Disassembling insomnia symptoms and their associations with depressive symptoms in a community sample: the differential role of sleep symptoms, daytime symptoms, and perception symptoms of insomnia

Ji, Xiaowen; Bastien, Célyne; Ellis, Jason; Hale, Lauren; Grandner, Michael

doi:10.1016/j.sleh.2018.12.009

Cited by 25 publications

(24 citation statements)

References 33 publications

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“…These researchers have used ISI without defining any sub-scales [49,50,51]. Recent research, however, suggests that ISI can be seen as a two- or three- factor solutions [52,53]. In our sample, which was composed of African-American older adults in economically challenged areas of south Los Angeles, we found supporting evidence for a two-factor model.…”

Section: Methodssupporting

confidence: 73%

Insomnia Symptoms among African-American Older Adults in Economically Disadvantaged Areas of South Los Angeles

et al. 2019

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Background. Although psychosocial and health factors impact insomnia symptoms, less is known about these effects in economically disadvantaged African-American older adults. Aims. This study investigated social and health determinants of insomnia symptoms among economically disadvantaged African-American older adults. Methods. This survey enrolled 398 African-American older adults (age ≥ 65 years) from economically disadvantaged areas of South Los Angeles. Gender, age, educational attainment, financial difficulty, number of chronic diseases, self-rated health, pain intensity, and depression were covariates. Total insomnia, insomnia symptoms, and insomnia impact were our outcomes. Linear regression was applied for data analysis. Results. Based on linear regression, higher financial difficulty (B = 0.48, 95% CI = 0.35–0.61), smoking status (B = 1.64, 95% CI = 0.13–3.16), higher pain intensity (B = 0.39, 95% CI = 0.11–0.67), higher number of chronic diseases (B = 0.34, 95% CI = 0.05–0.64), and more depressive symptoms (B = 0.35, 95% CI = 0.12–0.57) were associated with a higher frequency of insomnia symptoms. Based on a logistic regression model, lower age (B = 0.91, 95% CI = 0.91–1.00) and high financial difficulty (OR = 1.15, 95% CI = 1.08–1.24), pain (OR = 2.08, 95% CI = 1.14–3.80), chronic disease (OR = 1.27, 95% CI = 1.07–1.51) and depression (OR = 2.38, 95% CI = 1.22–4.65) were associated with higher odds of possible clinical insomnia. We also found specific predictors for insomnia symptoms and insomnia impact. Conclusions. Among African-American older adults in economically disadvantaged areas of South Los Angeles, insomnia symptoms co-occur with other economic, physical, and mental health challenges such as financial difficulty, smoking, multimorbidity, pain, and depression. There is a need to address sleep as a component of care of economically disadvantaged African-American older adults who have multiple social and health challenges.

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Section: Methodssupporting

confidence: 73%

Insomnia Symptoms among African-American Older Adults in Economically Disadvantaged Areas of South Los Angeles

et al. 2019

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“…Wallace and Wohlgemuth propose that when administered to OSA patients, the ISI should be scored according to a 'nocturnal' sub-score (comprising the first three items, ranging from 0 to 12), and a 'daytime' sub-score (comprising the subsequent four items, ranging from 0 to 16). This 'nocturnal' score has also recently been investigated in other insomnia research [66,67], and has previously been utilized in several COMISA treatment studies [52,63,64].…”

Section: Refining the Measurement Of Comisamentioning

confidence: 99%

Co-Morbid Insomnia and Sleep Apnea (COMISA): Prevalence, Consequences, Methodological Considerations, and Recent Randomized Controlled Trials

2019

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Co-morbid insomnia and sleep apnea (COMISA) is a highly prevalent and debilitating disorder, which results in additive impairments to patients' sleep, daytime functioning, and quality of life, and complex diagnostic and treatment decisions for clinicians. Although the presence of COMISA was first recognized by Christian Guilleminault and colleagues in 1973, it received very little research attention for almost three decades, until the publication of two articles in 1999 and 2001 which collectively reported a 30%-50% co-morbid prevalence rate, and re-ignited research interest in the field. Since 1999, there has been an exponential increase in research documenting the high prevalence, common characteristics, treatment complexities, and bi-directional relationships of COMISA. Recent trials indicate that co-morbid insomnia symptoms may be treated with cognitive and behavioral therapy for insomnia, to increase acceptance and use of continuous positive airway pressure therapy. Hence, the treatment of COMISA appears to require nuanced diagnostic considerations, and multi-faceted treatment approaches provided by multi-disciplinary teams of psychologists and physicians. In this narrative review, we present a brief overview of the history of COMISA research, describe the importance of measuring and managing insomnia symptoms in the presence of sleep apnea, discuss important methodological and diagnostic considerations for COMISA, and review several recent randomized controlled trials investigating the combination of CBTi and CPAP therapy. We aim to provide clinicians with pragmatic suggestions and tools to identify, and manage this prevalent COMISA disorder in clinical settings, and discuss future avenues of research to progress the field.

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“…Especially, daytime residual symptoms should be further emphasized in insomnia treatments for preventing relapse. A recent communitybased study showed that daytime symptoms, independent of nighttime insomnia symptoms, significantly associated with almost all depressive symptoms, and they were exclusively related to cognitive manifestation of depression [35]. Thus, it would be reasonable to include improvement of daytime symptoms to define a successful insomnia treatment outcome, which might also benefit depressive symptoms to a larger degree.…”

Section: Discussionmentioning

confidence: 99%

“…Residual insomnia symptoms have been widely reported in successfully treated depression [5,6], substance abuse [7], and post-traumatic stress disorder [8]. Even in remitted depression, 35.8% of the participants still had difficulties with initiating sleep (DIS); 55.8% continued to report difficulty maintaining sleep (DMS); 21.1% had residual early morning awakenings (EMA) [9]. The residual insomnia symptoms are also found to impair individuals' normal daytime functioning after depression treatment [10,11].…”

Section: Introductionmentioning

confidence: 99%

Residual symptoms after natural remission of insomnia: associations with relapse over 4 years

Ivers

Savard

et al. 2019

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Study Objectives Chronic insomnia tends to “wax and wane” over lifetime. The presence of residual insomnia symptoms is common, especially among naturally remitted individuals. This study aims to examine the features of these residual symptoms and their potential association with future relapse. Methods A population-based data set on the natural history of insomnia was used for this secondary analysis. Residual insomnia symptoms were investigated in those who had insomnia symptoms/syndrome at baseline and achieved full remission (according to predetermined diagnostic algorithm) within the following 1 year. Cox regressions were used to determine the hazard ratio (HR) of each residual symptom for predicting relapse in the next 4 years. The nature and severity of residual symptoms were examined with an extended version of the Insomnia Severity Index (ISI), which incorporates additional items on sleep quality and specific sleep-related daytime impairments (on daytime fatigue, cognitive functioning, mood, interpersonal relationship, and daily activities). In addition, the presence of depressive symptoms and medical conditions were controlled for in investigating risks of insomnia relapse. Results A total of 434 participants were included in this study (age ranges from 18 to 94; 65.9% female); 248 of them had relapsed within 4 years. The response rate ranged from 78% to 83%. The most frequently reported residual symptoms with at least moderate severity (ISI items ≥2 on 0–4 ISI item scale) were poor “Quality of sleep” (39.2 %), followed by “difficulty maintaining sleep” (DMS; 27%). The most common residual daytime impairments related to insomnia were fatigue (24.7 %), mood disturbances (23%) and cognitive disturbances (22.6%). After controlling for baseline insomnia and depression severity and concurrent physical diseases, impairments of cognition (HR = 1.46), poor quality of sleep (HR = 1.43), disturbed mood (HR = 1.39), being female (HR = 1.36), DMS (HR = 1.35), and fatigue (HR = 1.24) were significantly associated with insomnia relapse in the next 4 years. Moreover, residual poor sleep quality and daytime insomnia symptoms were independent of DMS in predicting relapse. Subgroup regressions according to sex showed that for male participants, residual cognition impairments (HR = 1.98) was the most significant predictors of future relapse, whereas residual DMS (HR = 1.46) significantly predicted relapse for women only. Conclusion A wide range of residual symptoms exists in individuals with naturally remitted insomnia. Notably, residual DMS is the most common residual nighttime symptom and the only nighttime symptom associated with insomnia relapse. Additionally, perceived poor sleep quality and cognitive, mood, and somatic impairments attributed to sleep disturbances are also related to future relapse. Attention to these residual symptoms when initiating insomnia treatment is warranted to minimize future relapse.

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Disassembling insomnia symptoms and their associations with depressive symptoms in a community sample: the differential role of sleep symptoms, daytime symptoms, and perception symptoms of insomnia

Cited by 25 publications

References 33 publications

Insomnia Symptoms among African-American Older Adults in Economically Disadvantaged Areas of South Los Angeles

Insomnia Symptoms among African-American Older Adults in Economically Disadvantaged Areas of South Los Angeles

Co-Morbid Insomnia and Sleep Apnea (COMISA): Prevalence, Consequences, Methodological Considerations, and Recent Randomized Controlled Trials

Residual symptoms after natural remission of insomnia: associations with relapse over 4 years

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