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Jo H, Lim M, Jeon HJ, Ahn J, Jeon S, Kim JK, Chung S. Data-driven shortened Insomnia Severity Index (ISI): a machine learning approach. Sleep Breath 2024:10.1007/s11325-024-03037-w. [PMID: 38684641 DOI: 10.1007/s11325-024-03037-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 03/21/2024] [Accepted: 04/17/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND The Insomnia Severity Index (ISI) is a widely used questionnaire with seven items for identifying the risk of insomnia disorder. Although the ISI is still short, more shortened versions are emerging for repeated monitoring in routine clinical settings. In this study, we aimed to develop a data-driven shortened version of the ISI that accurately predicts the severity level of insomnia disorder. METHODS We collected a sample of 800 responses from the EMBRAIN survey system. Based on the responses, seven items were grouped based on the similarity of their response using exploratory factor analysis (EFA). The most representative item within each group was selected by using eXtreme Gradient Boosting (XGBoost). RESULTS Based on the selected three key items, maintenance of sleep, interference with daily function, and concerns about sleep problems, we developed a data-driven shortened questionnaire of ISI, ISI-3 m (machine learning). ISI-3 m achieved the highest coefficient of determination (R 2 = 0.910 ) for the ISI score prediction task and the accuracy of 0.965, precision of 0.841, and recall of 0.838 for the multiclass-classification task, outperforming four previous versions of the shortened ISI. CONCLUSION As ISI-3 m is a highly accurate shortened version of the ISI, it allows clinicians to efficiently screen for insomnia and observe variations in the condition throughout the treatment process. Furthermore, the framework based on the combination of EFA and XGBoost developed in this study can be utilized to develop data-driven shortened versions of the other questionnaires.
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Affiliation(s)
- Hyeontae Jo
- Biomedical Mathematics Group, Pioneer Research Center for Mathematical and Computational Sciences, Institute for Basic Science, Daejeon, 34126, Republic of Korea
- Division of Applied Mathematical Sciences, Korea University, Sejong, 30019, Republic of Korea
| | - Myna Lim
- Department of Information Science, Cornell University, Ithaca, NY, 14850, USA
| | - Hong Jun Jeon
- Department of Psychiatry, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Junseok Ahn
- Department of Psychiatry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Saebom Jeon
- Biomedical Mathematics Group, Pioneer Research Center for Mathematical and Computational Sciences, Institute for Basic Science, Daejeon, 34126, Republic of Korea
- Department of Marketing Bigdata, Mokwon University, Daejeon, Republic of Korea
| | - Jae Kyoung Kim
- Biomedical Mathematics Group, Pioneer Research Center for Mathematical and Computational Sciences, Institute for Basic Science, Daejeon, 34126, Republic of Korea.
- Department of Mathematical Sciences, KAIST, 291 Daehak-Ro Yuseong-Gu, Daejeon, 34141, Republic of Korea.
| | - Seockhoon Chung
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, 86 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
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Chung S, Ahmed O, Cho E, Bang YR, Ahn J, Choi H, Um YH, Choi JW, Kim SJ, Jeon HJ. Psychometric Properties of the Insomnia Severity Index and Its Comparison With the Shortened Versions Among the General Population. Psychiatry Investig 2024; 21:9-17. [PMID: 38281736 PMCID: PMC10822735 DOI: 10.30773/pi.2023.0189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/08/2023] [Accepted: 09/17/2023] [Indexed: 01/30/2024] Open
Abstract
OBJECTIVE The aim of this study was to explore the psychometric properties of the Insomnia Severity Index (ISI) based on modern test theory, such as item response theory (IRT) and Rasch analysis, with shortened versions of the ISI among the general population. METHODS We conducted two studies to evaluate the reliability and validity of the shortened versions of the ISI in a Korean population. In Study I, conducted via online survey, we performed an exploratory factor analysis (n=400). In Study II, confirmatory factor analysis (CFA) was conducted (n=400). IRT and Rasch analysis were performed on all samples. Participants symptoms were rated using the ISI, Dysfunctional Beliefs and Attitudes about Sleep-16 items, Dysfunctional Beliefs about Sleep-2 items, Patient Health Questionnaire-9 items, and discrepancy between desired time in bed and desired total sleep time. RESULTS CFA showed a good fit for the 2-factor model of the ISI (comparative fit index=0.994, Tucker-Lewis index=0.990, root-meansquare-error of approximation=0.039, and standardized root-mean-square residual=0.046). The 3-item versions also showed a good fit for the model. All scales showed good internal consistency reliability. The scale information curve of the 2-item scale was similar to that of the full-scale ISI. The Rasch analysis outputs suggested a good model fit. CONCLUSION The shortened 2-factor ISI is a reliable and valid model for assessing the severity of insomnia in the Korean population. The results are needed to be explored further among the clinical sample of insomnia.
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Affiliation(s)
- Seockhoon Chung
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Oli Ahmed
- Department of Psychology, University of Chittagong, Chattogram, Bangladesh
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Eulah Cho
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young Rong Bang
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Junseok Ahn
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hayun Choi
- Department of Psychiatry, Veteran Health Service Medical Center, Seoul, Republic of Korea
| | - Yoo Hyun Um
- Department of Psychiatry, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae-Won Choi
- Department of Psychiatry, Nowon Eulji University Hospital, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Seong Jae Kim
- Department of Psychiatry, Chosun University Hospital, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Hong Jun Jeon
- Department of Psychiatry, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
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Lee W, Kim H, Shim J, Kim D, Hyeon J, Joo E, Joo BE, Oh J. The simplification of the insomnia severity index and epworth sleepiness scale using machine learning models. Sci Rep 2023; 13:6214. [PMID: 37069247 PMCID: PMC10106896 DOI: 10.1038/s41598-023-33474-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 04/13/2023] [Indexed: 04/19/2023] Open
Abstract
Insomnia and excessive daytime sleepiness (EDS) are the most common complaints in sleep clinics, and the cost of healthcare services associated with them have also increased significantly. Though the brief questionnaires such as the Insomnia Severity Index (ISI) and Epworth Sleepiness Scale (ESS) can be useful to assess insomnia and EDS, there are some limitations to apply for large numbers of patients. As the researches using the Internet of Things technology become more common, the need for the simplification of sleep questionnaires has been also growing. We aimed to simplify ISI and ESS using machine learning algorithms and deep neural networks with attention models. The medical records of 1,241 patients who examined polysomnography for insomnia or EDS were analyzed. All patients are classified into five groups according to the severity of insomnia and EDS. To develop the model, six machine learning algorithms were firstly applied. After going through normalization, the process with the CNN+ Attention model was applied. We classified a group with an accuracy of 93% even with only the results of 6 items (ISI1a, ISI1b, ISI3, ISI5, ESS4, ESS7). We simplified the sleep questionnaires with maintaining high accuracy by using machine learning models.
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Affiliation(s)
- Woodo Lee
- Department of Physics, Korea University, Seoul, 02841, South Korea
| | - Hyejin Kim
- College of Pharmacy, Sookmyung Women's University, Seoul, 04310, South Korea
| | - Jaekwoun Shim
- Institute of Educational Research, Korea University, Seoul, 02841, South Korea
| | - Dongsin Kim
- Sleep Research Center, NYX Corporation, Hanam, 12902, South Korea
| | - Janghun Hyeon
- Semiconductor Research Institute, Korea University, Seoul, 02841, South Korea
| | - Eunyeon Joo
- Department of Neurology, Samsung Medical Center, Seoul, 06351, South Korea
| | - Byung-Euk Joo
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University, Seoul, 31151, South Korea
| | - Junhyoung Oh
- Institute for Business Research and Education, Korea University, Seoul, 02841, South Korea.
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Chevalier LL, Michaud AL, Zhou ES, Chang G, Recklitis CJ. Validation of the Three-Item Insomnia Severity Index Short Form in Young Adult Cancer Survivors: Comparison with a Structured Diagnostic Interview. J Adolesc Young Adult Oncol 2022; 11:596-599. [PMID: 35085459 PMCID: PMC9784600 DOI: 10.1089/jayao.2021.0175] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Chronic insomnia affects ∼25% of young adult cancer survivors (YACS) but is often overlooked in routine follow-up. A recently introduced three-item version of the Insomnia Severity Index (ISI-3) was compared with a diagnostic interview (SCID-5) in 250 YACS (ages 18-40) to evaluate its validity in this population. The ISI-3 had good discrimination compared with the SCID-5 (area under the receiver operating characteristic curve = 0.88). Although no ISI-3 cutoff met study criteria for both sensitivity (≥0.85) and specificity (≥0.75), an ISI-3 cutoff of ≥4 had high sensitivity (94%) and moderate specificity (70%), and is recommended as the first step in a two-step screening procedure.
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Affiliation(s)
- Lydia L. Chevalier
- Perini Family Survivors' Center, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexis L. Michaud
- Perini Family Survivors' Center, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Eric S. Zhou
- Perini Family Survivors' Center, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Grace Chang
- Department of Psychiatry, VA Boston Healthcare System, Brockton, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher J. Recklitis
- Perini Family Survivors' Center, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Filosa J, Omland PM, Langsrud K, Hagen K, Engstrøm M, Drange OK, Knutsen AJ, Brenner E, Kallestad H, Sand T. Validation of insomnia questionnaires in the general population: The Nord-Trøndelag Health Study (HUNT). J Sleep Res 2020; 30:e13222. [PMID: 33111452 DOI: 10.1111/jsr.13222] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/14/2020] [Accepted: 09/30/2020] [Indexed: 01/26/2023]
Abstract
The primary aim was to validate questionnaire-based insomnia diagnoses from a modified Karolinska Sleep Questionnaire (KSQ) and the Insomnia Severity Index (ISI), by age category (< or >65 years), against a semi-structured face-to-face interview. Secondary aims were to split validity by diagnostic certainty of the interview and to compare prevalence estimates of questionnaire- and interview-based diagnoses. A total of 232 out of 1,200 invited (19.3%) from the fourth Nord-Trøndelag Health Study (HUNT4) completed questionnaires, including the KSQ and ISI, shortly before attending a face-to-face diagnostic interview for insomnia based on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Both a tentative (DSM-5 criteria A-E) and a definite (criteria A-H) interview diagnosis was evaluated. Cohen's kappa statistic quantified questionnaire validity. In all, 33% (95% confidence interval 27-39%) of participants had definite insomnia: 40% of women and 21% of men. The ISI (cut-off 12) and several KSQ-based diagnoses showed very good validity (κ ≤0.74) against the tentative, versus good validity (κ ≤0.61) against the definite interview diagnosis. Short questionnaires, requiring a daytime symptom at least three times a week, may underestimate insomnia prevalence. Validity was consistently higher for persons aged below versus above 65 years (definite insomnia: κ ≤0.64 vs. κ ≤0.56). Our results have implications for epidemiological population-based studies utilising insomnia questionnaires.
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Affiliation(s)
- James Filosa
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Petter Moe Omland
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway
| | - Knut Langsrud
- Division of Mental Health Care, St. Olavs Hospital, Trondheim, Norway
| | - Knut Hagen
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway
| | - Morten Engstrøm
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway
| | - Ole Kristian Drange
- Division of Mental Health Care, St. Olavs Hospital, Trondheim, Norway.,Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Eiliv Brenner
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway
| | - Håvard Kallestad
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Division of Mental Health Care, St. Olavs Hospital, Trondheim, Norway
| | - Trond Sand
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway
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