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Hardy C, Green B, Little V, Vanderwood K. Clinical Variables Associated with Successful Treatment of Depression or Anxiety in Collaborative Care. J Behav Health Serv Res 2024:10.1007/s11414-024-09892-5. [PMID: 38955986 DOI: 10.1007/s11414-024-09892-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2024] [Indexed: 07/04/2024]
Abstract
Collaborative Care, an evidence-based model, has proven effective in treating depression and anxiety in healthcare settings. However, limited attention has been paid to exploring treatment outcome differences by clinical variables and diagnosis within this model. While previous research suggests that early and frequent contacts and swift treatment access lead to positive outcomes for depression and anxiety, these aspects have not been comprehensively examined in Collaborative Care. This study investigates the impact of clinical variables on treatment completion in patients primarily diagnosed with anxiety or depression who received collaborative care treatment as a treatment program. Analysis was completed as an observational study of patients (n =2018) with behavioral health diagnoses spanning from 2016 to 2023. Classification analysis offers insights into optimal practices for implementing Collaborative Care across diverse healthcare populations from pediatric to geriatric. Identifying clinical characteristics associated with successful treatment in Collaborative Care has far-reaching implications for model adoption and enhancing patient outcomes. Across all results, patients who received more clinical support and had shorter enrollment durations showed a strong association with successful treatment completion.
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Drews HJ, Sejling C, Andersen TO, Varga TV, Jensen AK, Rod NH. Tracked and self-reported nighttime smartphone use, general health, and healthcare utilization: results from the SmartSleep Study. Sleep 2024; 47:zsae024. [PMID: 38349329 DOI: 10.1093/sleep/zsae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 12/16/2023] [Indexed: 03/21/2024] Open
Abstract
STUDY OBJECTIVES Nighttime smartphone use is an increasing public health concern. We investigated whether nighttime smartphone use is associated with general health and primary healthcare utilization. METHODS Four thousand five hundred and twenty individuals (age 35.6 ± 9.7 years, 35% male) provided self-reported information on smartphone use frequency, symptoms of depression, and general health (one-item perceived health and cross-symptom composite score). A subset of the study sample (n = 3221) tracked their nighttime smartphone use. Primary healthcare utilization, i.e. the number of weeks in which at least one service from the patient's general practitioner (GP) was billed in 2020, was extracted from Danish population registries. Statistical analysis comprised logistic and multiple linear regression, controlling for sociodemographics. RESULTS Three hundred and nineteen individuals (7%) reported using their smartphone almost every night or more. More frequent self-reported nighttime smartphone use was associated with poor general health across all measures. Using the smartphone almost every night or more was associated with 2.8 [95% CI: 1.9, 4.1] fold higher odds of reporting poor health and with an average of 1.4 [95% CI: 0.7, 2.1] additional GP utilizations per year compared to no use. Associations were also found for the cross-symptom composite score across all symptoms. Further adjustment for symptoms of depression attenuated some associations. Smartphone use towards the end of the sleep period (sleep-offset use) was associated with poorer self-reported general health, but not with healthcare utilization. CONCLUSIONS Nighttime smartphone use frequency is associated with poor general health and healthcare utilization. Further studies should investigate the underlying causal structure and nighttime smartphone use as a transdiagnostic intervention target.
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Affiliation(s)
| | - Christoffer Sejling
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Thea Otte Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Denmark
| | - Tibor V Varga
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Denmark
| | - Andreas Kryger Jensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Naja Hulvej Rod
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Denmark
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Benz F, Grolig L, Hannibal S, Buntrock C, Cuijpers P, Domschke K, Ebert DD, Ell J, Janneck M, Jenkner C, Johann AF, Josef A, Kaufmann M, Koß A, Mallwitz T, Mergan H, Morin CM, Riemann D, Riper H, Schmid SR, Smit F, Spille L, Steinmetz L, Van Someren EJW, Spiegelhalder K, Lehr D. Investigating non-inferiority of internet-delivered versus face-to-face cognitive behavioural therapy for insomnia (CBT-I): a randomised controlled trial (iSleep well). Trials 2024; 25:371. [PMID: 38858707 PMCID: PMC11163861 DOI: 10.1186/s13063-024-08214-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/30/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Insomnia is a highly prevalent disorder associated with numerous adverse health outcomes. Cognitive behavioural therapy for insomnia (CBT-I) is recommended as first-line treatment by clinical guidelines but is accessible to only a minority of patients suffering from insomnia. Internet-delivered CBT-I (iCBT-I) could contribute to the widespread dissemination of this first-line treatment. As there is insufficient evidence regarding non-inferiority, this study directly aims to compare therapist-guided internet-delivered versus face-to-face CBT-I in terms of insomnia severity post-treatment. Furthermore, a health-economic evaluation will be conducted, and potential benefits and disadvantages of therapist-guided iCBT-I will be examined. METHODS This study protocol describes a randomised controlled two-arm parallel-group non-inferiority trial comparing therapist-guided iCBT-I with face-to-face CBT-I in routine clinical care. A total of 422 patients with insomnia disorder will be randomised and treated at 16 study centres throughout Germany. Outcomes will be assessed at baseline, 10 weeks after randomisation (post), and 6 months after randomisation (follow-up). The primary outcome is insomnia severity measured using the Insomnia Severity Index. Secondary outcomes include depression-related symptoms, quality of life, fatigue, physical activity, daylight exposure, adverse events related to treatment, and a health-economic evaluation. Finally, potential moderator variables and several descriptive and exploratory outcomes will be assessed (e.g. benefits and disadvantages of internet-delivered treatment). DISCUSSION The widespread implementation of CBT-I is a significant healthcare challenge. The non-inferiority of therapist-guided iCBT-I versus face-to-face CBT-I will be investigated in an adequately powered sample in routine clinical care, with the same therapeutic content and same level of therapist qualifications provided with both interventions. If this trial demonstrates the non-inferiority of therapist-guided iCBT-I, healthcare providers may be more confident recommending this treatment to their patients, contributing to the wider dissemination of CBT-I. TRIAL REGISTRATION Trial registration number in the German Clinical Trials Register: DRKS00028153 ( https://drks.de/search/de/trial/DRKS00028153 ). Registered on 16th May 2023.
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Affiliation(s)
- F Benz
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - L Grolig
- Department of Health Psychology and Applied Biological Psychology, Institute of Sustainability Psychology, Leuphana University of Lüneburg, Lüneburg, Germany
| | - S Hannibal
- Department of Health Psychology and Applied Biological Psychology, Institute of Sustainability Psychology, Leuphana University of Lüneburg, Lüneburg, Germany
| | - C Buntrock
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto-von-Guericke-University, Magdeburg, Germany
| | - P Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania
| | - K Domschke
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - D D Ebert
- Psychology & Digital Mental Health Care, Department of Health Sciences, Technical University Munich, Munich, Germany
| | - J Ell
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M Janneck
- Institute for Interactive Systems, Department of Electrical Engineering and Computer Science, Technische Hochschule Lübeck, Lübeck, Germany
| | - C Jenkner
- Clinical Trials Unit, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - A F Johann
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Institute of Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - A Josef
- Clinical Trials Unit, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M Kaufmann
- Clinical Trials Unit, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - A Koß
- Clinical Trials Unit, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - T Mallwitz
- Institute for Interactive Systems, Department of Electrical Engineering and Computer Science, Technische Hochschule Lübeck, Lübeck, Germany
| | - H Mergan
- Institute for Interactive Systems, Department of Electrical Engineering and Computer Science, Technische Hochschule Lübeck, Lübeck, Germany
| | - C M Morin
- École de Psychologie, Centre d'étude des troubles du sommeil, Centre de recherche CERVO/Brain Research Center, Université Laval, Québec, Canada
| | - D Riemann
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - H Riper
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam UMC, Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - S R Schmid
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - F Smit
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Location VUmc, Amsterdam, the Netherlands
- Centre of Health-Economic Evaluation, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, the Netherlands
| | - L Spille
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - L Steinmetz
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - E J W Van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands
| | - K Spiegelhalder
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - D Lehr
- Department of Health Psychology and Applied Biological Psychology, Institute of Sustainability Psychology, Leuphana University of Lüneburg, Lüneburg, Germany
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Singh R, Atha R, Lenker KP, Calhoun SL, Liao J, He F, Vgontzas AN, Liao D, Bixler EO, Jackson CL, Fernandez-Mendoza J. Racial/ethnic disparities in the trajectories of insomnia symptoms from childhood to young adulthood. Sleep 2024; 47:zsae021. [PMID: 38270531 PMCID: PMC11082472 DOI: 10.1093/sleep/zsae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/03/2024] [Indexed: 01/26/2024] Open
Abstract
STUDY OBJECTIVES To examine differences in the longitudinal prevalence of childhood insomnia symptoms across black/African American, Hispanic/Latinx, and non-Hispanic white groups. METHODS Participants were 519 children from the Penn State Child Cohort (baseline [V1] from 2000-2005) who were followed up 8 years later as adolescents (V2) and 15 years later as young adults (S3). Mean age at S3 was 24.1 ± 2.7 years. Approximately, 76.5% identified as non-Hispanic white, 12.9% as black/African American, 7.1% as Hispanic/Latinx, and 3.5% as "other" race/ethnicity. Insomnia symptoms were defined as parent-reported (childhood) or self-reported (adolescence and young adulthood) moderate-to-severe difficulties initiating/maintaining sleep. Longitudinal trajectories of insomnia symptoms were identified across three-time points and the odds of each trajectory were compared between racial/ethnic groups, adjusting for sex, age, overweight, sleep apnea, periodic limb movements, psychiatric/behavioral disorders, and psychotropic medication use. RESULTS Black/African Americans compared to non-Hispanic whites were at significantly higher odds of having a childhood-onset persistent trajectory through young adulthood (OR = 2.58, 95% CI [1.29, 5.14]), while Hispanics/Latinx were at nonsignificantly higher odds to have the same trajectory (OR = 1.81, 95% CI [0.77, 4.25]). No significant racial/ethnic differences were observed for remitted and waxing-and-waning trajectories since childhood or incident/new-onset trajectories in young adulthood. CONCLUSIONS The results indicate that disparities in insomnia symptoms among black/African American and, to a lesser extent, Hispanic/Latinx groups start early in childhood and persist into young adulthood. Identifying and intervening upon upstream determinants of racial/ethnic insomnia disparities are warranted to directly address these disparities and to prevent their adverse health sequelae. CLINICAL TRIAL INFORMATION N/A; Not a clinical trial.
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Affiliation(s)
- Rupsha Singh
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Department of Health and Human Services, Baltimore, MD, USA
| | - Raegan Atha
- Sleep Research and Treatment Center, Department of Psychiatry and Behavioral Health, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
| | - Kristina P Lenker
- Sleep Research and Treatment Center, Department of Psychiatry and Behavioral Health, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
| | - Susan L Calhoun
- Sleep Research and Treatment Center, Department of Psychiatry and Behavioral Health, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
| | - Jiangang Liao
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Fan He
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Alexandros N Vgontzas
- Sleep Research and Treatment Center, Department of Psychiatry and Behavioral Health, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
| | - Duanping Liao
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Edward O Bixler
- Sleep Research and Treatment Center, Department of Psychiatry and Behavioral Health, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
| | - Chandra L Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Julio Fernandez-Mendoza
- Sleep Research and Treatment Center, Department of Psychiatry and Behavioral Health, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
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Boyle JT, Boeve AR, Moye JA, Driver JA, Ruopp M, O'Malley K. Insomnia Symptoms and Environmental Disruptors: A Preliminary Evaluation of Veterans in a Subacute Rehabilitation. Clin Gerontol 2024; 47:494-506. [PMID: 38320999 DOI: 10.1080/07317115.2024.2313494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
OBJECTIVES Evaluate insomnia symptoms and environmental disruptors at admission and discharge in a subacute rehabilitation care setting. METHODS Veterans (age ≥50) admitted to a Veterans Health Administration (VA) Hospital subacute rehabilitation between March and August 2022 completed baseline (N = 46) and follow up (N = 33) assessments with the Insomnia Severity Index (ISI), Sleep Need Questionnaire (SNQ), Epworth Sleepiness Scale (ESS), and an assessment of environmental sleep disruptors. Veterans were offered sleep resources after admission evaluations and outpatient referrals after discharge evaluations. Pearson correlation determined associations between length of stay (LOS), ISI, SNQ, and ESS scores at admission and discharge; chi-square and Wilcoxon Signed Rank Tests compared insomnia at admission and discharge. RESULTS One-half of participants reported clinically meaningful insomnia symptoms and sleep needs at baseline with no significant change at discharge. Almost all (89.1%) Veterans reported sleep was disturbed by environmental factors, primarily staff awakenings. LOS was correlated with ESS scores at discharge (r = .52, p = .002). CONCLUSIONS Environmental sleep disruption was common during a subacute rehabilitation admission and were not adequately addressed through sleep resources and treatment due to low uptake. CLINICAL IMPLICATIONS Providers should assess sleep at admission and lessen environmental sleep disruptors by reducing noise, light, and non-essential awakenings at night.
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Affiliation(s)
- Julia T Boyle
- Office of Research and Development, VA Boston Healthcare System, Boston, Massachusetts, USA
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA
- Geriatrics and Extended Care, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Angelica R Boeve
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychology, University of Maine, Orono, Maine, USA
- Department of Psychology, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Jennifer A Moye
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jane A Driver
- Geriatrics and Extended Care, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Marcus Ruopp
- Geriatrics and Extended Care, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Kelly O'Malley
- Geriatrics and Extended Care, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Hollenbeak CS, Jeon S, O’Connell M, Conley S, Yaggi H, Redeker NS. Costs and Resource Utilization of People with Stable Heart Failure and Insomnia: Evidence from a Randomized Trial of Cognitive Behavioral Therapy for Insomnia. Behav Sleep Med 2024; 22:263-274. [PMID: 37530117 PMCID: PMC10834836 DOI: 10.1080/15402002.2023.2241589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
OBJECTIVES Nearly half of patients with chronic heart failure (HF) report insomnia symptoms. The purpose of this study was to examine the impact of CBT-I versus HF self-management on healthcare costs and resource utilization among patients with stable chronic HF who participated in a clinical trial of the effects of CBT-I compared to HF self-management education (attention control) over 1 year. METHODS We measured resource utilization as self-reported (medical record review) physician office visits, emergency department visits, and inpatient admissions at 3-month intervals for 1 year after enrollment. Costs were estimated by applying price weights to visits and adding self-reported out-of-pocket and indirect costs. Univariate comparisons were made of resource utilization and costs between CBT-I and the HF self-management group. A generalized linear model (GLM) was used to model costs, controlling for covariates. RESULTS The sample included 150 patients [79 CBT-I; 71 self-management (M age = 62 + 13 years)]. The CBT-I group had 4.2 inpatient hospitalizations vs 4.6 for the self-management group (p = .40). There were 13.1 outpatient visits, in the CBT-I compared with 15.4 outpatient visits (p-value range 0.39-0.81) for the self-management group. Total costs were not significantly different in univariate or ($7,813 CBT-I vs. $7,538 self-management), p = .96) or multivariable analyses. CONCLUSIONS Among patients with both HF and insomnia, CBT-I and HF self-management were associated with similar resource utilization and total costs. Additional research is needed to estimate the value of CBT-I relative to usual care and other treatments for insomnia in patients with HF.
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Affiliation(s)
- Christopher S. Hollenbeak
- Department of Health Policy and Administration, College of Health and Human Development, The Pennsylvania State University, University Park, PA
| | | | | | | | - Henry Yaggi
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT
| | - Nancy S. Redeker
- School of Nursing, Yale University, West Haven, CT
- School of Nursing, University of Connecticut, Storrs, CT
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Chekani F. Authors' Response to the Letter to the Editor Entitled: How Can We Interpret Insomnia as a "Risk Factor" on Behavioral Symptom. J Am Med Dir Assoc 2024; 25:554. [PMID: 38182122 DOI: 10.1016/j.jamda.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 01/07/2024]
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Bachrach RL, Tighe CA, Beyer N, Hruska K, Phares A, Atchison K, Baniak L, Haas G, Bramoweth AD. Sleep and Alcohol Use Among Veterans Living With Long COVID. J Prim Care Community Health 2024; 15:21501319241246992. [PMID: 38628054 PMCID: PMC11025314 DOI: 10.1177/21501319241246992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/22/2024] [Accepted: 03/26/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVES Study objectives were to: (1) better understand sleep experiences and unhealthy alcohol use among Veterans with long COVID and (2) explore providers' perceptions of barriers and facilitators to delivering evidence-based care for sleep problems and unhealthy alcohol use in patients with long COVID. METHODS VA electronic health records were used to conduct chart reviews (n = 57) of patients evaluated in a VA COVID-19 Recovery Clinic during 1 calendar year; semi-structured interviews were completed with Veterans (n = 5) and clinicians (n = 7) recruited from the clinic. Veteran participants also completed quantitative, self-report measures assessing sleep- and alcohol-related experiences and behaviors. RESULTS Data from chart reviews and interviews suggested that Veterans with long COVID often had pre-existing sleep problems that were exacerbated during long COVID. Patients and providers agreed that sleep interventions would be beneficial and acceptable in the COVID-19 Recovery clinic. Conversely, few Veterans with long COVID had a pre-existing alcohol use disorder (AUD) diagnosis; alcohol use occurred less frequently and was less often discussed between patients and providers. Providers had mixed viewpoints on delivering alcohol-related care in the clinic; some were highly amenable, others were unsure whether patients would be receptive. CONCLUSIONS This study is among the first to take a mixed-method approach to understanding experiences of sleep-wake behaviors and unhealthy alcohol use in Veterans with long COVID. Characterizing sleep and alcohol-related experiences, examining associations with functioning, and exploring perspectives on treatment approaches is critical to support efforts to refine, personalize, and optimize evidence-based sleep and alcohol care for Veterans living with long COVID.
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Affiliation(s)
- Rachel L. Bachrach
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- University of Michigan, Ann Arbor, MI, USA
| | - Caitlan A. Tighe
- Providence College, Providence, RI, USA
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Nicole Beyer
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | | | - Angela Phares
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | | | - Lynn Baniak
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- University of Pittsburgh, Pittsburgh, PA, USA
| | - Gretchen Haas
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- University of Pittsburgh, Pittsburgh, PA, USA
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Chekani F, Fleming SP, Mirchandani K, Goswami S, Zaki S, Sharma M. Prevalence and Risk of Behavioral Symptoms among Patients with Insomnia and Alzheimer's Disease: A Retrospective Database Analysis. J Am Med Dir Assoc 2023; 24:1967-1973.e2. [PMID: 37879606 DOI: 10.1016/j.jamda.2023.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/01/2023] [Accepted: 09/12/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVES This study evaluated the prevalence and patterns of behavioral symptoms, including agitation/aggression (AA), psychotic symptoms (PS), anxiety/mood disorders (MD), and delirium among patients with Alzheimer's disease (AD) and their association with diagnosed insomnia. DESIGN A retrospective cohort analysis was conducted using the MarketScan Multi-State Medicaid Database 2016-2020. SETTING AND PARTICIPANTS Patients aged ≥50 with newly diagnosed AD (N = 56,904) were identified during 2017-2019 and categorized into insomnia and non-insomnia groups based on billing codes recorded in medical and pharmacy claims. METHODS The index date was defined as the earliest date of diagnosis/medication of insomnia. The new diagnosis of AD had to be established within 12 months before (baseline) or 3 months after the index date. Point prevalence of behavioral symptoms was estimated during baseline and the 12-month follow-up period. Propensity score matching was performed to match patients with and without insomnia. Multivariable conditional logistic regression was used to assess the risk of diagnosis of behavioral symptoms among insomnia and non-insomnia groups. RESULTS The study cohort included 7808 patients with newly diagnosed AD (mean age = 79.4, SD = 9.6 years). The point prevalence of behavioral symptoms was as follows: among those with insomnia (n = 3904), in the baseline, AA = 9.0%, PS = 12.5%, and MD = 57.8%, and during the follow-up, AA = 13.9%, PS = 16.3%, and MD = 72.1%; among those without insomnia (n = 3904), in the baseline, AA = 6.2%, PS = 9.2%, and MD = 41.4%; and during the follow-up, AA = 7.4%, PS = 10.4%, and MD = 49.2%. The likelihood of being diagnosed with any behavioral symptoms in the follow-up period was significantly higher among patients with insomnia than those without [adjusted odds ratio (OR), 2.7; 95% confidence interval (CI), 2.4-3.1]. CONCLUSIONS AND IMPLICATIONS In patients with AD, prevalence of behavioral symptoms and likelihood of being diagnosed with behavioral symptoms were significantly higher among patients with diagnosed insomnia. Further investigation is needed to understand the relationship between insomnia and behavioral symptoms in patients with AD.
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Affiliation(s)
- Farid Chekani
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ, USA.
| | - Sean P Fleming
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ, USA
| | - Kirti Mirchandani
- Real World Evidence, Complete HEOR Solutions (CHEORS), Chalfont, PA, USA
| | - Swarnali Goswami
- Real World Evidence, Complete HEOR Solutions (CHEORS), Chalfont, PA, USA
| | - Saba Zaki
- Real World Evidence, Complete HEOR Solutions (CHEORS), Chalfont, PA, USA
| | - Manvi Sharma
- Real World Evidence, Complete HEOR Solutions (CHEORS), Chalfont, PA, USA
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10
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Nielson SA, Perez E, Soto P, Boyle JT, Dzierzewski JM. Challenging beliefs for quality sleep: A systematic review of maladaptive sleep beliefs and treatment outcomes following cognitive behavioral therapy for insomnia. Sleep Med Rev 2023; 72:101856. [PMID: 37862834 DOI: 10.1016/j.smrv.2023.101856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/07/2023] [Accepted: 09/20/2023] [Indexed: 10/22/2023]
Abstract
Cognitive behavioral therapy for insomnia (CBT-I) is an empirically supported intervention for insomnia. Given the strong, consistent support of its efficacy, scholars have become increasingly interested in the behavioral and cognitive mechanisms targeted during CBT-I. The purpose of the systematic review was to synthesize findings from the literature regarding the associations among maladaptive sleep beliefs, a cognitive mechanism implicated in maintaining insomnia, and treatment outcomes following CBT-I. The systematic review was completed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Seventeen studies were included in the final sample of reviewed articles and a study quality assessment was performed for all studies included in the review. The results suggested that reductions in maladaptive sleep beliefs were associated with improved insomnia severity; however, reductions in maladaptive beliefs were not associated with changes in sleep efficiency or other sleep parameters. Moreover, in some cases, improved sleep parameters preceded reductions in maladaptive beliefs. Maladaptive sleep beliefs may be an important target for improving insomnia. Targeting maladaptive sleep beliefs may initiate a trickle-down process that limits the influence of other cognitive and behavioral processes maintaining insomnia. Additional investigation is needed to evaluate the directional relationship between improved insomnia symptoms and reduced maladaptive beliefs.
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Affiliation(s)
- Spencer A Nielson
- Virginia Commonwealth University, Department of Psychology, Richmond, VA, USA
| | - Elliottnell Perez
- Virginia Commonwealth University, Department of Psychology, Richmond, VA, USA
| | - Pablo Soto
- Virginia Commonwealth University, Department of Psychology, Richmond, VA, USA
| | - Julia T Boyle
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Kweon W, Lee KH, Choi SH, Shin J, Seo M, Jeon JE, Lee HY, Park C, Kim SY, Kim JW, Chang JH, Lee YJ. Amygdala resting-state functional connectivity alterations in patients with chronic insomnia disorder: correlation with electroencephalography beta power during sleep. Sleep 2023; 46:zsad205. [PMID: 37531589 DOI: 10.1093/sleep/zsad205] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 07/09/2023] [Indexed: 08/04/2023] Open
Abstract
STUDY OBJECTIVES This study investigated alterations in resting-state functional connectivity (RSFC) and hyperarousal biomarkers in patients with chronic insomnia disorder (CID), compared with good sleepers (GS). We also examined the relationships between altered RSFC and hyperarousal biomarkers. METHODS Fifty patients with CID and 52 GS completed self-reporting questionnaires, and then underwent polysomnography and resting-state functional magnetic resonance imaging. We analyzed RSFC in the amygdala (AMG) and anterior insula (aINS), which are core regions of the salience network that are likely to be involved in hyperarousal. We also analyzed electroencephalography (EEG) relative beta power and heart rate variability (HRV) parameters (e.g. low and high frequency) during sleep. We then tested between-group differences in the RSFC and hyperarousal biomarkers; we examined correlations of RSFC with EEG beta power and HRV. RESULTS Compared with GS, patients with CID showed more negative RSFC between the right amygdala (R.AMG) and left supramarginal gyrus (L.SMG), but less positive RSFC between the left aINS and bilateral lateral prefrontal cortex. The R.AMG-L.SMG RSFC was negatively correlated with EEG beta power in central regions (C3: r = -0.336, p = 0.012; C4: r = -0.314, p = 0.024). CONCLUSIONS Decreased RSFC between the R.AMG and L.SMG in patients with insomnia may reflect the difficulty in cortical top-down regulation of the AMG, indicating daytime hyperarousal. Individuals who experience hyperarousal during the daytime may also exhibit cortical hyperarousal during sleep, as indicated by increased EEG beta power.
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Affiliation(s)
- Woojin Kweon
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung Hwa Lee
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang Ho Choi
- School of Computer and Information Engineering, Kwangwoon University, Seoul, Republic of Korea
| | - Jiyoon Shin
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Mincheol Seo
- Department of Psychiatry, Veteran Health Service Medical Center, Seoul, Republic of Korea
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong Eun Jeon
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ha Young Lee
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chowon Park
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sun-Young Kim
- Department of Psychiatry, Ewha Womans University College of Medicine, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
| | - Jong Won Kim
- Department of Healthcare IT, Inje University, Kimhae, Kyunsangnam-do, Republic of Korea
| | - Jun Hyuk Chang
- Department of Computer Science, University of Chicago, Chicago, IL, USA
| | - Yu Jin Lee
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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12
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Ha S, Choi SJ, Lee S, Wijaya RH, Kim JH, Joo EY, Kim JK. Predicting the Risk of Sleep Disorders Using a Machine Learning-Based Simple Questionnaire: Development and Validation Study. J Med Internet Res 2023; 25:e46520. [PMID: 37733411 PMCID: PMC10557018 DOI: 10.2196/46520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/20/2023] [Accepted: 08/23/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Sleep disorders, such as obstructive sleep apnea (OSA), comorbid insomnia and sleep apnea (COMISA), and insomnia are common and can have serious health consequences. However, accurately diagnosing these conditions can be challenging as a result of the underrecognition of these diseases, the time-intensive nature of sleep monitoring necessary for a proper diagnosis, and patients' hesitancy to undergo demanding and costly overnight polysomnography tests. OBJECTIVE We aim to develop a machine learning algorithm that can accurately predict the risk of OSA, COMISA, and insomnia with a simple set of questions, without the need for a polysomnography test. METHODS We applied extreme gradient boosting to the data from 2 medical centers (n=4257 from Samsung Medical Center and n=365 from Ewha Womans University Medical Center Seoul Hospital). Features were selected based on feature importance calculated by the Shapley additive explanations (SHAP) method. We applied extreme gradient boosting using selected features to develop a simple questionnaire predicting sleep disorders (SLEEPS). The accuracy of the algorithm was evaluated using the area under the receiver operating characteristics curve. RESULTS In total, 9 features were selected to construct SLEEPS. SLEEPS showed high accuracy, with an area under the receiver operating characteristics curve of greater than 0.897 for all 3 sleep disorders, and consistent performance across both sets of data. We found that the distinction between COMISA and OSA was critical for accurate prediction. A publicly accessible website was created based on the algorithm that provides predictions for the risk of the 3 sleep disorders and shows how the risk changes with changes in weight or age. CONCLUSIONS SLEEPS has the potential to improve the diagnosis and treatment of sleep disorders by providing more accessibility and convenience. The creation of a publicly accessible website based on the algorithm provides a user-friendly tool for assessing the risk of OSA, COMISA, and insomnia.
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Affiliation(s)
- Seokmin Ha
- Biomedical Mathematics Group, Institute for Basic Science, Daejeon, Republic of Korea
- Department of Mathematical Sciences, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Su Jung Choi
- Graduate School of Clinical Nursing Science, Sungkyunkwan University, Seoul, Republic of Korea
| | - Sujin Lee
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Reinatt Hansel Wijaya
- Biomedical Mathematics Group, Institute for Basic Science, Daejeon, Republic of Korea
- Department of Computer Science, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Jee Hyun Kim
- Department of Neurology, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Eun Yeon Joo
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Kyoung Kim
- Biomedical Mathematics Group, Institute for Basic Science, Daejeon, Republic of Korea
- Department of Mathematical Sciences, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
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13
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Rani S, Shelyag S, Angelova M. Patterns of sedentary behaviour in adults with acute insomnia derived from actigraphy data. PLoS One 2023; 18:e0291095. [PMID: 37733680 PMCID: PMC10513233 DOI: 10.1371/journal.pone.0291095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/22/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Sleep disorders, such as insomnia, have been associated with extended periods of inactive, sedentary behaviour. Many factors contribute to insomnia, including stress, irregular sleep patterns, mental health issues, inadequate sleeping schedules, diseases, neurological disorders and prescription medications. OBJECTIVES Identification of the patterns of sedentary time and its duration in adults with acute insomnia and healthy controls to determine the statistically significant sedentary bouts; comparison of the sedentary behaviour patterns in acute insomnia adults with healthy controls. METHODS We investigate the daytime actigraphy data and identify temporal patterns of inactivity among adults with acute insomnia and healthy adults. Seven days of actigraphy data were utilised to calculate sedentary time and bouts of variable duration based on a threshold of activity counts (<100 counts per minute). Statistical analysis was applied to investigate sedentary bouts and total sedentary time during weekdays and weekend. A logistic regression model has been used to determine the significance of sedentary bouts. RESULTS We found that individuals with acute insomnia accumulate a significant amount of their sedentary time in medium (6-30 minutes and 31-60 minutes) and longer (more than 60 minutes) duration bouts in comparison to healthy adults. Furthermore, a low p value for total sedentary time (2.54 ⋅ 10-4) association with acute insomnia supports the finding that acute insomnia individuals are significantly more engaged in sedentary activities compared to healthy controls. Also, as shown by the weekend vs weekday analysis, the physical and sedentary activity patterns of acute insomnia adults demonstrate higher variability during the weekdays in comparison to the weekend. CONCLUSION The results of the present study demonstrate that adults with acute insomnia spend more time in low-intensity daily physical activities compared to healthy adults.
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Affiliation(s)
- Sunita Rani
- School of IT, Deakin University, Melbourne, Victoria, Australia
| | - Sergiy Shelyag
- School of IT, Deakin University, Melbourne, Victoria, Australia
- College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Maia Angelova
- School of IT, Deakin University, Melbourne, Victoria, Australia
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Yu DJ, Recchia F, Bernal JDK, Yu AP, Fong DY, Li SX, Chan RNY, Hu X, Siu PM. Effectiveness of Exercise, Cognitive Behavioral Therapy, and Pharmacotherapy on Improving Sleep in Adults with Chronic Insomnia: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Healthcare (Basel) 2023; 11:2207. [PMID: 37570447 PMCID: PMC10418444 DOI: 10.3390/healthcare11152207] [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: 06/14/2023] [Revised: 07/27/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023] Open
Abstract
Despite the well-established treatment effectiveness of exercise, cognitive behavioral therapy for insomnia (CBT-I), and pharmacotherapy on improving sleep, there have been no studies to compare their long-term effectiveness, which is of clinical importance for sustainable management of chronic insomnia. This study compared the long-term effectiveness of these three interventions on improving sleep in adults with chronic insomnia. MEDLINE, PsycINFO, Embase, and SPORTDiscus were searched for eligible reports. Trials that investigated the long-term effectiveness of these three interventions on improving sleep were included. The post-intervention follow-up of the trial had to be ≥6 months to be eligible. The primary outcome was the long-term effectiveness of the three interventions on improving sleep. Treatment effectiveness was the secondary outcome. A random-effects network meta-analysis was carried out using a frequentist approach. Thirteen trials were included in the study. After an average post-intervention follow-up period of 10.3 months, both exercise (SMD, -0.29; 95% CI, -0.57 to -0.01) and CBT-I (-0.48; -0.68 to -0.28) showed superior long-term effectiveness on improving sleep compared with control. Temazepam was the only included pharmacotherapy, which demonstrated superior treatment effectiveness (-0.80; -1.25 to -0.36) but not long-term effectiveness (0.19; -0.32 to 0.69) compared with control. The findings support the use of both exercise and CBT-I for long-term management of chronic insomnia, while temazepam may be used for short-term treatment.
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Affiliation(s)
- Danny J. Yu
- Division of Kinesiology, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; (D.J.Y.); (F.R.); (J.D.K.B.); (A.P.Y.)
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China;
| | - Francesco Recchia
- Division of Kinesiology, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; (D.J.Y.); (F.R.); (J.D.K.B.); (A.P.Y.)
| | - Joshua D. K. Bernal
- Division of Kinesiology, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; (D.J.Y.); (F.R.); (J.D.K.B.); (A.P.Y.)
| | - Angus P. Yu
- Division of Kinesiology, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; (D.J.Y.); (F.R.); (J.D.K.B.); (A.P.Y.)
| | - Daniel Y. Fong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China;
| | - Shirley X. Li
- Department of Psychology, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China; (S.X.L.); (X.H.)
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
| | - Rachel N. Y. Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China;
| | - Xiaoqing Hu
- Department of Psychology, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China; (S.X.L.); (X.H.)
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
| | - Parco M. Siu
- Division of Kinesiology, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; (D.J.Y.); (F.R.); (J.D.K.B.); (A.P.Y.)
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15
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Grandner M, Olivieri A, Ahuja A, Büsser A, Freidank M, McCall WV. The burden of untreated insomnia disorder in a sample of 1 million adults: a cohort study. BMC Public Health 2023; 23:1481. [PMID: 37537544 PMCID: PMC10399052 DOI: 10.1186/s12889-023-16329-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/18/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Insomnia disorder is a highly prevalent, significant public health concern associated with substantial and growing health burden. There are limited real-world data assessing the burden of insomnia disorder on daytime functioning and its association with comorbidities. The objective of this study was to leverage large-scale, real-world data to assess the burden of untreated insomnia disorder in terms of daytime impairment and clinical outcomes. METHODS This United States medical claims database study compares patients diagnosed with insomnia disorder but not receiving treatment ('untreated insomnia' cohort) to patients without an insomnia disorder diagnosis and without treatment ('non-insomnia' cohort). International Classification of Disease, Tenth Revision codes were used as a proxy to represent the three symptom domains (Sleepiness, Alert/Cognition, Mood) of the Insomnia Daytime Symptoms and Impacts Questionnaire (IDSIQ), a newly developed and validated tool used in clinical studies to assess daytime functioning in insomnia disorder. Chronic Fatigue (R53.83) and Other Fatigue (R53.83), Somnolence (R40.0) and Disorientation (R41.0) were selected as categories representing one or more IDSIQ domains. Clinical outcomes included cardiovascular events, psychiatric disorders, cognitive impairment and metabolic disorders. RESULTS Approximately 1 million patients were included (untreated insomnia: n = 139,959; non-insomnia: n = 836,975). Compared with the 'non-insomnia' cohort, the 'untreated insomnia' cohort was more likely to experience daytime impairments, with mean differences in occurrences per 100 patient-years for: (a) fatigue, at 27.35 (95% confidence interval [CI] 26.81, 27.77, p < 0.01); (b) dizziness, at 4.66 (95% CI 4.40, 4.90, p < 0.01); (c) somnolence, at 4.18 (95% CI 3.94, 4.43, p < 0.01); and (d) disorientation, at 0.92 (95% CI 0.77, 1.06, p < 0.01). During the 1-year look-back period, patients in the 'untreated insomnia' cohort were also more likely to have been diagnosed with arterial hypertension (40.9% vs. 26.3%), psychiatric comorbidities (40.1% vs. 13.2%), anxiety (29.2% vs. 8.5%), depression (26.1% vs. 8.1%) or obesity (21.3% vs. 11.1%) compared with those in the 'non-insomnia' cohort. CONCLUSIONS This large-scale study confirms the substantial burden of insomnia disorder on patients in a real-world setting, with significant daytime impairment and numerous comorbidities. This reinforces the need for timely insomnia disorder diagnosis and treatments that improve both sleep, as well as daytime functioning.
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Affiliation(s)
- Michael Grandner
- Department of Psychiatry, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Antonio Olivieri
- Idorsia Pharmaceuticals Ltd, Hegenheimermattweg 91, Allschwil, 4123, Switzerland
| | - Ajay Ahuja
- Idorsia Pharmaceuticals US Inc, Radnor, PA, USA
| | - Alexander Büsser
- Idorsia Pharmaceuticals Ltd, Hegenheimermattweg 91, Allschwil, 4123, Switzerland.
| | | | - William V McCall
- Department of Psychiatry and Health Behavior, Medical College of Georgia at Augusta University, Augusta, GA, USA
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16
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McLaren DM, Evans J, Baylan S, Smith S, Gardani M. The effectiveness of the behavioural components of cognitive behavioural therapy for insomnia in older adults: A systematic review. J Sleep Res 2023; 32:e13843. [PMID: 36802110 PMCID: PMC10909422 DOI: 10.1111/jsr.13843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/16/2022] [Accepted: 01/16/2023] [Indexed: 02/21/2023]
Abstract
Insomnia is more prevalent in older adults (> 60 years) than in the general population. Cognitive behavioural therapy for insomnia is the gold-standard treatment; however, it may prove too cognitively taxing for some. This systematic review aimed to critically examine the literature exploring the effectiveness of explicitly behavioural interventions for insomnia in older adults, with secondary aims of investigating their effect on mood and daytime functioning. Four electronic databases (MEDLINE - Ovid, Embase - Ovid, CINAHL, and PsycINFO) were searched. All experimental, quasi-experimental and pre-experimental studies were included, provided they: (a) were published in English; (b) recruited older adults with insomnia; (c) used sleep restriction and/or stimulus control; (d) reported outcomes pre-and-post intervention. Database searches returned 1689 articles; 15 studies, summarising the results of 498 older adults, were included - three focused on stimulus control, four on sleep restriction, and eight adopted multicomponent treatments comprised of both interventions. All interventions brought about significant improvements in one or more subjectively measured facets of sleep although, overall, multicomponent therapies demonstrated larger effects (median Hedge's g = 0.55). Actigraphic or polysomnographic outcomes demonstrated smaller or no effects. Improvements in measures of depression were seen in multicomponent interventions, but no intervention demonstrated any statistically significant improvement in measures of anxiety. This corroborates with the existing consensus that multicomponent approaches confer the most benefit, and adds to the literature by demonstrating this to be the case in brief, explicitly behavioural interventions. This review guides future study of treatments for insomnia in populations where cognitive behavioural therapy for insomnia is not appropriate.
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Affiliation(s)
- Declan M. McLaren
- School of Psychology and NeuroscienceThe University of GlasgowGlasgowScotland
| | - Jonathan Evans
- School of Health and WellbeingThe University of GlasgowGlasgowScotland
| | - Satu Baylan
- School of Health and WellbeingThe University of GlasgowGlasgowScotland
| | - Sarah Smith
- School of Psychology and NeuroscienceThe University of GlasgowGlasgowScotland
| | - Maria Gardani
- School of Health in Social ScienceThe University of EdinburghEdinburghScotland
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17
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Wickwire EM, Juday TR, Kelkar M, Heo J, Margiotta C, Frech FH. Economic burden of comorbid insomnia in 5 common medical disease subgroups. J Clin Sleep Med 2023; 19:1293-1302. [PMID: 37394794 PMCID: PMC10315590 DOI: 10.5664/jcsm.10592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/29/2023]
Abstract
STUDY OBJECTIVES Approximately 85% of insomnia co-occurs with other disorders. Whereas insomnia was once considered "secondary" to these disorders, it is now widely recognized as an independent condition warranting treatment. While it is clear that insomnia can affect the course of other medical conditions, there is scant literature on the economic impact of comorbid insomnia among patients with common medical conditions. The aim of this study was to determine the economic burden of comorbid insomnia in 5 medical diseases commonly associated with insomnia: type 2 diabetes mellitus (T2DM), cancer undergoing treatment, menopause undergoing hormone replacement therapy, osteoporosis, and Alzheimer's disease and related dementias (ADRDs). METHODS This retrospective cohort study used claims data from the IBM MarketScan Commercial and Medicare Supplemental Databases from January 1, 2014, through December 31, 2019. Insomnia and comorbid disease groups were defined using physician-assigned International Classification of Diseases diagnostic codes. Insomnia medication treatment was defined based on ≥1 prescription fills for the most commonly prescribed insomnia medications (zolpidem, low-dose trazodone, and benzodiazepines [as a class]). For each comorbid disease subgroup, 4 cohorts were created: (1) patients with either treated or untreated insomnia, (2) non-sleep-disordered controls, (3) patients with untreated insomnia, and (4) patients with treated insomnia. RESULTS Sample sizes for individuals with comorbid insomnia ranged from 23,168 (T2DM) to 3,015 (ADRDs). Within each disease subgroup and relative to non-sleep-disordered controls, patients with comorbid insomnia demonstrated greater adjusted health care resource utilization and costs across most points of service. Likewise, relative to individuals with untreated insomnia, those with treated insomnia generally demonstrated greater adjusted health care resource utilization and costs. CONCLUSIONS In this national analysis, both untreated comorbid insomnia and comorbid insomnia treated with commonly prescribed insomnia medications were associated with increased health care resource utilization and costs across most points of service. CITATION Wickwire EM, Juday TR, Kelkar M, Heo J, Margiotta C, Frech FH. Economic burden of comorbid insomnia in 5 common medical disease subgroups. J Clin Sleep Med. 2023;19(7):1293-1302.
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Affiliation(s)
- Emerson M. Wickwire
- Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
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18
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Wickwire EM, Juday TR, Gor D, Amari DT, Frech FH. Benzodiazepine Usage, Healthcare Resource Utilization, and Costs Among Older Adults Treated with Common Insomnia Medications: A Retrospective Cohort Study. CLINICOECONOMICS AND OUTCOMES RESEARCH 2023; 15:413-424. [PMID: 37287898 PMCID: PMC10243345 DOI: 10.2147/ceor.s406137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/29/2023] [Indexed: 06/09/2023] Open
Abstract
Background Benzodiazepines are commonly prescribed for insomnia management but are often associated with negative safety outcomes such as falls and abuse, particularly among older adults. Objective The purpose of this real-world study was to compare the impact of benzodiazepines, low-dose trazodone, and zolpidem immediate release (IR) on healthcare resource utilization (HCRU), and costs among older adults (age ≥ 65 years) with insomnia in the US. Methods Using the IBM MarketScan Medicare Supplemental Database, older adults with >1 physician-assigned diagnosis of insomnia and treated with benzodiazepines were matched 1:1 on age, sex, and index-date to individuals treated with trazodone, and separately matched 1:1 on age and sex, to individuals treated with zolpidem immediate release (IR). Between-groups differences were analyzed using general linear models (GLMs) that controlled for multiple confounders. Results Significant between-groups differences in HCRU and costs were observed such that relative to zolpidem IR and separately relative to low-dose trazodone, benzodiazepines were consistently associated with worsened outcomes. Conclusion These findings build upon and extend prior knowledge on the negative impact of benzodiazepines and suggest directions for future research.
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Affiliation(s)
- Emerson M Wickwire
- Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Timothy R Juday
- Health Economics & Outcomes Research, US Medical Affairs, Eisai Inc., Nutley, NJ, USA
| | - Deval Gor
- Real-World Evidence, Genesis Research, Hoboken, NJ, USA
| | - Diana T Amari
- Real-World Evidence, Genesis Research, Hoboken, NJ, USA
| | - Feride H Frech
- Health Economics & Outcomes Research, US Medical Affairs, Eisai Inc., Nutley, NJ, USA
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Othman A, Tashkandi A, Esilan H, Alfeheadi GM, Alqusair SA. Assessment of Insomnia Among Emergency Department Physicians in the Western Region of Saudi Arabia, 2023. Cureus 2023; 15:e40721. [PMID: 37485195 PMCID: PMC10360142 DOI: 10.7759/cureus.40721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/25/2023] Open
Abstract
Background Sleep is essential for physical and mental health, and insomnia is the most common sleep disorder. Insomnia is associated with multiple health issues that may affect physicians' health and their decision-making, and subsequently affect patients in the emergency department (ED). This study aimed to assess insomnia and its associated factors among ED physicians in the western region of Saudi Arabia. Methods A cross-sectional study was conducted using a validated online questionnaire to collect data from the target population. The questionnaire included demographic characteristics, the nature of the job, shift characteristics, and the Insomnia Severity Index tool. Data were analyzed using the statistical package for the social sciences (SPSS, version 29.0), and the Chi-square test was used for bivariate analysis. Results The study involved 106 ED physicians, primarily from Saudi Arabia, who worked in government hospitals and were mostly aged from 20 to 29 years old. Of the participants, 35.8% had moderate to severe clinical insomnia, with younger physicians experiencing more severe insomnia than their older colleagues. This highlights the potential role of age in the development of insomnia. No significant associations were found between insomnia severity and other demographic or work-related factors. Conclusion This study found a high prevalence of insomnia among ED physicians in Saudi Arabia, emphasizing the need for further research and interventions to address this issue. Improving the sleep quality of ED physicians is crucial for their health and well-being, as well as for the safety and quality of care provided to their patients.
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Affiliation(s)
- Ahmed Othman
- Emergency, Prince Mohammed Bin Abdulaziz Hospital, Madinah, SAU
| | - Abdulhadi Tashkandi
- Emergency Medicine, Prince Mohammed Bin Abdulaziz National Guard Hospital, Medinah- AlMunawarah, SAU
| | - Hattan Esilan
- Emergency Medicine, Prince Mohmmed Bin Abdulaziz Hospital, Madinah, SAU
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20
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Rojanapairat O, Beggs A, Zeidler M, Prasad B. Race and Socioeconomic Status: Interlinked Drivers of Sleep Health Disparities. Health Equity 2023; 7:307-311. [PMID: 37284532 PMCID: PMC10240326 DOI: 10.1089/heq.2023.0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 06/08/2023] Open
Abstract
The effect of race and socioeconomic status on sleep disorders has significant effects on the availability of healthcare and health outcomes. This paper examines how race and SES contribute to sleep health disparities, emphasizing the importance of understanding their impact on sleep disorders and treatment particularly in minority populations and veterans.
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Affiliation(s)
- Oragun Rojanapairat
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Abigail Beggs
- Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare, Los Angeles, California, USA
| | - Michelle Zeidler
- Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare, Los Angeles, California, USA
| | - Bharati Prasad
- Department of Medicine, Jesse Brown VA Medical Center and the University of Illinois at Chicago, Chicago, Illinois, USA
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21
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Olatunde K, Patton S. Association Between Insomnia and Healthcare Utilization: A Scoping Review of the Literature. Am J Lifestyle Med 2023. [DOI: 10.1177/15598276231164953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Insomnia is a sleep disorder that affects significant portion of the population. It can result in adverse health outcomes and increased healthcare utilization. The purpose of this review was to identify existing research on the association between insomnia and healthcare utilization. A five-stage scoping review process was conducted guided by the Joanna Briggs Institute process. Data sources searched through 2022 were PubMed, HINARI, Google Scholar and Cochrane, with additional studies identified through hand searching. Descriptive and exploratory analyses were conducted from the findings of the selected studies. After reviewing 124 references, 23 studies were selected. A strong and positive association between insomnia and healthcare utilization and healthcare costs was identified. We also found that insomnia was associated with absenteeism from work, lower work performance ratings, disability, difficulties in daily activities, and life dissatisfaction. An unexpected theme that emerged from the included studies is that there is a large population with persistent insomnia who do not seek help that could benefit from improved management. Findings suggest that identifying and managing insomnia could result in a decrease in healthcare utilization and costs. Further research is needed to determine the most effective methods of identifying and managing insomnia.
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Affiliation(s)
- Kolade Olatunde
- Department of Public Policy/Health Policy, University of Arkansas, Fayetteville, AR, USA
| | - Susan Patton
- Department of Nursing, University of Arkansas, Fayetteville, AR, USA
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Lalovic B, Savant Landry I, Moline M, Reyderman L, Hussein Z. Exposure-Response Analyses of Polysomnography and Subjective Sleep Efficacy End Points From the Phase 3 Trials of Lemborexant, a Dual Orexin Receptor Antagonist for the Treatment of Insomnia. J Clin Pharmacol 2023; 63:498-511. [PMID: 36524428 DOI: 10.1002/jcph.2192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022]
Abstract
This report describes polysomnography and sleep diary exposure-response analyses from Study E2006-G000-304 (Study 304), a 1-month trial of 5- or 10-mg lemborexant, zolpidem, or placebo; and Study E2006-G000-303 (Study 303), a 6-month trial of 5- or 10-mg lemborexant or placebo. Studies 304 and 303 included 1006 (86%) and 956 (68%) (female) participants, respectively; >40% were ≥65 years, with individual lemborexant exposures derived from a previously described pharmacokinetic model. Linear mixed-effects analyses of polysomnography: latency to persistent sleep (LPS), sleep efficiency (SE), and wake after sleep onset (WASO) quantified the change from baseline given lemborexant exposure, time, and covariates, guided by consensus recommendations regarding clinical significance. A small impact of sex, body weight, and race was predicted for LPS and SE, irrespective of treatment. Effect of age on LPS was small; baseline SE was estimated to be 8% higher for a 50-year-old versus an 80-year-old, decreasing to 6% by 1 month. Baseline WASO was 13 minutes longer for Black versus White subjects, corresponding to a 5-minute lower change from baseline at the end of the study. For subjective end points, the statistically significant covariate effects for age, sex, and race were not deemed therapeutically relevant, likely reflecting physiologic sleep pattern changes across age and study subgroups. Both polysomnography and subjective analyses indicated clinically meaningful differences from baseline for both lemborexant treatments, with effects being greater for 10-mg versus 5-mg lemborexant, while indicating that covariate-specific lemborexant dose adjustments are not warranted.
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Luyster FS, Boudreaux-Kelly MY, Bon JM. Insomnia in chronic obstructive pulmonary disease and associations with healthcare utilization and costs. Respir Res 2023; 24:93. [PMID: 36964552 PMCID: PMC10039604 DOI: 10.1186/s12931-023-02401-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/16/2023] [Indexed: 03/26/2023] Open
Abstract
Insomnia has been linked to adverse chronic obstructive pulmonary disease (COPD) outcomes including exacerbations, yet its impact on COPD-related healthcare utilization and costs is unknown. In this study, we investigated the associations between insomnia and healthcare utilization and costs in patients with COPD. A retrospective cohort of veterans with COPD were identified from national Veterans Affairs administration data for fiscal years 2012-2017. Insomnia was operationalized as having an insomnia diagnosis based on International Classification of Disease codes or having a prescription of > 30 doses of a sedative-hypnotic medication in a given fiscal year. The index date for insomnia was the first date when dual criteria for COPD and insomnia was met. The index date for those without insomnia was set as the COPD index date. Our primary outcomes were 1-year healthcare utilization and costs related to outpatient visits and hospitalizations after index date. COPD-related healthcare utilization variables included number of prescription fills of corticosteroids and/or antibiotics and outpatient visits and hospitalizations with a primary diagnosis of COPD. Out of 1,011,646 patients (96% men, mean age 68.4 years) diagnosed with COPD, 407,363 (38.8%) had insomnia. After adjustment for confounders, insomnia was associated with higher rates of outpatient visits, hospitalizations, and fills for corticosteroids and/or antibiotics, longer hospital length of stay, and $10,344 higher hospitalization costs in the 12 months after index date. These findings highlight the importance of insomnia as a potentially modifiable target for reducing the burden of COPD on patients and healthcare systems.
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Affiliation(s)
- Faith S Luyster
- School of Nursing, University of Pittsburgh, 3500 Victoria St, 415 Victoria Building, Pittsburgh, PA, 15241, USA.
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
| | | | - Jessica M Bon
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
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Chalet FX, Saskin P, Ahuja A, Thompson J, Olopoenia A, Modi K, Morin CM, Wickwire EM. The Associations between Insomnia Severity and Health Outcomes in the United States. J Clin Med 2023; 12:jcm12062438. [PMID: 36983438 PMCID: PMC10053531 DOI: 10.3390/jcm12062438] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/15/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Little is known about the associations between insomnia severity, insomnia symptoms, and key health outcomes. Using 2020 United States National Health and Wellness Survey (NHWS) data, we conducted a retrospective, cross-sectional analysis to determine the associations between insomnia severity and a number of health outcomes germane to patients (health-related quality of life (HRQoL), employers and government (workplace productivity), and healthcare payers (healthcare resource utilization (HCRU)). The Insomnia Severity Index (ISI) questionnaire was used to evaluate overall insomnia severity. HRQoL was assessed using the physical and mental component summary scores of the Short Form-36v2 (SF-36v2) questionnaire, and health utility status was measured using the Short Form-6D (SF-6D) and EuroQoL-5D (EQ-5D) questionnaires. Workplace productivity was measured using the Work Productivity and Activity Impairment (WPAI) questionnaire. After adjusting for confounders, greater insomnia severity was significantly associated with worsened quality of life, decreased productivity, and increased HCRU in an apparent linear fashion. These findings have important implications for future research, including the need for specific assessment of insomnia symptoms and their impact on key health outcomes.
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Affiliation(s)
| | - Paul Saskin
- Idorsia Pharmaceuticals US Inc., One Radnor Corporate Center, Suite 101, 100 Matsonford Rd, Radnor, PA 19087, USA
| | - Ajay Ahuja
- Idorsia Pharmaceuticals US Inc., One Radnor Corporate Center, Suite 101, 100 Matsonford Rd, Radnor, PA 19087, USA
| | | | | | - Kushal Modi
- Cerner Enviza, 51 Valley Stream Pkwy, Malvern, PA 19355, USA
| | - Charles M Morin
- Department of Psychology, Cervo Brain Research Centre, Laval University, Québec City, QC G1V 0A6, Canada
| | - Emerson M Wickwire
- Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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25
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Impact of Gender on Insomnia. Brain Sci 2023; 13:brainsci13030480. [PMID: 36979290 PMCID: PMC10046211 DOI: 10.3390/brainsci13030480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 03/16/2023] Open
Abstract
There is a distinct preponderance of female insomniacs when compared to male insomniacs. The aim of this study was to examine possible gender differences in the causes for insomnia, and the phenotypes of insomnia, and to investigate whether gender-specific insomnia diagnosis and treatment could be relevant in clinical practice. Data were collected from 121 insomniac patients by a medical specialist in the framework of normal clinical practice in Germany. The data consist of the patient’s medical history and various sleep-related patient questionnaires. Data from both genders were tested for independence using chi-square tests and Mann–Whitney U tests. We found a correlation between the gender of the patient and insomnia phenotypes in several aspects: concomitant lipometabolic disorders, diabetes mellitus, and high BMIs are more common in male insomniacs (p < 0.05). Frequency of insomnia occurrence in certain age groups, insomnia severity, distribution of SOI (sleep onset insomnia), SMI (sleep maintenance insomnia) and combined SOI + SMI, sleep duration, the time needed to seek medical consultation, trying out sleep-inducing drugs/techniques and the trigger, etiology and familial predisposition of the insomniac disorder were independent of the patient’s gender. We would like to re-evaluate the results with a larger number of patients in a further study.
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Park K, Kim J. Longitudinal association between perceived discrimination and sleep problems among young adults in the United States: Tests of moderation by race/ethnicity and educational attainment. Soc Sci Med 2023; 321:115773. [PMID: 36801753 DOI: 10.1016/j.socscimed.2023.115773] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 01/26/2023] [Accepted: 02/10/2023] [Indexed: 02/17/2023]
Abstract
RATIONALE Although perceived discrimination is known to affect sleep, the findings of previous research are limited because they are mostly based on either cross-sectional data or non-generalizable samples, such as clinical samples. There is also little evidence on whether perceived discrimination differently affects sleep problems across different groups. OBJECTIVE This study examines whether perceived discrimination is related to sleep problems when considering unmeasured confounding factors and how that relationship varies by race/ethnicity and socioeconomic status from a longitudinal perspective. METHODS This study uses Waves 1, 4, and 5 of the National Longitudinal Study of Adolescent to Adult Health (Add Health) and conducts hybrid panel modeling to estimate both within- and between-individual effects of perceived discrimination on sleep problems. RESULTS First, the results of the hybrid modeling show that increased perceived discrimination in daily life is related to poorer sleep quality when accounting for unobserved heterogeneity as well as time-constant and time-varying covariates. Moreover, the moderation analyses and the subgroup analyses demonstrate that the association was not found among Hispanics and among those with a bachelor's degree or more. That is, Hispanic origin and college attainment weaken the associations between perceived discrimination and sleep problems, and the differences by race/ethnicity and socioeconomic status are statistically significant. CONCLUSIONS This study suggests a robust link between discrimination and sleep problems and further elaborates on whether this association varies among different groups. Efforts to reduce interpersonal and institutional discrimination (e.g., discrimination at the workplace or in the community) can help to improve sleep problems and thereby promote overall health. We also suggest that future research consider the moderating roles of susceptible and resilient factors in the relationships between discrimination and sleep.
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Affiliation(s)
- Kiwoong Park
- Department of Sociology, University of New Mexico, Albuquerque, NM, USA
| | - Jinho Kim
- Department of Health Policy and Management, Korea University, Seoul, Republic of Korea; Interdisciplinary Program in Precision Public Health, Korea University, Seoul, Republic of Korea.
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Chekani F, Zhu Z, Khandker RK, Ai J, Meng W, Holler E, Dexter P, Boustani M, Ben Miled Z. Modeling acute care utilization: practical implications for insomnia patients. Sci Rep 2023; 13:2185. [PMID: 36750631 PMCID: PMC9905481 DOI: 10.1038/s41598-023-29366-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
Machine learning models can help improve health care services. However, they need to be practical to gain wide-adoption. In this study, we investigate the practical utility of different data modalities and cohort segmentation strategies when designing models for emergency department (ED) and inpatient hospital (IH) visits. The data modalities include socio-demographics, diagnosis and medications. Segmentation compares a cohort of insomnia patients to a cohort of general non-insomnia patients under varying age and disease severity criteria. Transfer testing between the two cohorts is introduced to demonstrate that an insomnia-specific model is not necessary when predicting future ED visits, but may have merit when predicting IH visits especially for patients with an insomnia diagnosis. The results also indicate that using both diagnosis and medications as a source of data does not generally improve model performance and may increase its overhead. Based on these findings, the proposed evaluation methodologies are recommended to ascertain the utility of disease-specific models in addition to the traditional intra-cohort testing.
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Affiliation(s)
| | - Zitong Zhu
- Computer Science, IUPUI, Indianapolis, IN, 46202, USA
| | | | - Jizhou Ai
- Merck & Co., Inc., Rahway, NJ, 07065, USA
| | | | - Emma Holler
- School of Public Health, Indiana University, Bloomington, IN, 47405, USA
| | - Paul Dexter
- School of Medicine, Indiana University, Indianapolis, IN, 46202, USA.,Regenstrief Institute, Indianapolis, IN, 46202, USA
| | - Malaz Boustani
- School of Medicine, Indiana University, Indianapolis, IN, 46202, USA.,Regenstrief Institute, Indianapolis, IN, 46202, USA
| | - Zina Ben Miled
- Regenstrief Institute, Indianapolis, IN, 46202, USA. .,Electrical and Computer Engineering, IUPUI, Indianapolis, IN, 46202, USA.
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Tegeler CL, Munger Clary H, Shaltout HA, Simpson SL, Gerdes L, Tegeler CH. Cereset Research Standard Operating Procedures for Insomnia: A Randomized, Controlled Clinical Trial. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2023; 12:27536130221147475. [PMID: 36816469 PMCID: PMC9933987 DOI: 10.1177/27536130221147475] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 11/29/2022] [Accepted: 12/06/2022] [Indexed: 01/19/2023]
Abstract
Background Interventions for insomnia that also address autonomic dysfunction are needed. Objective We evaluate Cereset Research™ Standard Operating Procedures (CR-SOP) in a pilot randomized, controlled trial. CR-SOP is a less operator-dependent, more generalizable innovation of HIRREM®, a noninvasive, closed-loop, allostatic, acoustic stimulation neurotechnology demonstrated to improve insomnia and autonomic function. Methods Adults with Insomnia Severity Index (ISI) scores of ≥8 were randomized to receive ten sessions of CR-SOP, with tones linked to brainwaves (LB, intervention), or a sham condition of random tones not linked to brainwaves (NL, control). Measures were collected at enrollment and 0-14 days and 4-6 weeks post-allocated intervention. The primary outcome was differential change in ISI from baseline to 4-6 weeks post-intervention. Secondary self-report measures assessed sleep quality65 and behavioral outcomes. Ten-minute recordings of heart rate and blood pressure were collected to analyze autonomic function (heart rate variability [HRV] and baroreflex sensitivity). Results Of 22 randomized, 20 participants completed the allocated condition. Intention to treat analysis of change from baseline to the 4-6 week outcome demonstrated mean ISI score reduction of 4.69 points among controls (SE 1.40). In the intervention group, there was an additional 2.58 point reduction in ISI score (SE 2.13; total reduction of 7.27, P = .24). Sleep quality and some measures of autonomic function improved significantly among the intervention group compared to control. Conclusions This pilot study compared use of a standardized, allostatic, acoustic neurotechnology intervention with a sham, active control condition. The magnitude of change in insomnia severity was clinically relevant and similar to the findings in a prior, fully powered trial, but the differential improvement observed was not statistically significant. Significant improvements were demonstrated in sleep quality and some autonomic function measures.
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Affiliation(s)
- Catherine L. Tegeler
- Department of Neurology, Wake Forest School of Medicine (WFSM), Winston-Salem, NC, USA
| | - Heidi Munger Clary
- Department of Neurology, Wake Forest School of Medicine (WFSM), Winston-Salem, NC, USA
| | | | - Sean L. Simpson
- Department of Biostatistics and Data Sciences, WFSM, Winston-Salem, NC, USA
| | - Lee Gerdes
- Brain State Technologies, LLC, Scottsdale, AZ, USA
| | - Charles H. Tegeler
- Department of Neurology, Wake Forest School of Medicine (WFSM), Winston-Salem, NC, USA,Charles H. Tegeler, MD, Department of Neurology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1078, USA.
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29
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Carvalhas-Almeida C, Cavadas C, Álvaro AR. The impact of insomnia on frailty and the hallmarks of aging. Aging Clin Exp Res 2023; 35:253-269. [PMID: 36583849 PMCID: PMC9895045 DOI: 10.1007/s40520-022-02310-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/21/2022] [Indexed: 12/31/2022]
Abstract
Throughout the course of life, there are age-related changes in sleep. Despite these normal changes, there is a high percentage of older adults that report sleep dissatisfaction with a high pervasiveness of chronic insomnia, the most common sleep disorder worldwide, with its prevalence being expected to continuously increase due to the growing rates of aging and obesity. This can have different adverse health outcomes, especially by promoting both physical and cognitive decline, which ultimately may aggravate frailty in older adults. Moreover, age-related frailty and sleep dysfunction may have a common mechanism related to the hallmarks of cellular aging. Cellular aging was categorized into nine hallmarks, such as DNA damage, telomere attrition and epigenetic changes. In the context of geriatric and chronic insomnia research, this review aims at discussing the current evidence from both animal models and human cohorts addressing the link between chronic insomnia, the hallmarks of aging and their impact on frailty. Moreover, the most recent research about the putative effect of insomnia therapeutic approaches on hallmarks of aging will be also highlighted.
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Affiliation(s)
- Catarina Carvalhas-Almeida
- CNC-Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
- Centre for Innovation in Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
- Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
- EIT Health Ageing PhD School and Multidisciplinary Institute of Ageing (MIA-Portugal), Coimbra, Portugal
| | - Cláudia Cavadas
- CNC-Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
- Centre for Innovation in Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
- Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
- Institute for Interdisciplinary Research (IIIUC), University of Coimbra, Coimbra, Portugal
| | - Ana Rita Álvaro
- CNC-Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal.
- Centre for Innovation in Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal.
- Institute for Interdisciplinary Research (IIIUC), University of Coimbra, Coimbra, Portugal.
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Yamamoto M, Lim CT, Huang H, Spottswood M, Huang H. Insomnia in primary care: Considerations for screening, assessment, and management. THE JOURNAL OF MEDICINE ACCESS 2023; 7:27550834231156727. [PMID: 36938324 PMCID: PMC10021100 DOI: 10.1177/27550834231156727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/25/2023] [Indexed: 03/17/2023]
Abstract
Insomnia, including insomnia disorder, is a common but often overlooked complaint in primary care settings. It is a risk factor for various medical and psychiatric diagnoses and is associated with substantial health care costs. While cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment for insomnia disorder, access to CBT-I is limited. This article provides a pragmatic approach to screening, assessment, and treatment of insomnia in the primary care setting, promoting a population health approach. The authors review the role of CBT-I, treatment of comorbid conditions, and pharmacologic recommendations in working with primary care patients with insomnia. In addition, the authors highlight the potential utility of technology in improving access to insomnia care.
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Affiliation(s)
- Mari Yamamoto
- Department of Family Medicine,
University of Washington School of Medicine, Seattle, WA, USA
- Mari Yamamoto, Department of Family
Medicine, University of Washington School of Medicine, Seattle, WA 98125, USA.
| | - Christopher T Lim
- Department of Psychiatry, Boston
Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Heather Huang
- Departments of Internal Medicine and
Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison,
WI, USA
| | - Margaret Spottswood
- Department of Psychiatry, University of
Vermont College of Medicine, Burlington, VT, USA
- Community Health Centers of Burlington,
Burlington, VT, USA
| | - Hsiang Huang
- Department of Psychiatry, Cambridge
Health Alliance, Cambridge, MA, USA
- Harvard Medical School, Boston, MA,
USA
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Die Wirksamkeit einer videogestützten psychoedukativen Selbsthilfe zur Behandlung der Insomnie. SOMNOLOGIE 2022. [DOI: 10.1007/s11818-022-00393-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Chaput JP, Janssen I, Sampasa-Kanyinga H, Carney CE, Dang-Vu TT, Davidson JR, Robillard R, Morin CM. Economic burden of insomnia symptoms in Canada. Sleep Health 2022; 9:185-189. [PMID: 36319579 DOI: 10.1016/j.sleh.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/14/2022] [Accepted: 09/24/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To estimate health care and productivity costs associated with insomnia symptoms in Canadian adults. METHODS Three pieces of information were needed to calculate estimates based on a prevalence-based approach: (1) the pooled relative risk estimates of health outcomes consistently associated with insomnia symptoms obtained from recent meta-analyses of prospective cohort studies; (2) the direct (health care) and indirect (lost productivity due to premature mortality) costs of these health outcomes using the Economic Burden of Illness in Canada information; and (3) the prevalence of insomnia symptoms in Canadian men (18.1%) and women (29.5%) obtained from a nationally-representative survey. RESULTS The direct, indirect, and total costs of insomnia symptoms in Canada in 2021 were $1.9 billion, $12.6 million, and $1.9 billion, respectively. This value represents 1.9% of the overall burden of illness costs for 2021 in Canada. The 2 most expensive chronic diseases attributable to insomnia symptoms were type 2 diabetes ($754 million) and depression ($706 million). The main contributor to the costs for type 2 diabetes and depression was prescription drugs. A 5% decrease in insomnia symptoms (from 23.8% to 18.8%) would result in an estimated $353 million in avoided costs while a 5% increase in insomnia symptoms (from 23.8% to 28.8%) would result in an estimated $333 million in additional expenditures yearly. CONCLUSIONS Insomnia symptoms greatly contribute to the economic burden of illness in Canada. Reducing the prevalence of insomnia symptoms would reduce its societal burden.
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Affiliation(s)
- Jean-Philippe Chaput
- Healthy Active Living and Obesity Research Group, CHEO Research Institute, Ottawa, Ontario, Canada; Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Ian Janssen
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada; Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Hugues Sampasa-Kanyinga
- Healthy Active Living and Obesity Research Group, CHEO Research Institute, Ottawa, Ontario, Canada
| | - Colleen E Carney
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Thien Thanh Dang-Vu
- Institut Universitaire de Gériatrie de Montréal and CRIUGM, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada; PERFORM Centre, Center for Studies in Behavioral Neurobiology, Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Quebec, Canada
| | - Judith R Davidson
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Rebecca Robillard
- The University of Ottawa Institute of Mental Health Research at The Royal, Ottawa, Ontario, Canada; School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Charles M Morin
- School of Psychology, Laval University, Quebec City, Quebec, Canada
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Forma F, Pratiwadi R, El-Moustaid F, Smith N, Thorndike F, Velez F. Network meta-analysis comparing the effectiveness of a prescription digital therapeutic for chronic insomnia to medications and face-to-face cognitive behavioral therapy in adults. Curr Med Res Opin 2022; 38:1727-1738. [PMID: 35938209 DOI: 10.1080/03007995.2022.2108616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the effectiveness of the only Food and Drug Administration-authorized prescription digital therapeutic (PDT) Somryst versus face-to-face cognitive behavioral therapy for insomnia (CBT-I), or FDA-approved prescription medications for insomnia. METHODS A systematic literature review was undertaken to identify relevant studies. A Bayesian network meta-analysis (NMA) was conducted to examine (1) mean change in insomnia severity index (ISI); (2) proportional change in ISI remitters; (3) mean change in wake after sleep onset (WASO); and (4) mean change in sleep onset latency (SOL). RESULTS Twenty studies provided data on the PDT, CBT-I, CBT-I in combination with self-help (SH), or two prescription medications (eszopiclone and zolpidem). The PDT was associated with significant mean change in ISI (-5.77, 95% Credible Interval [CrI] - 8.53, -3.07) and ISI remitters (OR 12.33; 95% CrI 2.28, 155.91) compared to placebo, and had the highest probability of being the most effective treatment overall for ISI mean change (56%), and ISI remitters (64%). All evaluated interventions significantly outperformed placebo for WASO but no significant differences were observed for SOL (five interventions). Sensitivity analyses excluding medications and meta-regression (assessing type, duration, delivery method for CBT-I) did not affect NMA results. CONCLUSIONS This network meta-analysis demonstrated that a PDT delivering CBT-I had the highest probability of being most effective compared to face-to-face CBT-I, prescription sleep medications, or placebo, as measured by reductions in mean ISI score from baseline and ISI-determined remittance.
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Robinson CL, Supra R, Downs E, Kataria S, Parker K, Kaye A, Viswanath O, Urits I. Daridorexant for the Treatment of Insomnia. Health Psychol Res 2022; 10:37400. [PMID: 36045942 DOI: 10.52965/001c.37400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 07/19/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose of Review Insomnia is a complex sleeping disorder that affects the lives of many individuals worldwide. Insomnia often occurs in the presence of coexisting comorbidities making it a complex disorder that requires a multifactorial approach to therapy. First-line therapy is cognitive-behavioral therapy for insomnia (CBT-I). Pharmacotherapy for insomnia falls into four classes based on mechanism of action: benzodiazepine receptor agonists (BZRAs), histamine receptor antagonists, melatonin receptor agonists, and dual orexin receptor antagonists (DORAs). Recent Findings Daridorexant is a dual orexin type 1 and types 2 (OX1 and OX2) receptor antagonist that was recently approved by the US FDA for the treatment of adults suffering from insomnia. It was shown to be effective in reducing insomnia symptoms, increasing daytime functioning, and improving the overall quality of sleep. Daridorexant offers patients relief from insomnia while avoiding the severe side effects and dependency issues of traditional treatments like benzodiazepines and sedatives. Summary In this article, we review the most recent data on insomnia treatments and summarize the safety and efficacy of daridorexant in treating insomnia.
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Affiliation(s)
| | | | - Evan Downs
- Louisiana State University Health New Orleans School of Medicine
| | - Saurabh Kataria
- Department of Neurology, Louisiana State University Health Science Center at Shreveport
| | - Katelyn Parker
- Louisiana State University Health New Orleans School of Medicine
| | - Alan Kaye
- Department of Anesthesia, Louisiana State University Health New Orleans School of Medicine
| | - Omar Viswanath
- Envision Physician Services, Valley Anesthesiology and Pain Consultants
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35
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Forma F, Knight TG, Thorndike FP, Xiong X, Baik R, Velez FF, Maricich YA, Malone DC. Real-World Evaluation of Clinical Response and Long-Term Healthcare Resource Utilization Patterns Following Treatment with a Digital Therapeutic for Chronic Insomnia. CLINICOECONOMICS AND OUTCOMES RESEARCH 2022; 14:537-546. [PMID: 35983014 PMCID: PMC9379126 DOI: 10.2147/ceor.s368780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/01/2022] [Indexed: 11/23/2022] Open
Abstract
Background and Objectives This analysis evaluated insomnia severity and long-term impact on healthcare resource utilization (HCRU) and costs after treatment with Somryst® (previously called SHUTi), a digital therapeutic delivering cognitive behavioral therapy for insomnia (CBT-I). Methods Change from baseline in insomnia severity index (ISI) score was assessed using last observed ISI score. A pre/post analysis of claims data was conducted, comparing HCRU in patients with self-identified sleep problems who successfully initiated the therapeutic (index date) between June 1, 2016 and December 31, 2018. Results A total of 248 patients were analyzed (median age 56.5 years, 57.3% female, mean ISI score 19.13, 52.4% treated with sleep aid medications pre-index). After 9 weeks, mean ISI score declined by 37.2% from baseline (19.1 vs 12.0), 58.8% of patients achieved ISI responder status (ISI score improved by =>7; NNT: 1.7), and 26.6% of patients achieved insomnia remission (ISI score <8; NNT for remission: 3.8). After two-year follow-up, post-index events were reduced (compared to 2 years pre-index) for emergency department visits (-53%; IRR: 0.47; 95% CI 0.27, 0.82; P=0.008), hospiatizations (-21%; IRR: 0.79; 95% CI 0.46, 1.35; P=0.389) and hospital outpatient visits (-13%; IRR: 0.87; 95% CI 0.66, 1.14; P=0.315). Slightly increased rates were observed for ambulatory surgical center visits (2%; IRR: 1.02; 95% CI 0.73, 1.44; P=0.903) and office visits (2%; IRR: 1.02; 95% CI 0.92, 1.14; P=0.672). The number of patients treated with sleep aid medications dropped 18.5% (52.4% pre-index vs 42.7% post-index). Average number of prescriptions decreased from 3.98 pre-index to 3.73 post-index (P= 0.552). Total two-year cost reduction post-index vs pre-index was $510,678, or -$2059 per patient. Conclusion In a real-world cohort of patients with chronic insomnia, treatment with a digital therapeutic delivering CBT-I was associated with reductions in insomnia severity, emergency department visits, and net costs.
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Affiliation(s)
- Felicia Forma
- Pear Therapeutics, Inc., Medical Affairs Department, Boston, MA, USA
| | - Tyler G Knight
- Labcorp Drug Development, Market Access Consulting Department, Gaithersburg, MD, USA
| | | | - Xiaorui Xiong
- Pear Therapeutics, Inc., Medical Affairs Department, Boston, MA, USA
| | - Rebecca Baik
- Labcorp Drug Development, Market Access Consulting Department, Gaithersburg, MD, USA
| | - Fulton F Velez
- Pear Therapeutics, Inc., Medical Affairs Department, Boston, MA, USA
| | - Yuri A Maricich
- Pear Therapeutics, Inc., Medical Affairs Department, Boston, MA, USA
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36
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Amari DT, Juday T, Frech FH, Wang W, Wu Z, Atkins N, Wickwire EM. Falls, healthcare resources and costs in older adults with insomnia treated with zolpidem, trazodone, or benzodiazepines. BMC Geriatr 2022; 22:484. [PMID: 35658904 PMCID: PMC9166444 DOI: 10.1186/s12877-022-03165-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 05/23/2022] [Indexed: 11/24/2022] Open
Abstract
Background Falls are the leading cause of injury-related death among older Americans. While some research has found that insomnia heightens falls, health care resource utilization (HCRU) and costs, the impact of insomnia treatments on fall risk, mortality, HCRU and costs in the elderly population, which could be of substantial interest to payers, has not been fully elucidated. This study evaluated the risk of falls and related consequences among adults ≥ 65 years of age treated with common prescription medications for insomnia compared with non-sleep disordered controls. Methods This was a retrospective cohort analysis of deidentified Medicare claims from January 2011 through December 2017. Medicare beneficiaries treated for insomnia receiving zolpidem extended-release, zolpidem immediate-release, trazodone, or benzodiazepines were matched with non-sleep disordered controls. The main outcomes were falls, mortality, healthcare resource utilization (HCRU), and medical costs during the 12 months following the earliest fill date for the insomnia medication of interest. Generalized linear models controlled for several key covariates, including age, race, sex, geographic region and Charlson Comorbidity Index score. Results The study included 1,699,913 Medicare beneficiaries (59.9% female, mean age 75 years). Relative to controls, adjusted analyses showed that beneficiaries receiving insomnia medication experienced over twice as many falls (odds ratio [OR] = 2.34, 95% CI: 2.31–2.36). In adjusted analyses, patients receiving benzodiazepines or trazodone had the greatest risk. Crude all-cause mortality rates were 15-times as high for the insomnia-treated as controls. Compared with controls, beneficiaries receiving insomnia treatment demonstrated higher estimated adjusted mean number of inpatient, outpatient, and emergency department visits and longer length of inpatient stay. All-cause total adjusted mean costs were higher among insomnia treated patients ($967 vs $454). Conclusions Individuals receiving insomnia treatment had an increased risk of falls and mortality and higher HCRU and costs compared with matched beneficiaries without sleep disorders. Trazodone and benzodiazepines were associated with the greatest risk of falls. This analysis suggests that significant risks are associated with common, older generation insomnia medication treatments in the elderly. Nonetheless, these results should be interpreted with caution as the use of these medications may be indicative of underlying morbidity with potential for residual confounding. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03165-6.
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Landry I, Hall N, Aluri J, Filippov G, Setnik B, Dayal S, Reyderman L, Moline M. Effect of alcohol coadministration on the pharmacodynamics, pharmacokinetics, and safety of lemborexant: A randomized, placebo-controlled crossover study. J Psychopharmacol 2022; 36:745-755. [PMID: 35634694 PMCID: PMC9150140 DOI: 10.1177/02698811221080459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Lemborexant is a dual orexin receptor antagonist approved to treat insomnia in adults in several countries including the USA, Canada, and Japan. AIMS This study was conducted to investigate effects of lemborexant and alcohol coadministration on postural stability, cognitive performance, and the pharmacokinetics, safety, and tolerability of lemborexant. METHODS This was a Phase 1, double-blind, placebo-controlled, four-period crossover study in 32 healthy adults. Individuals were randomized into one of four treatment sequences to receive single doses of placebo, lemborexant 10 mg (LEM10), alcohol (males, 0.7 g/kg; females, 0.6 g/kg), and LEM10 plus alcohol, each separated by a 14-day washout. Postural stability (body sway) was measured by ataxiameter and a cognitive performance assessment battery evaluated four domains of attention and memory. RESULTS Pharmacodynamic outcomes were analyzed for the 18 participants who completed all four treatments. Change from baseline in body sway showed no significant differences between lemborexant plus alcohol versus alcohol alone. Compared with alcohol alone, coadministration of lemborexant with alcohol showed additive negative effects on cognitive performance domains, corresponding approximately with peak plasma lemborexant concentrations (median = 1.5 h). Cognitive performance was also impaired with lemborexant alone at 0.5 and 2 h in this experimental paradigm with morning dosing. Alcohol increased plasma lemborexant exposure by 70% based on area under the curve to 72 h, and increased peak plasma lemborexant concentrations by 35%. The most commonly reported treatment-emergent adverse event was somnolence. CONCLUSION Coadministration of lemborexant with alcohol showed additive negative effects on cognitive measures, but not on postural stability, compared with alcohol alone. Lemborexant exposure was increased with alcohol. Lemborexant alone or with alcohol was well tolerated. Patients are advised not to consume alcohol with lemborexant.
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Affiliation(s)
| | | | | | | | - Beatrice Setnik
- Syneos Health, Raleigh, NC, USA,Department of Toxicology & Pharmacology, University of Toronto, Toronto, ON, Canada
| | | | | | - Margaret Moline
- Eisai Inc., Nutley, NJ, USA,Margaret Moline, Clinical Research, Eisai Inc., 200 Metro Blvd, Nutley, NJ 07110, USA.
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Huyett P, Bhattacharyya N. The association between sleep disorders on employment and income among adults in the United States. J Clin Sleep Med 2022; 18:1967-1972. [PMID: 35499281 PMCID: PMC9340609 DOI: 10.5664/jcsm.10040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To examine the association between sleep disorders, employment status, and income among US adults aged 18-64 years. METHODS The 2018-2019 Medical Expenditure Panel Survey medical conditions file was queried for adults aged 18-64 years with a diagnosis of a sleep disorder (International Classification of Diseases, 10th Revision, code G47.x) and linked to the household dataset. Comparisons in rates of wage, supplemental, and social security income as well as mean wage income were made between those with and without sleep disorders. Multivariate analyses, adjusting for demographics and comorbidities, were conducted. RESULTS A sleep disorder was diagnosed in 4.4% ± 0.2% of the study population (approximately 8.8 ± 0.4 million adults aged 18-64 years in the United States; mean age 46.9 years, 55.8% female). Adults with sleep disorders were less likely to have wage income from employment (adjusted odds ratio 0.5, 95% confidence interval 0.4-0.6, P < .001) and more likely to have Supplemental Security (1.8, 1.4-2.4, P < .001) and Social Security income (2.0, 1.6-2.4, P < .001) compared with those without sleep disorders. Among wage-earning adults, those with sleep disorders had $2,496 less mean annual wage income compared with those without a sleep disorder ($20,445 vs $22,941, P = .007), adjusting for demographics and comorbidities. CONCLUSIONS There are significantly higher indirect costs associated with sleep disorders. This study specifically demonstrates lower employment rates, lower wages, and higher welfare income utilization among those with sleep disorders despite using a very conservative estimate of sleep disorder prevalence. CITATION Huyett P, Bhattacharyya N. The association between sleep disorders, employment, and income among adults in the United States. J Clin Sleep Med. 2022;18(8):1967-1972.
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Affiliation(s)
- Phillip Huyett
- Division of Sleep Medicine and Surgery, Department of Otolaryngology- Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
| | - Neil Bhattacharyya
- Department of Otolaryngology- Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
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Wickwire EM, Amari DT, Juday TR, Frech F, Gor D, Malhotra M. Incremental health care resource use and costs among adult patients with depression and treated for insomnia with zolpidem, trazodone, or benzodiazepines. Curr Med Res Opin 2022; 38:711-720. [PMID: 35262444 DOI: 10.1080/03007995.2022.2047537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To quantify health care resource utilization (HCRU) and costs associated with insomnia treated with commonly prescribed insomnia medications among patients with depression. METHODS A retrospective cohort study was conducted using IBM MarketScan Commercial and Medicare Supplemental Databases to identify adults with: (1) ≥1 ICD-9/ICD-10 code for depression; (2) ≥1 commonly prescribed medication for insomnia (zolpidem immediate release [IR], zolpidem extended release [ER], trazodone, or benzodiazepines); and (3) ≥12 months of eligibility before and after initiating insomnia medication. A 1:1 age- and sex-matched control cohort with depression but without sleep-related disorders was identified. Adjusted HCRU and costs were compared using generalized linear models. RESULTS A total of 21,027 patients (mean age = 48.3 years, 69.5% female) with depression and treated insomnia (D + TI; 1.9% zolpidem ER, 32.0% zolpidem IR, 50.0% trazodone, 16.1% benzodiazepines) were matched to controls. Although mean number of inpatient visits were similar (0.1 for both), relative to controls, D + TI had a higher mean number of ED (0.2 vs 0.1, p < .001) and outpatient visits (2.2 vs 1.3, p < .001). Adjusted total costs per patient per month were higher among D + TI patients ($2450 vs $1095, p < .001). Inpatient and ED costs were higher among patients prescribed zolpidem IR, trazodone, or benzodiazepines, but not zolpidem ER. CONCLUSIONS Relative to controls with depression but without sleep disorders, overall, health care costs for adults with D + TI were 2.2-fold higher; costs and HCRU varied by insomnia medication. Further study of the impact of newer insomnia treatments on patient outcomes in depression and comorbid insomnia is warranted.
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Affiliation(s)
- Emerson M Wickwire
- Department of Psychiatry, University of Maryland, Baltimore, MD, USA
- Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland, Baltimore, MD, USA
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40
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Effects of cognitive behavioral therapy for insomnia on subjective and objective measures of sleep and cognition. Sleep Med 2022; 97:13-26. [DOI: 10.1016/j.sleep.2022.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/02/2022] [Accepted: 05/16/2022] [Indexed: 11/17/2022]
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Ranney RM, Gloria R, Metzler TJ, Huggins J, Neylan TC, Maguen S. Brief behavioral treatment for insomnia decreases trauma-related nightmare frequency in veterans. J Clin Sleep Med 2022; 18:1831-1839. [PMID: 35393934 DOI: 10.5664/jcsm.10002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Trauma-related nightmares are highly prevalent among veterans and are associated with higher severity insomnia and PTSD. Cognitive behavioral therapy for insomnia (CBT-I, typically 6-8 sessions) has been shown to reduce trauma-related nightmares. Brief behavioral treatment for insomnia (BBTI, 4 sessions) has been found to be comparable to CBT-I in decreasing insomnia severity; however, the effects of BBTI on nightmares have not been investigated. The current study tested the effects of BBTI on both trauma-related nightmares and non-trauma-related bad dreams using an active control group, progressive muscle relaxation therapy (PMRT). Additionally, we tested whether baseline trauma-related nightmare frequency and baseline non-trauma-related bad dream frequency moderated changes in insomnia severity. METHODS Participants were 91 military veterans with insomnia disorder randomized to BBTI or PMRT. Participants reported insomnia severity on the Insomnia Severity Index and reported trauma-related nightmare frequency and non-trauma-related bad dream frequency on the Pittsburgh Sleep Quality Index--PTSD Addendum. RESULTS We found that BBTI significantly reduced trauma-related nightmares from baseline to post-treatment while PMRT did not. However, reductions in trauma-related nightmares were not maintained at six month follow up. Neither BBTI nor PMRT reduced non-trauma-related bad dreams from baseline to post-treatment. We also found that neither baseline trauma-related nightmare frequency nor baseline non-trauma-related bad dream frequency moderated changes in insomnia symptom severity. CONCLUSIONS Findings from the current study suggest that BBTI may help to reduce trauma-related nightmares. Further research is needed to better understand potential mechanisms underlying how improved sleep may reduce trauma-related nightmares. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Brief Behavioral Insomnia Treatment Study (BBTI); Identifier: NCT02571452; URL: https://clinicaltrials.gov/ct2/show/NCT02571452.
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Affiliation(s)
- Rachel M Ranney
- Veterans Affairs San Francisco Health Care System, San Francisco, CA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco School of Medicine, San Francisco, CA.,Sierra Pacific Mental Illness Research Education, and Clinical Center, San Francisco, CA
| | - Rebecca Gloria
- Veterans Affairs San Francisco Health Care System, San Francisco, CA
| | - Thomas J Metzler
- Veterans Affairs San Francisco Health Care System, San Francisco, CA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco School of Medicine, San Francisco, CA.,Sierra Pacific Mental Illness Research Education, and Clinical Center, San Francisco, CA
| | - Joy Huggins
- Veterans Affairs San Francisco Health Care System, San Francisco, CA
| | - Thomas C Neylan
- Veterans Affairs San Francisco Health Care System, San Francisco, CA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco School of Medicine, San Francisco, CA.,Sierra Pacific Mental Illness Research Education, and Clinical Center, San Francisco, CA
| | - Shira Maguen
- Veterans Affairs San Francisco Health Care System, San Francisco, CA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco School of Medicine, San Francisco, CA.,Sierra Pacific Mental Illness Research Education, and Clinical Center, San Francisco, CA
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Winegar R. Maladaptive coping mechanisms of sleep. Nurse Pract 2022; 47:30-38. [PMID: 35171865 DOI: 10.1097/01.npr.0000819624.10897.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Patients with insomnia have been shown to use many maladaptive coping mechanisms. This article examines the effect of such coping mechanisms on sleep quality by reviewing results of polysomnography and the Epworth Sleepiness Scale among 137 patients. The study showed that sleep quality was affected by these mechanisms.
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Affiliation(s)
- Rhonda Winegar
- Rhonda Winegar is Pre-Licensure BSN Program Director at Aspen University, Austin, Tex
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Amari DT, Juday TR, Frech FH, Wang W, Gor D, Atkins N, Wickwire EM. Fall Risk, Healthcare Resource Use, and Costs Among Adult Patients in the United States Treated for Insomnia with Zolpidem, Trazodone, or Benzodiazepines: A Retrospective Cohort Study. Adv Ther 2022; 39:1324-1340. [PMID: 35072889 DOI: 10.1007/s12325-022-02041-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/07/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Falls are a common cause for morbidity and mortality among patients taking prescription insomnia medication. The objective of this study is to compare the risk of falls, all-cause healthcare resource utilization (HCRU), and costs among patients treated with commonly used, older generation insomnia medications and non-sleep-disordered controls. METHODS This retrospective cohort study used the IBM® MarketScan® Commercial and Medicare Supplemental Databases to identify patients aged at least 18 years treated with commonly prescribed medications for insomnia (zolpidem, trazodone, benzodiazepines) between 1 January 2012 and 30 September 2017. The insomnia-treated cohort were age- and sex-matched (1:1) to non-sleep-disordered controls. Odds ratios (ORs) compared risk of falls in each cohort, adjusting for covariates. Costs were adjusted to 2018 dollars, the most recent year for the study data. RESULTS Relative to matched controls (n = 313,086), the insomnia-treated cohort had a higher rate of falls (3.34% vs. 1.33%), and higher risk of falls [OR = 2.36 (95% confidence interval 2.27-2.44)]. Relative to other index treatments, patients treated with trazodone had the greatest risk of falls. Compared with matched controls, the estimated mean number of inpatient visits, emergency department visits, outpatient visits, and mean length of inpatient stay were all significantly higher among patients treated for insomnia. Such patients incurred greater total costs per patient per month than matched controls ($2100 versus $888; estimated mean ratio, 2.36; 95% CI 2.35-2.38; p < 0.0001). CONCLUSIONS Relative to matched controls, the insomnia-treated cohort showed higher risk of falls with greater HCRU and costs. Each outcome measured was highest among patients treated with trazodone, relative to other index treatments. Findings suggest the need for new treatment options to optimize quality of care for patients with insomnia.
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Affiliation(s)
- Diana T Amari
- Genesis Research, 111 River Street, Ste 1120, Hoboken, NJ, 07030, USA
| | | | - Feride H Frech
- Eisai Inc., 100 Tice Blvd, Woodcliff Lake, NJ, 07677, USA
| | - Weiying Wang
- Genesis Research, 111 River Street, Ste 1120, Hoboken, NJ, 07030, USA
| | - Deval Gor
- Genesis Research, 111 River Street, Ste 1120, Hoboken, NJ, 07030, USA
| | - Norman Atkins
- Eisai Inc., 100 Tice Blvd, Woodcliff Lake, NJ, 07677, USA
| | - Emerson M Wickwire
- Department of Psychiatry, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD, 21201, USA
- Division of Pulmonary and Critical Care Medicine, Sleep Disorders Center, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD, 21201, USA
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Uchiyama M, Ito K, Okumura Y, Yi J, Crawford B, Abe M. Medical Costs Associated with Insomnia Treatment with Suvorexant Monotherapy in Japan: Results from a Retrospective Cohort Study Using a Large-Scale Claims Database. Drugs Real World Outcomes 2022; 9:219-229. [PMID: 35129832 PMCID: PMC9114234 DOI: 10.1007/s40801-021-00279-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 11/26/2022] Open
Abstract
Background The association of insomnia treatment with medical costs is not well characterized in Japan, despite the high economic burden of insomnia. Objective The aim of this study was to investigate the impact of suvorexant, the first dual orexin receptor antagonist, on direct medical costs in insomnia patients. Patients and Methods This retrospective cohort study, conducted using a large-scale claims database, included Japanese patients with diagnosed insomnia receiving suvorexant who were treatment naïve or treatment switchers (pre-treated with a different hypnotic and switched to suvorexant). Total medical costs were estimated for 1 year before and after suvorexant initiation; p-values were calculated for the difference in costs. Results Of the 1730 patients included, 1116 were treatment naïve and 614 were treatment switchers. Switching to suvorexant did not change the total treatment cost (US$4693–US$4692; p = 0.9964). Although treatment-naïve patients on average incurred US$3259 after suvorexant initiation, much of the additional cost was attributed to drugs other than hypnotics in the outpatient setting (US$332; p < 0.0001). While ~ 10% of the additional medical costs in the outpatient setting were attributable to hypnotics in both groups (treatment naïve: US$106, p < 0.0001; treatment switchers: US$115, p < 0.0001), no difference was observed in the inpatient setting. Conclusion Suvorexant as an initial insomnia treatment was associated with higher total medical costs, given the additional burden of initiating treatment and monitoring costs associated with a new insomnia diagnosis. However, despite a switch from another hypnotic, suvorexant did not increase the incremental economic burden. The hypnotic cost remained proportionately low, demonstrating that suvorexant initiation did not raise the cost of insomnia treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s40801-021-00279-y.
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Affiliation(s)
- Makoto Uchiyama
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
| | - Kaoru Ito
- Market Access, MSD K.K., Tokyo, Japan.
- Renagence LLC, 2-19-44 Takamatsu, Morioka, Iwate, 020-0114, Japan.
| | - Yasuyuki Okumura
- Department of Psychiatry and Behavioral Science, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Jingbo Yi
- Real World Evidence, Syneos Health, Tokyo, Japan
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Roth T, Rosenberg R, Morin CM, Yardley J, Pinner K, Perdomo C, Atkins N, Pappadopulos E, Malhotra M, Moline M. Impact of lemborexant treatment on insomnia severity: analyses from a 12-month study of adults with insomnia disorder. Sleep Med 2022; 90:249-257. [DOI: 10.1016/j.sleep.2022.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/13/2022] [Accepted: 01/27/2022] [Indexed: 11/26/2022]
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Wickwire EM, Abdelwadoud M, Collen J, Edwards H, Labra C, Capaldi VF, Williams SG, Manber R, Assefa SZ, Drake CL, Albrecht JS, Bevan J, Mahoney A, Tatum ED, Pierre E, Mantua J, Grandner MA, Mullins CD. Active Duty Service Members, Primary Managers, and Administrators' Perspectives on a Novel Sleep Telehealth Management Platform in the U.S. Military Healthcare System. Mil Med 2022; 187:e1201-e1208. [PMID: 35089344 DOI: 10.1093/milmed/usac006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/29/2021] [Accepted: 01/10/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Sleep disorders are common in the military, and there is a gross shortage of sleep specialists in the military health system. The purposes of the present study were to (1) understand perceptions and expectations surrounding sleep telehealth approaches and (2) solicit feedback to optimize and refine a proposed novel sleep telehealth management platform. To accomplish these objectives, we investigated the perceptions, expectations, and preferences of active duty service members (ADSMs) with sleep disorders, primary care managers (PCMs), and administrative stakeholders regarding sleep telehealth management. MATERIALS AND METHODS Using convenience sampling, we conducted five focus groups with 26 ADSMs and 11 individual interviews with PCMs from two military treatment facilities in the U.S National Capital Region and 11 individual interviews with administrative sleep stakeholders (9 military and 2 civilian). RESULTS Active duty service members, PCMs, and administrative stakeholders provided insight regarding expectations for sleep telehealth as well as suggestions to optimize the novel sleep telehealth platform. In terms of outcomes, ADSMs expected sleep telehealth to improve sleep and convenience. Primary care managers expected improved sleep and other comorbidities, enhanced operational readiness, and reduced mortalities among their patients. Administrators expected increased access to care, optimized utilization of health services, realized cost savings, reduced accidents and errors, and improved military performance. In terms of the platform, for ADSMs, desired characteristics included delivery of timely clinical reports, improved patient-provider communication, and enhanced continuity of care. For PCMs and administrators,an ideal sleep telehealth solution will improve the diagnosis and triage of sleep patients, save PCM time, be easy to use, and integrate with the electronic health record system. CONCLUSION The proposed sleep telehealth platform appealed to nearly all participants as a significant force multiplier to enhance sleep disorder management in the military. Stakeholders offered valuable recommendations to optimize the platform to ensure its successful real-world implementation.
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Affiliation(s)
- Emerson M Wickwire
- Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Moaz Abdelwadoud
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA
| | - Jacob Collen
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Walter Reed National Military Medical Center, Sleep Disorders Center, Silver Spring, MD 20814, USA
| | - Hillary Edwards
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA
| | - Christian Labra
- Department of Family Medicine, Fort Belvoir Community Hospital, Ft Belvoir, VA 22060, USA
| | - Vincent F Capaldi
- Center For Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Scott G Williams
- Center For Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Rachel Manber
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Palo Alto, CA 94305, USA
| | - Samson Z Assefa
- Sleep Medicine Clinic, Fort Belvoir Community Hospital, Ft Belvoir, VA 22060, USA
| | | | - Jennifer S Albrecht
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Jeffrey Bevan
- Department of Family Medicine, Fort Belvoir Community Hospital, Ft Belvoir, VA 22060, USA
| | - Alexandra Mahoney
- Department of Family Medicine, Fort Belvoir Community Hospital, Ft Belvoir, VA 22060, USA
| | - Eileen D Tatum
- Department of Family Medicine, Fort Belvoir Community Hospital, Ft Belvoir, VA 22060, USA
| | - Elysse Pierre
- Department of Family Medicine, Fort Belvoir Community Hospital, Ft Belvoir, VA 22060, USA
| | - Janna Mantua
- Center For Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Michael A Grandner
- Department of Psychiatry, University of Arizona College of Medicine, Tucson, AZ 85724, USA
| | - C Daniel Mullins
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA
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47
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Wickwire EM, Albrecht JS, Capaldi VF, Jain SO, Gardner RC, Werner JK, Mukherjee P, McKeon AB, Smith MT, Giacino JT, Nelson LD, Williams SG, Collen J, Sun X, Schnyer DM, Markowitz AJ, Manley GT, Krystal AD. Trajectories of Insomnia in Adults After Traumatic Brain Injury. JAMA Netw Open 2022; 5:e2145310. [PMID: 35080600 PMCID: PMC8792888 DOI: 10.1001/jamanetworkopen.2021.45310] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
IMPORTANCE Insomnia is common after traumatic brain injury (TBI) and contributes to morbidity and long-term sequelae. OBJECTIVE To identify unique trajectories of insomnia in the 12 months after TBI. DESIGN, SETTING, AND PARTICIPANTS In this prospective cohort study, latent class mixed models (LCMMs) were used to model insomnia trajectories over time and to classify participants into distinct profile groups. Data from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study, a longitudinal, multisite, observational study, were uploaded to the Federal Interagency Traumatic Brain Injury Repository (FITBIR) database. Participants were enrolled at 1 of 18 participating level I trauma centers and enrolled within 24 hours of TBI injury. Additional data were obtained directly from the TRACK-TBI investigators that will be uploaded to FITBIR in the future. Data were collected from February 26, 2014, to August 8, 2018, and analyzed from July 1, 2020, to November 15, 2021. EXPOSURES Traumatic brain injury. MAIN OUTCOMES AND MEASURES Insomnia Severity Index assessed serially at 2 weeks and 3, 6, and 12 months thereafter. RESULTS The final sample included 2022 participants (1377 [68.1%] men; mean [SD] age, 40.1 [17.2] years) from the FITBIR database and the TRACK-TBI study. The data were best fit by a 5-class LCMM. Of these participants, 1245 (61.6%) reported persistent mild insomnia symptoms (class 1); 627 (31.0%) initially reported mild insomnia symptoms that resolved over time (class 2); 91 (4.5%) reported persistent severe insomnia symptoms (class 3); 44 (2.2%) initially reported severe insomnia symptoms that resolved by 12 months (class 4); and 15 (0.7%) initially reported no insomnia symptoms but had severe symptoms by 12 months (class 5). In a multinomial logistic regression model, several factors significantly associated with insomnia trajectory class membership were identified, including female sex (odds ratio [OR], 1.65 [95% CI, 1.02-2.66]), Black race (OR, 2.36 [95% CI, 1.39-4.01]), history of psychiatric illness (OR, 2.21 [95% CI, 1.35-3.60]), and findings consistent with intracranial injury on computed tomography (OR, 0.36 [95% CI, 0.20-0.65]) when comparing class 3 with class 1. CONCLUSIONS AND RELEVANCE These results suggest important heterogeneity in the course of insomnia after TBI in adults. More work is needed to identify outcomes associated with these insomnia trajectory class subgroups and to identify optimal subgroup-specific treatment approaches.
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Affiliation(s)
- Emerson M. Wickwire
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore
- Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore
| | - Jennifer S. Albrecht
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Vincent F. Capaldi
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Sonia O. Jain
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego
| | | | - J. Kent Werner
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Neurology, The Johns Hopkins University, Baltimore, Maryland
| | - Pratik Mukherjee
- Department of Radiology, School of Medicine, University of California, San Francisco
| | - Ashlee B. McKeon
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Michael T. Smith
- Division of Behavioral Medicine, Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph T. Giacino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
| | - Lindsay D. Nelson
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee
- Department of Neurology, Medical College of Wisconsin, Milwaukee
| | - Scott G. Williams
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Medicine, Fort Belvoir Community Hospital, Fort Belvoir, Virginia
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jacob Collen
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Sleep Disorders Center, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Xiaoying Sun
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego
| | | | - Amy J. Markowitz
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco
| | - Geoffrey T. Manley
- Brain and Spinal Injury Center, University of California, San Francisco
- Department of Neurosurgery, University of California, San Francisco
| | - Andrew D. Krystal
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
- Weill Institute for Neurosciences, University of California, San Francisco
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Manzar MD, Albougami A, Hassen HY, Sikkandar MY, Pandi-Perumal SR, Bahammam AS. Psychometric Validation of the Athens Insomnia Scale Among Nurses: A Robust Approach Using Both Classical Theory and Rating Scale Model Parameters. Nat Sci Sleep 2022; 14:725-739. [PMID: 35478720 PMCID: PMC9035448 DOI: 10.2147/nss.s325220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 03/01/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Few studies have investigated the validity of the Athens insomnia scale (AIS) using a robust approach of both classical theory and the rating scale model. Therefore, in this study, we investigated psychometric validation of the AIS using both of these approaches in nurses. METHODS Nurses (n= 563, age= 33.2±7.1 years) working in health facilities in Saudi Arabia participated in a cross-sectional study. Participants completed the AIS, socio-demographics tool, and sleep health-related questions. RESULTS Confirmatory factor analysis (CFA) favored a 2-factor structure with both comparative fit index (CFI), and incremental fit index (IFI) having values above 0.95. The 2-factor model had the lowest values of Akaike information criterion (AIC), root mean square error of approximation (RMSEA), χ 2, and χ 2/df. This 2-factor structure showed configural invariance (CFI more than 0.95, RMSEA less than 0.08, and Χ2/df less than 3), and metric, scalar, and strict invariance (based on Δ CFI ≤-0.01, and Δ RMSEA ≥ 0.015 criteria). No ceiling/floor effects were seen for the AIS total scores. Infit and outfit mean square values for all the items were within the acceptable range (<1.4, >0.6). The threshold estimates for each item were ordered as expected. Cronbach's α for the AIS tool, factor-1 score, factor-2 score was 0.86, 0.82, and 0.72, respectively. AIS factor scores-1/2 were significantly associated with a habitual feeling of tiredness after usual night sleep (p<0.001), Impairment of daytime socio-occupational functioning (p<0.05), and with a feeling of daytime fatigue, irritability, and restlessness (p<0.05). CONCLUSION The findings favor the validity of a 2-factor structure of the AIS with adequate item properties, convergent validity, and reliability in nurses.
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Affiliation(s)
- Md Dilshad Manzar
- Department of Nursing, College of Applied Medical Sciences, Majmaah University, Al Majmaah, 11952, Saudi Arabia
| | - Abdulrhman Albougami
- Department of Nursing, College of Applied Medical Sciences, Majmaah University, Al Majmaah, 11952, Saudi Arabia
| | - Hamid Yimam Hassen
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, 2610, Belgium
| | - Mohamed Yacin Sikkandar
- Department of Medical Equipment Technology, College of Applied Medical Sciences, Majmaah University, Al Majmaah, 11952, Saudi Arabia
| | - Seithikurippu R Pandi-Perumal
- Somnogen Canada Inc, Toronto, ON, Canada.,Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
| | - Ahmed S Bahammam
- The University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, 11324, Saudi Arabia.,National Plan for Science and Technology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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49
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Rani S, Shelyag S, Karmakar C, Zhu Y, Fossion R, Ellis JG, Drummond SPA, Angelova M. Differentiating acute from chronic insomnia with machine learning from actigraphy time series data. FRONTIERS IN NETWORK PHYSIOLOGY 2022; 2:1036832. [PMID: 36926085 PMCID: PMC10013073 DOI: 10.3389/fnetp.2022.1036832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/11/2022] [Indexed: 11/29/2022]
Abstract
Acute and chronic insomnia have different causes and may require different treatments. They are investigated with multi-night nocturnal actigraphy data from two sleep studies. Two different wrist-worn actigraphy devices were used to measure physical activities. This required data pre-processing and transformations to smooth the differences between devices. Statistical, power spectrum, fractal and entropy analyses were used to derive features from the actigraphy data. Sleep parameters were also extracted from the signals. The features were then submitted to four machine learning algorithms. The best performing model was able to distinguish acute from chronic insomnia with an accuracy of 81%. The algorithms were then used to evaluate the acute and chronic groups compared to healthy sleepers. The differences between acute insomnia and healthy sleep were more prominent than between chronic insomnia and healthy sleep. This may be associated with the adaptation of the physiology to prolonged periods of disturbed sleep for individuals with chronic insomnia. The new model is a powerful addition to our suite of machine learning models aiming to pre-screen insomnia at home with wearable devices.
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Affiliation(s)
- S Rani
- School of Information Technology, Deakin University, Geelong, VIC, Australia
| | - S Shelyag
- School of Information Technology, Deakin University, Geelong, VIC, Australia
| | - C Karmakar
- School of Information Technology, Deakin University, Geelong, VIC, Australia
| | - Ye Zhu
- School of Information Technology, Deakin University, Geelong, VIC, Australia
| | - R Fossion
- Centro de Ciencias de la Complejidad (C3) and Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, CDMX, Mexico.,Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, CDMX, Mexico
| | - J G Ellis
- Department of Psychology, Northumbria University, Newcastle Upon Tyne, United Kingdom
| | - S P A Drummond
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - M Angelova
- School of Information Technology, Deakin University, Geelong, VIC, Australia
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50
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Ree MJ, Richardson C. Insomnia disorder update: the benefits of screening and treatment for this common presentation. Intern Med J 2021; 51:1798-1805. [PMID: 34796636 DOI: 10.1111/imj.15567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 05/02/2021] [Accepted: 06/19/2021] [Indexed: 11/28/2022]
Abstract
Insomnia is a chronic condition and major healthcare problem for Australians across the lifespan. Insomnia's high prevalence and disease burden render it an important target for treatment. Further, and importantly, there exist established bidirectional links between insomnia and a range of health conditions, with insomnia both contributing to risk, maintenance and relapse of comorbid conditions. Recent clinical research demonstrates that treating insomnia in its own right is important for resolution of insomnia and for optimising treatment outcomes for comorbid presenting problems. Due to its effectiveness and favourable side-effect profile, Cognitive Behaviour Therapy-Insomnia (CBT-I) is the recommended first-line treatment even when comorbid conditions are present. CBT-I is a brief treatment often delivered in four to eight consultations. Individual, group and online CBT-I have each demonstrated effectiveness. Outcomes for online CBT-I are often stronger when individualised clinician support is provided. Specifically assessing for and treating insomnia in clinical practice may provide an opportunity to optimise treatment outcome in many patients.
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Affiliation(s)
- Melissa J Ree
- School of Psychological Science, The University of Western Australia, Perth, Western Australia, Australia
| | - Cele Richardson
- School of Psychological Science, The University of Western Australia, Perth, Western Australia, Australia
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