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Towards quantitative cutoffs for insomnia: how current diagnostic criteria mischaracterize remission.

ABSTRACT: Although sleep symptoms of insomnia can be quantified, none of the current diagnostic systems stipulate quantitative cutoffs for sleep-onset latency (SOL) or wake time after sleep onset (WASO). Diagnoses are based instead on idiographic patient reports of "difficulty" falling/staying asleep. Therefore, we examined whether remission of insomnia as per the diagnostic criteria results from a normalization of quantitative sleep disturbance, or if it is simply reflective of tolerance to sleep symptoms.This study involved a yearlong prospective investigation of 649 adults (48.1?±?11.6 years; 69.3% female) with DSM-5-based insomnia. Participants completed measures of sleep disturbance, perceived sleep-related distress, daytime sleepiness, functional impairment, and workplace productivity at baseline and follow-up one year later.A total of 271 participants no longer met the DSM-5-based insomnia criteria at follow-up. However, 66% of these remitters reported ?31?min of SOL and/or WASO. Daytime impairment in this subgroup of remitters was no different from that among individuals who met the diagnostic criteria at both baseline and follow-up (ie, chronic insomniacs). By contrast, follow-up impairment was significantly lower (F?=?12.3; P?

SUBMITTER: Pillai V

PROVIDER: S-EPMC4983260 | biostudies-literature | 2016 Oct

REPOSITORIES: biostudies-literature

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Towards quantitative cutoffs for insomnia: how current diagnostic criteria mischaracterize remission.

Pillai Vivek V Roth Thomas T Drake Christopher L CL

Sleep medicine 20160213

<h4>Objective</h4>Although sleep symptoms of insomnia can be quantified, none of the current diagnostic systems stipulate quantitative cutoffs for sleep-onset latency (SOL) or wake time after sleep onset (WASO). Diagnoses are based instead on idiographic patient reports of "difficulty" falling/staying asleep. Therefore, we examined whether remission of insomnia as per the diagnostic criteria results from a normalization of quantitative sleep disturbance, or if it is simply reflective of toleranc ...[more]

PMID: 27288048

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Project description:ImportanceInsomnia is a significant public health problem, but there is little information on its natural history.ObjectiveTo assess the incidence, persistence, and remission rates of insomnia over a 5-year naturalistic follow-up period.Design, setting, and participantsThis cohort study included participants with and without sleep problems selected from the adult population in Canada from August 2007 to June 2014. Participants completed an annual survey about their sleep and health status for 5 consecutive years.ExposureUsing validated algorithms, participants were classified at each assessment as being good sleepers (n = 1717), having an insomnia disorder (n = 538), or having subsyndromal insomnia (n = 818).Main outcomes and measuresSurvival analyses were used to derive incidence rates of new insomnia among the subgroup of good sleepers at baseline and persistence and remission rates among those with insomnia at baseline. Sleep trajectories were examined by looking at year-person transitions between each consecutive year summed over the 5-year follow-up period. All inferential analyses were weighted according to normalized sampling weights.ResultsThe sample included 3073 adults (mean [SD] age, 48.1 [15.0] years; range, 18.0-95.0 years; 1910 [62.2%] female). Overall, 13.9% (95% CI, 11.0%-17. 5%) of initial good sleepers developed an insomnia syndrome during the 5-year follow-up period, and incidence rates were higher among women than among men (17.6% [95% CI, 13.6%-22.7%] vs 10.1% [95% CI, 6.6%-15.3%; χ2 = 4.43; P = .03). A total of 37.5% (95% CI, 32.6%-42.5%) of participants with insomnia at baseline reported insomnia persisting at each of the 5 annual follow-up times. For subsyndromal insomnia, rates were 62.5% at 1 year to 26.5% at 5 years. For syndromal insomnia, rates were 86.0% at 1 year to 59.1% at 5 years. Conversely, remission rates among those with subsyndromal insomnia were almost double the rates among those with an insomnia syndrome at 1 year (37.5% [95% CI, 31.7%-44.0%] vs 14.0% [95% CI, 9.3%-20.8%]), 3 years (62.7% [95% CI, 56.7%-68.7%] vs 27.6% [95% CI, 20.9%-35.9%]), and 5 years (73.6% [95% CI, 68.0%-78.9%%] vs 40.9% [95% CI, 32.7%-50.4%]). Yearly trajectories showed that individuals who were good sleepers at baseline were 4.2 (95% CI, 3.51-4.89) times more likely to stay good sleepers in the subsequent year, but once they developed insomnia, they were equally likely to report symptoms (47% probability) than to return to a good sleeper status (53% probability) 1 year later. Similarly, those with an insomnia syndrome at any given assessment were more likely (adjusted odds ratio, 1.60; 95% CI, 1.19-2.60) to remain in that status (persistence) than to improve (remittance) at the next assessment; even among those who improved, the odds of relapse were greater (adjusted odds ratio, 2.04; 95% CI, 1.23-3.37) than those to improve in the following year.Conclusions and relevanceThe findings suggest that insomnia is often a persistent condition. Considering the long-term adverse outcomes associated with persistent insomnia, these findings may have important implication for the prognosis and management of insomnia.

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Towards quantitative cutoffs for insomnia: how current diagnostic criteria mischaracterize remission.

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Towards quantitative cutoffs for insomnia: how current diagnostic criteria mischaracterize remission.

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