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VOLUME 34, ISSUE 08

INSOMNIA SYMPTOMS AND PERCEIVED HEALTH
Nighttime Insomnia Symptoms and Perceived Health in the America Insomnia Survey (AIS)

http://dx.doi.org/10.5665/sleep.1150

James K. Walsh, PhD1; Catherine Coulouvrat, MD2; Goeran Hajak, MD3; Matthew D. Lakoma, MPH4; Maria Petukhova, PhD4; Thomas Roth, PhD5; Nancy A. Sampson, BA4; Victoria Shahly, PhD4; Alicia Shillington, PhD6; Judith J. Stephenson, SM7; Ronald C. Kessler, PhD4

1Sleep Medicine and Research Center, St. Luke's Hospital, St. Louis, MO ; 2Sanofi-Aventis ; 3Department of Psychiatry and Psychotherapy, University of Regensburg, Germany ; 4Department of Health Care Policy, Harvard Medical School, Boston, MA ; 5Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI ; 6Epi-Q, Inc., Oak Brook, IL ; 7HealthCore, Inc., Wilmington, DE



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Study Objectives:

To explore the distribution of the 4 cardinal nighttime symptoms of insomnia—difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), early morning awakening (EMA), and nonrestorative sleep (NRS)—in a national sample of health plan members and the associations of these nighttime symptoms with sociodemographics, comorbidity, and perceived health.

Design/Setting/Participants:

Cross-sectional telephone survey of 6,791 adult respondents.

Intervention:

None.

Measurements/Results:

Current insomnia was assessed using the Brief Insomnia Questionnaire (BIQ)—a fully structured validated scale generating diagnoses of insomnia using DSM-IV-TR, ICD-10, and RDC/ICSD-2 inclusion criteria. DMS (61.0%) and EMA (52.2%) were more prevalent than DIS (37.7%) and NRS (25.2%) among respondents with insomnia. Sociodemographic correlates varied significantly across the 4 symptoms. All 4 nighttime symptoms were significantly related to a wide range of comorbid physical and mental conditions. All 4 also significantly predicted decrements in perceived health both in the total sample and among respondents with insomnia after adjusting for comorbid physical and mental conditions. Joint associations of the 4 symptoms predicting perceived health were additive and related to daytime distress/impairment. Individual-level associations were strongest for NRS. At the societal level, though, where both prevalence and strength of individual-level associations were taken into consideration, DMS had the strongest associations.

Conclusions:

The extent to which nighttime insomnia symptoms are stable over time requires future long-term longitudinal study. Within the context of this limitation, the results suggest that core nighttime symptoms are associated with different patterns of risk and perceived health and that symptom-based subtyping might have value.

Citation:

Walsh JK; Coulouvrat C; Hajak G; Lakoma MD; Petukhova M; Roth T; Sampson NA; Shahly V; Shillington A; Stephenson JJ; Kessler RC. Nighttime insomnia symptoms and perceived health in the America Insomnia Survey (AIS). SLEEP 2011;34(8):997-1011.

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