These patients with comorbid insomnia other fractures. Cross-sectional studies have attempted symptoms, and stroke were associated with retention of insom- to determine if people with insomnia have more medical prob- nia. One cross-sectional study surveyed noninsti- very little prevalence data has been reported by these studies, and tutionalized adults, 18 to 79 years old, and found that participants some of the samples used may limit generalizability.
Finally, a cross-sectional study of 12, Hungarians found This was not an industry supported study. Lichstein has received re- that insomnia was related to greater healthcare utilization i.
The above studies have several strengths including large and generally representative samples. However, prevalence rates Submitted for publication October 6, were not given for the percentage of people with insomnia who Accepted for publication October 17, have a particular disorder.
This makes it difficult to determine Address correspondence to: Daniel J Taylor, PhD, Department of Psychol- the severity of the problem within the insomnia population, espe- ogy, The University of North Texas, PO Box , Denton, TX ; Tel: cially considering that statistically significant results could have ; Fax: ; Email: djtaylor unt. Thus, it is im- to focus considerably more effort in this area.
We wished to develop a morbid medical problems, it is also important to determine the compendium of medical problems comorbid with insomnia for prevalence of insomnia in specific medical conditions. After all, use in future studies examining the treatment of insomnia in these only a small percentage of people with insomnia will have cancer, populations.
It was hypothesized that people with insomnia PWI but the prevalence of insomnia in patients with cancer may be would have a higher prevalence of medical problems than people very high and may be a significant problem deserving of more not having insomnia PNI. Conversely, it was hypothesized that clinical and research attention. We used unre- all of these rates were significantly higher than in a less-than-ideal stricted random sampling until a cell i.
In a study of 11, Canadians, the prevalence of insomnia was each decade was filled, and then it was closed to further sam- higher in people who were dissatisfied with their health or who pling. Because the population of Memphis, Tennessee, is equally had difficulty in activities of daily living, migraines, or circula- divided between African Americans and Caucasian Americans, tory, digestive, respiratory, or rheumatic diseases, than in people we were also able to obtain sufficient numbers of both groups.
Upon receipt, participants began completing the sleep symptom; higher than pain, anorexia, fatigue, or nausea. How- using SPSS For one, the definitions of insomnia varied greatly Participants among studies, with only a couple of studies7,9 having definitions Of the volunteers recruited, an adjusted response rate of that definitively corresponded to any of the currently accepted Thus, toward the end of the study, insomnia,18,19 which is arguably the sample of most interest.
A sec- when homes were contacted that did not have a member who fell ond issue is that few of the studies controlled for potential con- into one of our remaining target cells, this number was coded as founds, such as the presence of underlying sleep disorders e. We also coded businesses as sleep apnea or mental disorders e. These under- ineligible rather than nonresponse.
If desired, more detail is giv- lying disorders could be causing both the insomnia20 and medi- en about our adjustment methods elsewhere.
The ethnic representa- Patients more likely to have anxiety than people without insomnia. Data from participants Breathing Chronic pain AIDS was excluded from Depression and Anxiety the analysis because there was only 1 person with this diagnosis, Depression scores were obtained using the item Beck De- making interpretation of the findings inconclusive.
Table 1 shows pression Inventory. PWI were significantly more likely to report a medical prob- ity. More PWI reported heart disease, cancer, high blood pres- adequate reliability and validity. Sleep Diary Prevalence of Insomnia in Medical Problems Participants completed a sleep diary23 every morning for 14 consecutive days.
The information collected from the diary was We then performed a logistic regression with insomnia status used to determine the sleep onset-latency, number of awakenings PWI vs PNI as the dependent variable, and each medical disor- throughout the night, wake time after sleep onset, total sleep time, der analyzed separately as the independent variable, to determine frequency of insomnia episodes number of episodes during the if people with each medical disorder were more likely to have 14 day recording period , and sleep-quality rating Likert-type insomnia than people without the medical disorder.
The diagnosis prevalence rates of insomnia for people with specific medical of insomnia was operationally defined as a self-report of insomnia problems and people without these disorders. People with heart for a minimum of 6 months, with at least 3 nights per week of a disease, cancer, high blood pressure, neurologic disease, breath- sleep-onset latency of 31 minutes or longer, b wake after sleep ing problems, urinary problems, diabetes, chronic pain, and gas- onset of 31 minutes or longer, or c a combination of the 2, and a trointestinal problems were significantly more likely than those daytime complaint.
This was done in an attempt to construct of the prevalence of chronic insomnia comorbid with medical the most unbiased logistic-regression model estimating the rela- problems using a random sample. As expected based on the avail- tionship between insomnia status and medical problems.
Table 3 able literature, PWI had a higher prevalence of comorbid medical shows the confounding variables associated with each dependent problems than did PNI, and people with chronic medical prob- lems had a higher prevalence of insomnia than did people without variable.
Specifically, PWI had a higher incidence Since other studies have already shown that anxiety and de- of heart disease, high blood pressure, neurologic disease, breath- pression scores are higher in PWI than PNI, these scores were ing problems, urinary problems, chronic pain, and gastrointesti- also considered confounds.
Further, logistic regressions were conducted again with depression, anxi- people with heart disease, cancer, high blood pressure, neurologic ety and significant sleep disorders symptoms Table 3 included disease, breathing problems, urinary problems, chronic pain, and as covariates. Although the analyses showed a slight decrease in gastrointestinal problems were more likely than people without significance, PWI still had significantly more heart disease, high these disorders to have insomnia Table 2.
Controlling for de- blood pressure, neurologic disease, breathing problems, chronic pression, anxiety, and sleep symptoms resulted in a decrease in pain, and gastrointestinal problems Table 1 ; cancer and diabetes the significance of the differences seen in several of the medi- were no longer significant.
However, when we also took into account the overlap between Again, to ascertain the possible contribution that depression, medical disorders, only people with high blood pressure, breath- anxiety, and occult sleep disorders might add to the equation, logis- ing problems, urinary problems, chronic pain, and gastrointestinal tic regression analyses were conducted which included depression problems had more insomnia than people without these medical and anxiety scores along with sleep disorder symptom questions problems.
Although Although other studies have shown an association between in- these analyses showed decreases in significance for most disor- somnia and medical problems4, the current findings were the ders, only 1 became nonsignificant diabetes. However, when first to actually provide prevalence rates of medical problems in we adjusted for these confound variables as well as included all people with insomnia.
Although comparative data do not exist, of the medical disorders into the same model simultaneously al- we can compare these results with the available insomnia preva- lowing us to account for overlap between medical disorders , we lence data in specific medical problems. In the case of cancer, found that only high blood pressure, breathing problems, urinary these results Table 3—Analyses of Confounding Variables In addition, our sample is not completely representative of a larger population e.
Examples of why our sample differs from Limb jerk. Unfortunately, High blood pressure Snoring. Yet, the field continues Sleep attacks. This lim- Sleep attacks. It Urinary Problems Snoring. However, we would hypothesize these individuals would Limb jerk.
Breathing problems. Sleep attacks. We did Insomnia Snoring. Future research studies, within specific medical conditions, should examine this question more ease We did not have a renal-failure group causation; they can only demonstrate association and, as such, with which to compare with results from other researchers.
In truth, when another medical problem is present, to focus on the prevalence of medical problems in people with determining if insomnia was caused by the other disorder is next insomnia, but, conversely, to study the prevalence of insomnia to impossible. Therefore, the panel from the National Institutes in people with specific medical problems to provide a broader of Health State-of-the-Science Conference on Insomnia recom- picture of the association between physical health and insomnia.
For example, we only had 15 individuals with neurologic nia is treatable, indicating that the insomnia is at least partially disorders; thus, the estimates of prevalence of insomnia in this independent from the comorbid disorder. Sample size is gener- It is possible that insomnia could serve to exacerbate and wors- ally a problem because it lowers power, which may lead to failing en symptoms for people with chronic illnesses, thus significantly to find significant results when they in fact exist i.
However, this was obviously not a problem for the current terfering with treatment. A second problem with small sample sizes is that they may that points to insomnia decreasing pain thresholds, and pain is the result in spurious results. The assumptions of logistic regression number one predictor of disability. Thus, those data should be inter- people with chronic illnesses more susceptible to a cold or flu, preted very cautiously. However, this was the only such medical potentially further compromising health.
Savard J, Morin CM. Insomnia in the context of cancer: a review of health breakdown begins to occur. J Clin Oncol ;1 Future longitudinal research studies are now needed, which Physical symptom profiles of depressed and preferably should start in subjects in their teenage years, to deter- nondepressed patients with cancer. Palliat Med ; Quan- mine the course of insomnia in relationship to the aforementioned titative criteria for insomnia.
Bev Res Ther ; This research, which also cannot demonstrate Derivation of research causality, can help us determine the risk relationship between in- diagnostic criteria for insomnia: report of an American Academy of somnia and various medical problems and will allow us to make Sleep Medicine Work Group.
Sleep ; Insomnia as a Health Risk as being causal factors. For example, is insomnia a result of the Factor. Behav Sleep Med ; Epide- the disorder, a medication side effect, or a combination of these miology of insomnia, depression, and anxiety. Finishing one page will certainly lead you to review next page, and better. Artour Rakhimov has numerous followers. This is what the writer describes to the readers as well as utters the definition. Artour Rakhimov here without going outside?
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