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VOLUME 35, ISSUE 01

PERSISTENT INSOMNIA, SHORT SLEEP DURATION AND MENTAL HEALTH
Persistent Insomnia: the Role of Objective Short Sleep Duration and Mental Health

http://dx.doi.org/10.5665/sleep.1586

Alexandros N. Vgontzas, MD1; Julio Fernandez-Mendoza, PhD1; Edward O. Bixler, PhD1; Ravi Singareddy, MD1; Michele L. Shaffer, PhD2; Susan L. Calhoun, PhD1; Duanping Liao, MD, PhD2; Maria Basta, MD3; George P. Chrousos, MD4

1Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA; 2Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA; 3Department of Psychiatry, School of Medicine, University of Crete, Iraklion, Greece; 4First Department of Pediatrics and Unit on Endocrinology, Metabolism, and Diabetes, University of Athens, Athens, Greece



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Study Objectives:

Few population-based, longitudinal studies have examined risk factors for persistent insomnia, and the results are inconsistent. Furthermore, none of these studies have examined the role of polysomnographic (PSG) variables such as sleep duration or sleep apnea on the persistence of insomnia.

Design:

Representative longitudinal study.

Setting:

Sleep laboratory.

Participants:

From a random, general population sample of 1741 individuals of the adult Penn State Cohort, 1395 were followed-up after 7.5 years.

Measurements:

Individuals underwent one-night PSG and full medical evaluation at baseline and a telephone interview at follow-up. PSG sleep duration was analyzed as a continuous variable and as a categorical variable: < 6 h sleep (short sleep duration) and ≥ 6 h sleep (longer sleep duration).

Results:

The rates of insomnia persistence, partial remission, and full remission were 44.0%, 30.0%, and 26.0%, respectively. Objective short sleep duration significantly increased the odds of persistent insomnia as compared to normal sleep (OR = 3.19) and to fully remitted insomnia (OR = 4.92). Mental health problems at baseline were strongly associated with persistent insomnia as compared to normal sleep (OR = 9.67) and to a lesser degree compared to fully remitted insomnia (OR = 3.68). Smoking, caffeine, and alcohol consumption and sleep apnea did not predict persistent insomnia.

Conclusions:

Objective short sleep duration and mental health problems are the strongest predictors of persistent insomnia. These data further support the validity and clinical utility of objective short sleep duration as a novel marker of the biological severity of insomnia.

Citation:

Vgontzas AN; Fernandez-Mendoza J; Bixler EO; Singareddy R; Shaffer ML; Calhoun SL; Liao D; Basta M; Chrousos GP. Persistent insomnia: the role of objective short sleep duration and mental health. SLEEP 2012;35(1):61-68.

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