people with heart disease (OR = 1.6 [95% CI: 1.2-23], P = 0.004), hypertension (1.5 [12-18], P < 0.001), diabetes (1.4 [105-20], P = 0.04), stomach ulcers (2.1 [1.6-2.7], P < 0.001), arthritis (1.8 [1.5-2.2], P < 0.001), migraine (1.8 [1.5-2.1], P < 0.001), asthma (1.6 [1.3-2.0], P = 0.04), COPD (1.9 [1.5-2.5], P < 0.001), neurological problems (2.0 [1.5-2.7], P < 0.001), and menstrual problems (1.7 [1.3-2.1], P < 0.001) than in people without these disorders. Prevalence of insomnia increased with increasing number of medical disorders. However, polysomnographic sleep was not significantly different in persons with or without medical disorders for most disorders assessed. This large population-based study suggests that insomnia is highly prevalent in diverse chronic medical disorders. However, polysomnographic evidence of disturbed sleep is present in only a subset of comorbid insomnia populations.

Gender differences in insomnia and the role of paid work and family responsibilities

A higher prevalence of insomnia in females has been consistently demonstrated across countries and cultures. The aim of this study was to clarify whether gender differences in insomnia could be explained by gender differences in paid work and family responsibilities. Participants were employees at two local governments in Hokkaido, Japan, who underwent annual health checkups from April 2003 to March 2004. All data were obtained via self-administered questionnaires. Insomnia was evaluated by the Athens Insomnia Scale. For work and family characteristics, occupation, working hours, days off, shift work, visual display terminal (VDT) work, occupational stress, marital status, hours spent on household tasks, childcare, and caregiving were chosen. Data from 7,451 participants (5,951 men and 1,500 women) were analyzed. Logistic regression analysis examined how much paid work and family responsibilities explained gender differences in insomnia. The prevalence of insomnia in female subjects (31.0%) was significantly larger than in males (23.2%), but the gender difference disappeared after adjustment for paid work and family responsibilities. The results of stratified analyses revealed that significant gender differences were found only among workers with comparatively favorable work and family conditions, such as non-shift work, less than 6h/day of VDT work, exposure to low levels of occupational stress, household tasks for less than 1h/day, and not living with persons who needed care and support. These results suggest that gender differences in insomnia are explained, in the main, by gender differences in work and family characteristics.

Zolpidem withdrawal delirium

The Z-category hypnotics are promoted for their relative safety. However, this view is challenged by the emerging clinical evidence in the form of zolpidem related intoxication delirium and seizures, and dependence and complicated withdrawal. We report the case of a zolpidem-naive alcohol-dependent inpatient that, while undergoing alcohol de-addiction, was prescribed zolpidem for insomnia and developed delirium during taper-off. He was successfully detoxified for alcohol, treated for delirium and put on disulfiram prophylaxis. The case highlights the need for being cautious while using zolpidem for insomnia in alcohol dependent subjects.