Total Insomnia Severity Index Score Research Articles

The Role of Smartphone Addiction as a Mediator between Psychological Resilience and Insomnia in Medical Students at a University.

To explore the mediating effect of smartphone addiction between psychological resilience and insomnia among university students. This study included 581 clinical medical students from the Dalian Medical University, enrolled between September 2020 and May 2023. The Smartphone Addiction Scale (SAS-SV), Insomnia Severity Index (ISI), and Connor-Davidson Resilience Scale (CD-RISC) were used to assess smartphone addiction, insomnia, and psychological resilience among the students. The Process macro and Bootstrap methods were employed to analyze the mediating effect of smartphone addiction between psychological resilience and insomnia. The detection rate of smartphone addiction was 28.06% (163/581), and the detection rate of insomnia was 26.17% (152/581). The total SAS-SV score was 27.60 ± 14.27, the total ISI score was 6.60 ± 5.33, and the total CD-RISC score was 72.86 ± 6.88. There was a significant negative correlation between the total CD-RISC score and the total SAS-SV score (r = -0.4129, P < .0001), and a significant negative correlation between the total CD-RISC score and the total ISI score (r = -2.942, P < .0001). The total SAS-SV score and the total ISI score were significantly positively correlated (r = 0.5687, P < .0001). Psychological resilience was used as the independent variable, insomnia as the dependent variable, and smartphone addiction as the mediating variable in the mediation effect analysis. Psychological resilience negatively predicted insomnia (β = -0.0940, P < .0001), smartphone addiction positively predicted insomnia (β = 0.1564, P < .0001), and smartphone addiction mediated the relationship between psychological resilience and insomnia (effect value = -0.1339, 95% CI: -0.1680 to -0.1034), with an effect size of 58.75%. Psychological resilience directly affects insomnia and also indirectly affects insomnia through the mediating effect of smartphone addiction.

Effects of insomnia on symptomatic dry eye during COVID-19 in China: An online survey.

Sleep is an essential determinant of health and quality of life. This study aimed to evaluate sleep disorders and symptomatic dry eye (DE) occurrence. This study was a cross-sectional survey of 1393 participants in China. The insomnia severity index (ISI) Questionnaire was used to evaluate sleep quality, and the ocular surface disease index (OSDI) questionnaire was used to assess DE symptoms. Subjects were divided into 2 groups based on subjects with and without symptomatic DE. The patients who had DE (10.48 ± 7.27) had substantially lower ISI scores compared to those without DE (3.57 ± 5.10) (P = .003). Furthermore, each ISI item and total ISI score was significantly correlated with OSDI dry eye severity and total OSDI dry eye score. Higher prevalence of insomnia was found in participants with symptomatic DE, and insomnia correlated significantly with DE symptoms. The present results suggest that clinicians and healthcare workers need to remember that DE and insomnia are highly co-existing health issues.

0651 Sleep Reactivity as a Vulnerability Factor for Depressive Symptoms

Abstract Introduction Insomnia and depression are closely linked. While poor sleep is often classified as a symptom of depression, research now supports that insomnia often precedes and predicts the onset of depression. One factor that may explain this relationship is sleep reactivity, or the tendency to experience sleep disturbances in response to stressful life events. Sleep reactivity is considered a vulnerability factor for insomnia. This study aimed to replicate recent findings that suggest sleep reactivity is also independently related to depression. Methods Survey data was collected from 236 U.S. adults (69.1% White, 61.9.3% Female, 18-85 y) regarding demographic information, sleep patterns, and general health and well-being. Depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale (CESD). Insomnia symptoms were assessed using the Insomnia Severity Index (ISI). Sleep reactivity was assessed using the Ford Insomnia Response to Stress Test (FIRST). A hierarchical multiple regression was conducted with total CESD scores as the dependent variable. Total ISI scores and gender were entered as covariates in model 1 and total FIRST scores as the predictor variable in model 2. Results The fitted regression for model 1 was statistically significant (R2 = 0.37, F(2,233) = 64.47, p &amp;lt; .001). It was found that both greater ISI and being female gender predicted depression scores (β = 1.04, p &amp;lt; .001, and β = 1.64, p = .05). For model 2, the regression was also significant (R2 = 0.38, F(3,232) = 47.60, p &amp;lt; .001). Greater FIRST scores were related to greater depressive symptoms (β = 0.23, p = .02), even after controlling for both insomnia symptoms and gender. Conclusion Sleep reactivity is independently related to depression symptoms, independent of insomnia. Future studies examining how multiple types of stress reactivity impact an individual’s risk for developing depression should be considered. Support (if any) K23 HL141581

Prevalence of Insomnia and Associated Factors Among Medical Students Who Recovered From Acute COVID-19 Infection (P2-13.004)

<h3>Objective:</h3> This study aimed to investigate the prevalence of insomnia in medical students who recovered from acute COVID-19 infection and to evaluate the extent of its impact. <h3>Background:</h3> One of the most important health consequences of the COVID-19 pandemic is the prevalence of sleep-related issues, specifically insomnia. Under normal conditions, medical students are at high risk of problems associated with poor sleep quality. For this reason, we hypothesized that sleep disturbances have the potential to be amplified in medical students who recovered from acute COVID-19 infection. <h3>Design/Methods:</h3> A cross-sectional study was conducted from June to September 2022 among medical students who had recovered from acute COVID-19 infection. Data was collected through a survey with questions on sociodemographic aspects, health habits, and COVID-19 history. Insomnia severity and subjective sleep quality were measured using the Insomnia Severity Index (ISI) and the Pittsburgh Sleep Quality Index (PSQI) questionnaires. <h3>Results:</h3> A total of 117 students were included in the study. Their mean age was 21.8 ± 1.96 years (ranging from 18 to 28), and 58.1% were female. 65% of medical students demonstrated some degree of insomnia (Total ISI score ≥8) further categorized as sub-threshold or mild (39.3%), moderate (24.8%), and severe (0.9%). 78.6% of the students reported some degree of sleep difficulty (PSQI ≥5). A statistically significant association was found between students with a history of symptomatic COVID and sleep quality. The correlation coefficient between the PSQI and ISI was 0.679, <i>p</i> &lt;0.001. Significant correlations were found between self-reported physical health, emotional health, and questionnaire scores. <h3>Conclusions:</h3> The prevalence of insomnia among Ecuadorian medical students that recovered from acute COVID-19 infection is significantly high. Specific interventions should be considered to provide sleep health education, cognitive behavioral therapy for insomnia, meditation, and wellness activities to identify and manage sleep issues in medical students. <b>Disclosure:</b> Mr. Gruezo has nothing to disclose. Miss Chango has nothing to disclose. Miss Jaramillo Castro has nothing to disclose. Mr. ROSERO BASURTO has nothing to disclose. Mr. Viñan Paucar has nothing to disclose. Mr. Paredes has nothing to disclose. Mr. Jara Escobar has nothing to disclose. Dr. Bejar has nothing to disclose. Dr. Jimenez Zambrano has nothing to disclose.

Insomnia Severity Index: A reliability generalisation meta-analysis.

The aim of the current study was to conduct a reliability generalisation (RG) meta-analysis of Cronbach's alpha for the Insomnia Severity Index (ISI). A systematic search of three databases (PubMed, Scopus, and Web of Science) from inception to 12 March 2021 was performed. Publications that reported Cronbach's alpha for the total ISI score were included. Only psychometric-focussed studies were considered. Meta-analysis was carried out using a random-effects model to derive a pooled estimate of Cronbach's alphas. The number of participants in the included publications ranged from 25 to 12,056, with 33 studies (42 estimates) comprising internal consistency coefficients, and a combined sample size of N=29,688. The age range of the included publications was from 13.4 to 74.3 years. Data extraction implied 33 publications out of 706 found through the database search. Cronbach's alphas ranged from 0.65 to 0.92. The majority of the reported coefficients were ≥0.7 and presented a low risk of bias (n=32). The pooled alpha coefficient was 0.83 (IC [0.81-0.85]; SE=0.009) with high heterogeneity among the included publications (I2 =97%). Subgroup analyses including moderators such as continent, setting, risk of bias, and age did not affect significantly the overall result. In general, the cumulative estimate of Cronbach's alpha for the ISI is good. However, this finding should be interpreted with caution since there is a high heterogeneity level and some of the studies might not have checked the assumptions underlying Cronbach's alphas.

The impact of sleep–wake problems on health-related quality of life among Japanese nursing college students: a cross sectional survey

AimThis study was conducted to examine the impact of sleep–wake problems on health-related quality of life of Japanese nursing college students. MethodsThis cross-sectional study was conducted in 2019 on 150 third and fourth-year nursing college students from two locations in Japan. Insomnia severity was assessed using the Insomnia Severity Index (ISI) and health-related quality of life using the SF-8 questionnaire. The total sleep time (TST) was divided into 3 groups: < 6 h, 6–7 h (reference), and ≥ 7 h. The total ISI score was divided into 2 groups: ≥ 8 points and < 8 points (reference). Logistic regression analysis was performed to evaluate sleep–wake problems related to decline in mental health.ResultsThe median mental health indicated in the SF-8 questionnaire was divided into two groups, and the factors causing decline in mental health were investigated. The odds ratios (95% confidence interval) for adjusted ISI ≥ 8 and TST on weekdays < 6 h was 6.51 (2.96–14.30) and 3.38 (1.40–8.17), respectively. Mental health status was significantly lower when ISI ≥ 8 and even lower when TST < 6 h.ConclusionInsomnia and short sleep duration are associated with decreased mental health status in nursing college students. Many tended to lack sleep on weekdays. Sleep–wake problems identified while in university should be comprehensively dealt with.

Cross-sectional survey following a longitudinal study on mental health and insomnia of people with sporadic COVID-19.

BACKGROUNDIn the post-pandemic era, the emergence of sporadic cases of coronavirus disease 2019 (COVID-19) and the scale of the pandemic are unpredictable. Therefore, the impact of sporadic cases of COVID-19 and isolation measures on mental health and sleep in different groups of people need to be analyzed. AIMTo clarify the severity of psychological problems and insomnia of staff and community residents around a hospital with sporadic cases of COVID-19, and their relationship with quarantine location and long-term changes.METHODSA cross-sectional survey was conducted on community residents and medical staff. Many of these medical staff had been subjected to different places of quarantine. Community residents did not experience quarantine. Hospital anxiety and depression scale (HADS), acute stress disorder scale (ASDS) and insomnia severity index (ISI) were used to evaluate anxiety and depression, acute stress disorder symptoms, and the severity of insomnia. Additionally, we conducted a 1-year follow-up study on medical staff, with related scales measurement immediately after and one year after the 2-wk quarantine period.RESULTSWe included 406 medical staff and 226 community residents. The total scores of ISI and subscale in HADS of community residents were significantly higher than that of medical staff. Further analysis of medical staff who experienced quarantine showed that 134 were quarantined in hotels, 70 in hospitals and 48 at home. Among all subjects, the proportions of HADS, ASDS and ISI scores above normal cutoff value were 51.94%, 19.17% and 31.11%, respectively. Multivariable logistic regression analysis found that subjects with higher total ASDS scores had a greater risk to develop anxiety and depression. The total ISI score for medical staff in hotel quarantine was significantly higher than those in home quarantine. Total 199 doctors and nurses who completed the 1-year follow-up study. Compared with baseline, HADS and ASDS scores decreased significantly one year after the end of quarantine, while ISI scores did not change significantly. CONCLUSIONSporadic COVID-19 cases had a greater psychological impact on residents in surrounding communities, mainly manifested as insomnia and depressive symptoms. Hotel quarantine aggravated the severity of insomnia in medical staff, whose symptoms lasted ≥ 1 year.

0688 Insomnia Symptom Severity Predicts Greater Alcohol Use During the COVID-19 Pandemic: A Longitudinal Study

IntroductionIndividual stress levels undeniably increased following the start of the COVID-19 pandemic. Not surprisingly, sleep problems, including insomnia, have intensified during the pandemic due to the increase in overall stress levels. The impact that greater insomnia has had on other health outcomes, for example problematic drinking, has yet to be examined. Therefore, the aim of the present study was to assess whether greater insomnia symptom severity predicted future alcohol use patterns (i.e., frequency and severity).MethodsThe study used data from a nationwide sample of 2,979 who were surveyed at two different points during the COVID-19 pandemic (T1 = initial months after the start of the pandemic [April – June 2020]; T2 = 10-12 months later). Of those, 1,971 adults (mean age = 46.0 years; 80% women) reported having had an alcoholic beverage during the past 3 months and were included in the subsequent analyses. Insomnia symptom severity was assessed at both time points using the Insomnia Severity Index (ISI). Self-reported alcohol frequency (i.e., days per week) and severity (i.e., drinks per day) were assessed at T2.ResultsAt T2, participants reported drinking alcoholic beverages (mean ± standard deviation) 2.7 ± 2.1 days during a typical week and drinking 1.8 ± 1.1 alcoholic beverages on days they did drink. According to results from separate multiple regression analyses, where T1 ISI scores were entered as the independent variable and alcohol frequency and severity were entered as the dependent variables, total ISI scores at T1 were associated with less frequent (β = -0.075, p = .001) but more severe drinking patterns (β = .088, p < .001). These associations remained significant while controlling for current insomnia symptom severity.ConclusionBaseline insomnia symptom severity was a predictor of future alcohol use patterns. Specifically, people with greater insomnia at T1 reported, on average, less frequent drinking (i.e., fewer days per week), yet greater consumption on days that they did drink alcohol. These data highlight the importance of assessing the impact that insomnia has had (and continues to have) on other behavioral health outcomes during the ongoing pandemic.Support (If Any)K23HL141581 (PI: Vargas); R25HL10544 (PI: Jean-Louis); K24AG055602 (PI: Perlis)

The impact of COVID-19 infection on the quality of life of healthcare workers

AbstractObjectivesCOVID-19 pandemic has negatively affected the entire world and one of its impacts was the increased level of stress and anxiety, especially among healthcare workers. Therefore, this study aims at evaluating the quality of life (QoL) and sleep quality of healthcare workers in Iraq.MethodsThis study assessed the QoL and sleep quality by using World Health Organization Quality of Life Instruments (WHOQOL-BREF) and the Insomnia Severity Index (ISI), respectively. The questionnaires were administered through an online cross-sectional survey targeted at workers in medical fields in Iraq from 1st to 20th of August 2021.Key findingsThree hundred healthcare workers participated, and females constituted 75.3%. The two questionnaires had very good internal consistency. The highest scoring domain was social relationships, followed by physical health. A significant difference was found in the mean scores of psychological health domain between males and females, with higher scores observed in males. The mean of the total ISI score was 11.58 ± 6.88 with a range between 0 and 27. Severe insomnia was observed in only 9.7% of the participants. A significant negative correlation (r = −0.118) was found between age and ISI scores of the participants. Significant differences were found between males and females with higher ISI mean scores observed among males.ConclusionsThe QoL and sleep pattern can be affected by COVID-19 infection with the psychological aspect of QoL being the most affected and some degrees of insomnia being observed in many participants.

719 Insomnia in Those Diagnosed with COVID-19

IntroductionRecent meta-analyses suggest that as many as 75% of COVID-19 patients report sleep problems. Here, we sought to characterize this in terms of self-reported insomnia. We hypothesized that those endorsing a positive COVID-19 diagnosis would also report greater levels of insomnia than those with a negative diagnosis.MethodsBetween April and September 2020 we administered the Insomnia Severity Index (ISI), each month to a total of 6162 English speaking adults in the United States ranging in age from 18–84 (M=36.2 years, SD=12.1; 53.9% female), recruited from all 50 states and the District of Columbia using Amazon Mechanical Turk (MTurk) crowdsourcing platform. Data collections occurred cross-sectionally, approximately one month apart. Data were analyzed using Kruskal-Wallis H tests.ResultsIn total, 247 (4.01%) participants responded “Yes” to the question “Have you been formally diagnosed with COVID-19?” (male=128, female=119). Those reporting “yes” had a higher mean score on the ISI (M=14.52, SD=5.56) compared to reporting “no” (M=9.98, SD=6.55). Total ISI scores were higher for those who reported that they were diagnosed with COVID-19 than those that did not, χ2(1)=121.818, p=0.0001. Among those that reported that they were diagnosed with COVID-19, 57.11% had ISI scores indicating moderate to severe clinical insomnia compared to 25.42% of those who were not diagnosed with COVID-19.ConclusionThose who reported that they had been diagnosed with COVID 19 had greater insomnia compared to those without such a diagnosis. This could be due to greater stress and anxiety in those who had a positive COVID-19 diagnosis due to the many uncertainties surrounding the short and long-term prognosis as well as potential impacts on the individual’s family and workplace. However, it is important to consider the broader health picture of those diagnosed with COVID-19. This study is limited by the nature of the self-reported data, where we cannot verify a positive COVID-19 test. Causality cannot be inferred due to the cross-sectional nature of this study. Future work will need to determine the extent to which sleep-related factors are due to biological versus psychological factors associated with the diagnosis of COVID-19.Support (if any):

188 Racial Disparities in Sleep During the COVID-19 Pandemic

IntroductionThe purpose of the present study was to estimate average sleep duration and sleep disturbance in the United States during the COVID-19 pandemic. In addition, we investigated whether sleep varied as a function of sociodemographic variables, in particular race. Long standing disparities in condition and available resources between racial demographics often lead to disparities in health. At the advent of a pandemic, which strains these systems further, it is important to assess whether or not racial disparities persist. This is important given that racial groups are likely affected by the pandemic, both directly and indirectly, in various ways. Here, we plan to at least assess whether there are any disparities with regard to sleep.Methods4,048 adults (Mage = 45.8 years; 79% women) completed an online survey during April – June 2020. The final sample’s self-reported race/ethnicity consisted of 84% White, 5.1% Black, 3.4% LatinX, 4.2% Asian or Asian American, and 2.9% Multi-racial. Sleep disturbance was assessed using a retrospective sleep diary and the Insomnia Severity Index (ISI).ResultsAverage sleep duration in the sample was 7.1 hours. Participants reported taking on average 32 minutes (SD = 38 mins) to fall asleep and reported waking up for 32 minutes (SD = 53 mins) during the night. Approximately 17% of the sample endorsed clinically elevated insomnia symptoms (based on the ISI ≥ 15 cut-off). With regard to racial differences, shorter total sleep time (TST), longer sleep latencies (SL), and greater total ISI scores were observed in Black (mean TST = 6.4 hours; SL = 37.7 minutes; ISI Total = 9.8) and LatinX (mean TST = 6.9 hours; SL = 37.1 minutes; ISI Total = 9.6) participants relative to White participants (Mean TST = 7.1 hours; SL = 30.9 minutes; ISI Total = 8.4). All p’s < 0.05.ConclusionSociodemographic variables, particularly race, should be considered when estimating the relative impact of sleep on overall health. These findings are significant as they may have implications for a number of health disparities observed in the United States, especially during the COVID-19 pandemic.Support (if any)Vargas: K23HL141581

654 Potential Longitudinal Association Between COVID-19 Infection Outcomes and Insomnia Symptoms

IntroductionThe COVID-19 pandemic has had an unequivocal negative impact worldwide, including increases in stress related to social isolation, unemployment, grief, and fear of contracting the virus. This increased stress has likely led to a greater prevalence of sleep continuity disturbance (i.e., insomnia) in the general population. The goal of the present study was to assess the prevalence of sleep continuity disturbance (i.e., insomnia) in the United States during the initial months of the pandemic. In addition, longitudinal assessment is currently ongoing in order to further assess participant experiences with COVID-19. Specifically, these follow-up data will be used to assess whether, among those that contracted COVID-19, insomnia at baseline (Time 1) predicts worse outcomes (e.g., symptoms of greater frequency, duration, or severity) upon follow-up (Time 2).MethodsA national survey was conducted from April-June 2020. Participants answered questions regarding social distancing practices, mood, sleep, physical activity, and COVID-19 symptoms. Insomnia symptom prevalence and severity were estimated with a retrospective sleep diary and the Insomnia Severity Index (ISI). A follow-up assessment is currently ongoing and will be completed in March 2021. The follow-up survey consists of similar questions and additional items regarding COVID-19 testing, symptoms [frequency, duration, and severity], and outcomes [outpatient treatment, incidence and duration of hospitalization, and incidence and type of respiratory assistance].Results4,133 adults (Mage = 45.8 years; range = 18 - 86 years; 78.7% female) completed the baseline survey. The prevalence of clinically significant sleep continuity disturbance (≥ 30 minutes) was 44.6% for sleep latency problems and 36.2% for wake after sleep onset problems. Nearly 34% of subjects reported average total sleep times of less than 7 hours. Over 17% of subjects (n = 719) reported total ISI scores in the clinical range (ISI total score ≥ 15).ConclusionThe present study suggests the prevalence of clinically significant insomnia symptoms during COVID-19 remain high in the general population (17–45% depending on definition of insomnia). Similarly, the prevalence of short sleep is elevated. Whether these incident data are associated with COVID-19 outcomes remains to be determined and will be the subject of follow-up analyses in January/February 2021.Support (if any)Vargas: K23HL141581; Perlis: K24AG055602

0373 Blacks with Obstructive Sleep Apnea Report Greater Nighttime Insomnia Symptoms than Whites, but Don’t Endorse Daytime Impairment

Abstract Introduction Few studies have assessed insomnia severity in racial/ethnic minority patients with OSA. In recognition of the burden of OSA in blacks compared to whites, the current study sought to examine insomnia symptoms in a sample of black and white patients newly diagnosed with OSA, prior to treatment, at 3 and 6 months. Methods 94 patients newly diagnosed with OSA provided demographics (age, sex, race/ethnicity), socioeconomic status, and completed the well-known and validated Insomnia Severity Index (ISI). To assess insomnia complaints, we ascertained total ISI score, nighttime sleep complaints, and daytime impairment. Linear regression and repeated measures analysis were conducted. Results Mean age was 57.43 years ±13.55; 63.8% were men and 35% were black. Mean BMI was 32.35±7.04and 35% were diagnosed with hypertension. The mean ISI score for the total sample was 13.06±7.06. The total ISI was significantly higher in blacks than whites, respectively (M=15.00±7.17; M=12.02±6.83, p&amp;lt;0.05) indicating moderate clinical insomnia in blacks, but not whites. In covariate-adjusted linear regression, nighttime complaints were statistically more pronounced in blacks (b=1.71, SE=0.82, p&amp;lt;0.05) and women (b=2.05, SE=0.72, p&amp;lt;0.01). There were no significant racial/ethnic differences with daytime impairment, but gender differences in daytime impairment remained (b=2.93, SE=1.04 p&amp;lt;0.01). Results from repeated measures effects of race over time revealed that blacks had higher nighttime complaints across all time-points (b=2.51, SE=1.10, p&amp;lt;0.05), but we did not observe a race-by-time interaction effect (b=-0.89, SE=0.50). Conclusion For the first time, we observed that overall ISI score and nighttime complaints are more pronounced in blacks than whites. Notably, only women endorsed complaints of daytime impairment. Findings from the study may contribute to understanding who will need treatment for relief of insomnia complaints. Support K23HL125939

The effect of OSAS risk, excessive daytime sleepiness, insomnia severity and sleep quality on dry eye syndrome

The purpose of this study was to investigate the association between sleep disturbances and dry eye syndrome (DES). 201 patients with DES were included in this study. Tear fluid break-up time (TBUT) and Schirmer I tests were performed. Patients with DES filled out Ocular Surface Disease Index (OSDI) questionnaire. The respondents completed the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale (ESS), and the STOP-Bang questionnaire. OSDI, PSQI, ISI and ESS were recorded and compared within DES severity. The study population consisted of 87.6% (n = 176) female with age 52.33 ± 14.49 (18–80) years. The total ESS score was significantly correlated with the OSDI score (p = 0.045), although the ESS total score was not statistically correlated with the Schirmer I test and TBUT test scores (p = 0.239, p = 0.463). A positive correlation was identified between the total ISI score and the OSDI score (p = 0.001). The total ISI score was negatively correlated with the Schirmer I test and TBUT test scores (p = 0.003, p = 0.001). The total PSQI score was positively correlated with the OSDI score (p < 0.0001), and the total PSQI score was negatively correlated with the Schirmer I test and TBUT test scores (both p < 0.0001). The total STOP-Bang score was not statistically correlated with the OSDI score, or the Schirmer I test and TBUT test scores (p = 0.105, p = 0.399, p = 0.061, respectively). A relationship was found between DES and sleep disorders based on subjective questionnaires. Our finding suggests that the treatment of DES and sleep disorders with a multidisciplinary approach will lead to an increase in the quality of life of patients.

Impact of migraine on the clinical presentation of insomnia: a population-based study

BackgroundInsomnia and migraine are closely related; insomnia aggravates migraine symptoms. This study was conducted to investigate the impact of migraine on the clinical presentation of insomnia symptoms.MethodsThe data of the Korean Headache-Sleep Study (KHSS) were used in the present study. The KHSS is a nation-wide cross-sectional population-based survey regarding headache and sleep in Korean adults aged 19 to 69 years. If a participant’s Insomnia Severity Index (ISI) score ≥ 10, she/he was classified as having insomnia. The clinical presentation of insomnia symptoms was assessed using total and subcomponent scores of the ISI.ResultsOf 2695 participants, 290 (10.8%) and 143 (5.3%) individuals were assigned as having insomnia and migraine, respectively. The proportions of migraine (12.8% vs. 4.4%, p < 0.001) and non-migraine headache (59.0% vs. 39.9%, p < 0.001) were higher among individuals with insomnia compared to those without insomnia. Among participants with insomnia, total ISI scores were not significantly different among participants with migraine, non-migraine, and non-headache [median and interquartile range: 13.0 (11.0–17.5) vs. 13.0 (11.0–17.5) vs. 12.0 (11.0–16.0), p = 0.245]. ISI scores for noticeability of sleep problems to others were significantly higher among participants with migraine [3.0 (2.0–4.0) vs. 2.0 (2.0–3.0), p = 0.011] and non-migraine headache [3.0 (2.0–4.0) vs. 2.0 (2.0–3.0), p = 0.001] compared to those without headache history. Other ISI subcomponent scores did not significantly differ between headache status groups.ConclusionsParticipants with insomnia had an increased risk of migraine and non-migraine headache compared to those without insomnia. Among participants with insomnia, overall insomnia severity was not significantly influenced by the headache status.

Prospective Evaluation of Sleep Improvement Following Carpal Tunnel Release Surgery

Sleep disturbance due to nighttime awakening is a well-documented symptom of carpal tunnel syndrome. While relief of nighttime waking following carpal tunnel release (CTR) has been demonstrated, the effect of CTR on overall sleep quality has not been fully investigated. We hypothesized that CTR would result in significant improvement in overall sleep quality as well as patients' overall satisfaction with their sleep habits. Cases of carpal tunnel syndrome with positive nerve studies, and treated with CTR, were prospectively enrolled. Demographic data, electromyography (EMG) severity, Quick Disabilities of the Arm, Shoulder, and Hand questionnaire, and Insomnia Severity Index (ISI) scale data were collected. A total of 398 patients were enrolled, with 99% available at 2 weeks and 64% available at 3-month final follow-up. At final follow-up, average Quick Disabilities of the Arm, Shoulder, and Hand score improved significantly from the preoperative value. Average ISI score on all 7 sleep categories on the survey improved significantly from before surgery to the first postoperative visit. However, the total ISI score did not further improve significantly between the 2-week and the 3-month postoperative visits. The ISI score improvements did not correlate with EMG severity. Patients undergoing CTR demonstrated significant improvement in mean scores for 7 aspects of sleep quality. Sleep improvement was unrelated to preoperative EMG severity and was experienced within 2 weeks of surgery. Therapeutic II.

Sleep disturbance in relatives of palliative patients cared for at home

The aim of the present pilot study was to investigate insomnia, sleep quality, and daytime sleepiness in relatives of dying patients cared for at home. The study has a descriptive, comparative, and cross-sectional design. The sample consisted of relatives of patients cared for through palliative home care in Uppsala County on 3 specific days. Relatives completed a questionnaire consisting of demographic questions, and items from the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale (ESS), and the Richard Campell Sleep Questionnaire (RCSQ). Seventy-five relatives answered the questionnaire. The average total ISI score was 9.6, with 23% reporting moderate or severe clinical insomnia. The mean sleep duration was 6.5 hours, the mean assessed need of sleep was 8 hours, and the mean discrepancy was 1 hour. The total mean ESS score was 5.6 and only 15% of respondents reported excessive daytime sleepiness. Four percent scored very poor sleep quality, whereas 39% scored very good sleep quality (RCSQ). Two general age- and gender-related patterns were observed. Negative correlations were found between age and sleep problems, with younger relatives reporting more insomnia problems and more daytime sleepiness than did older relatives. The other general pattern was that womens' sleep quality was significantly inferior to that of men. A significant positive correlation was found between ISI and ESS, but not between RCSQ and ESS. The picture of the relatives' sleep condition is fairly complex. A minority reported clinical insomnia problems or excessive daytime sleepiness, and 73% reported getting less sleep than they wanted.

Factors related to insomnia and sleepiness in the late third trimester of pregnancy

To assess the presence of insomnia and sleepiness and related factors in the late third trimester of pregnancy. A total of 370 singleton gravids completed a general questionnaire containing personal data, the Insomnia Severity Index (ISI) and the Epworth Sleepiness Scale (ESS). In addition, maternal anthropometry was recorded upon survey. Median [interquartile range] maternal age and gestational age upon survey was of 31 [7.0] years and 39 [1.8] weeks, respectively. A 73.5% of women displayed some degree of insomnia (Total ISI score 8-28) and 22.2% sleepiness (Total ESS score ≥10). Determined rho Spearman coefficients showed significant correlations between ISI scores and gestational age at survey and survey to birth interval (weeks) and between ESS scores and maternal weight and arm circumference at survey and neonatal birth weight. Multiple linear regression analysis found that smoking habit, higher blood pressure and shorter survey to birth interval (weeks) significantly predicted higher ISI scores, and hence a higher risk of insomnia. Employed status, increased arm circumference and neonatal weight predicted higher ESS scores (sleepiness). Insomnia and sleepiness were prevalent in the late third trimester of pregnancy in which lifestyle factors and maternal and neonatal body composition were significant predictors.

The Insomnia Severity Index: Psychometric Indicators to Detect Insomnia Cases and Evaluate Treatment Response

Although insomnia is a prevalent complaint with significant morbidity, it often remains unrecognized and untreated. Brief and valid instruments are needed both for screening and outcome assessment. This study examined psychometric indices of the Insomnia Severity Index (ISI) to detect cases of insomnia in a population-based sample and to evaluate treatment response in a clinical sample. Participants were 959 individuals selected from the community for an epidemiological study of insomnia (Community sample) and 183 individuals evaluated for insomnia treatment and 62 controls without insomnia (Clinical sample). They completed the ISI and several measures of sleep quality, fatigue, psychological symptoms, and quality of life; those in the Clinical sample also completed sleep diaries, polysomnography, and interviews to validate their insomnia/good sleep status and assess treatment response. In addition to standard psychometric indices of reliability and validity, item response theory analyses were computed to examine ISI item response patterns. Receiver operating curves were used to derive optimal cutoff scores for case identification and to quantify the minimally important changes in relation to global improvement ratings obtained by an independent assessor. ISI internal consistency was excellent for both samples (Cronbach α of 0.90 and 0.91). Item response analyses revealed adequate discriminatory capacity for 5 of the 7 items. Convergent validity was supported by significant correlations between total ISI score and measures of fatigue, quality of life, anxiety, and depression. A cutoff score of 10 was optimal (86.1% sensitivity and 87.7% specificity) for detecting insomnia cases in the community sample. In the clinical sample, a change score of -8.4 points (95% CI: -7.1, -9.4) was associated with moderate improvement as rated by an independent assessor after treatment. These findings provide further evidence that the ISI is a reliable and valid instrument to detect cases of insomnia in the population and is sensitive to treatment response in clinical patients.

Factors relating to insomnia during the menopausal transition as evaluated by the Insomnia Severity Index

Background Although the menopause associates to poor sleep quality, insomnia severity data in the menopausal transition is scarce or lacking. Objective To assess insomnia prevalence, severity and related factors in mid-aged women. Methods In this cross-sectional study 340 women (40 to 59 years) completed the Insomnia Severity Index (ISI) and a general questionnaire containing personal/partner data. Hot flush presence and intensity was also assessed with the Menopause Rating Scale (MRS). Results Median age of the sample was 48.0 years, with 63.5% having lower education and 52.9% being postmenopausal. At the moment of the survey 7.1% were on hormone therapy, 8.2% on phytoestrogens and 2.1% on psychotropic drugs. A 63.8% were abdominally obese (waist circumference > 88 cm) and 65.5% sedentary. According to item 1 of the MRS, 60.9% presented hot flushes, graded in 17.4% as severe-very severe. Regarding the partner ( n = 255), erectile dysfunction was present in 23.9%, premature ejaculation 37.6%, 35.3% abused alcohol and 42.4% were faithful. The ISI tool displayed a high internal consistency (alpha Cronbach coefficient = 0.87), identifying 41.5% of women with some degree of insomnia (Total ISI score ≥8) further categorized as sub-threshold or mild (32.0%), moderate (7.4%) and severe (2.1%). Multiple linear regression analysis obtained two best fit models predicting total ISI scores, one not including and one including partner data. In the first model, hot flush severity, psychotropic use and sedentarism displayed significant positive correlations with total ISI scores. In the second, hot flush intensity, psychotropic drug use and male erectile dysfunction positively correlated whereas partner faithfulness inversely with ISI scores. Conclusion In this mid-aged series insomnia severity was related to female and partner factors; several of which are susceptible of intervention.