Insomnia Subtypes and Their Relationship to Excessive Daytime Sleepiness in Brazilian Community-Dwelling Older Adults

Hara, Cláudia; Stewart, Robert; Lima‐Costa, Maria Fernanda; Rocha, Fábio Lopes; Fuzikawa, Cíntia; Uchôa, Elizabeth; Firmo, Josélia O. A.; Castro-Costa, Érico

doi:10.5665/sleep.1172

Cited by 12 publications

(11 citation statements)

References 35 publications

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“…These subtypes include difficulty in initiating sleep (DIS), difficulty in maintaining sleep (DMS) and early morning awakening (EMA) [9]. There are differences in the prevalence, association with excessive daytime sleepiness and psychiatric comorbidities among these subtypes [10].…”

Section: Introductionmentioning

confidence: 99%

Gender differences influence over insomnia in Korean population: A cross-sectional study

Choi

Chu

et al. 2020

PLoS ONE

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Study objectives Insomnia is the most common sleep disorder with significant psychiatric/physical comorbidities in the general population. The aim of this study is to investigate whether socioeconomic and demographic factors are associated with gender differences in insomnia and subtypes in Korean population. Method The present study used data from the nationwide, cross-sectional study on sleep among all Koreans aged 19 to 69 years. The Insomnia Severity Index (ISI) was used to classify insomnia symptoms and their subtypes (cutoff value: 9.5). The Pittsburgh Sleep Quality Index (PSQI), Goldberg Anxiety Scale (GAS) and Patient Health Questionnaire-9 (PHQ-9) were used to measure sleep quality, anxiety and depression. Results A total of 2695 participants completed the survey. The overall prevalence of insomnia symptoms was 10.7%, including difficulty in initiating sleep (DIS) (6.8%), difficulty in maintaining sleep (DMS) (6.5%) and early morning awakening (EMA) (6.5%), and these symptoms were more prevalent in women than in men. Multivariate analysis showed that female gender, shorter sleep time and psychiatric complications were found to be independent predictors for insomnia symptoms and subtypes. After adjusting for covariates among these factors, female gender remained a significant risk factor for insomnia symptoms and their subtypes. As for men, low income was related to insomnia. Conclusion Approximately one-tenth of the sample from the Korean general population had insomnia symptoms. The prevalence of insomnia symptom and the subtypes were more prevalent in women than men. Gender is an independent factor for insomnia symptoms.

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Section: Introductionmentioning

confidence: 99%

Gender differences influence over insomnia in Korean population: A cross-sectional study

Choi

Chu

et al. 2020

PLoS ONE

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“…The poor quality of sleep interferes with the general health status of the elderly, causing an increase in morbidity and mortality rates and negative outcomes in cognitive functions [36,37,38] There was an emphasis on insomnia in female hyperfrequent elderly (36.3%). According to Hara et al [39] and Lopes et al [40], insomnia occurs in the Brazilian population from 32.9% to 82.3% of the elderly, with prevalence in female. Sectional studies estimated a high prevalence of insomnia ranging from 10 to 50% of patients followed by PHC [41,42,43].…”

Section: Discussionmentioning

confidence: 99%

Effect of Expressive Therapies on Sleep Disorders in Hyperfrequent elderly of Primary Health Care

Grangeiro¹,

Gomes²,

Cunha³

et al. 2020

IJAERS

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The study aimed to verify the efficacy of expressive therapies (ET) in sleep disorders in hyperfrequent elderly (HE) of Primary Health Care (PHC). Quasi-experimental study, with 69 elderly people assisted at PHC in a metropolitan region of the Midwest, divided into two groups: intervention (elderly with high attendance) and control (low-frequency elderly). Sleep questionnaires were used: Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI) and STOP-bang (SB), in addition to the investigation of sociodemographic variables, anthropometric and health service-related. For data analysis, chi-square tests, multivariate analysis of variance and Wilks' Lambda test were used, considering p ≤ 0.05. The intervention group (IG) showed a decrease in PSQI scores (p = 0.003), ESE (p = 0.006), IGI (p <0.001), SB (p = 0.002) with significant differences between groups. ET were effective in the female and male IG, attenuating sleep disorders. Thus, by reducing sleep disorders in the group of HE people with the use of non-pharmacological intervention in PHC, it is possible to improve sleep quality and, consequently, reduce the use of health services, reducing financial costs for the health system public.

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“…For example, predetermined categories have included insomnia disorder subtypes, such as psychophysiological, paradoxical, or idiopathic insomnia, insomnia related to a mental disorder, which has been associated with different disease characteristics, [45][46][47] treatment perceptions, 47,48 and treatment responses. 47,49 Nightly insomnia symptoms (sleep onset or sleep maintenance problems or EMA) have also been associated with different disease characteristics [50][51][52][53][54][55][56] and treatment responses. 57,58 More recently, the heterogeneity driven by objective TST has garnered attention.…”

Section: Discussionmentioning

confidence: 99%

Characterization of Patients Who Present With Insomnia: Is There Room for a Symptom Cluster-Based Approach?

Crawford

Chirinos

Iurcotta

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: This study examined empirically derived symptom cluster profiles among patients who present with insomnia using clinical data and polysomnography. Methods: Latent profile analysis was used to identify symptom cluster profiles of 175 individuals (63% female) with insomnia disorder based on total scores on validated self-report instruments of daytime and nighttime symptoms (Insomnia Severity Index, Glasgow Sleep Effort Scale, Fatigue Severity Scale, Beliefs and Attitudes about Sleep, Epworth Sleepiness Scale, Pre-Sleep Arousal Scale), mean values from a 7-day sleep diary (sleep onset latency, wake after sleep onset, and sleep efficiency), and total sleep time derived from an in-laboratory PSG. Results:The best-fitting model had three symptom cluster profiles: "High Subjective Wakefulness" (HSW), "Mild Insomnia" (MI) and "Insomnia-Related Distress" (IRD). The HSW symptom cluster profile (26.3% of the sample) reported high wake after sleep onset, high sleep onset latency, and low sleep efficiency. Despite relatively comparable PSG-derived total sleep time, they reported greater levels of daytime sleepiness. The MI symptom cluster profile (45.1%) reported the least disturbance in the sleep diary and questionnaires and had the highest sleep efficiency. The IRD symptom cluster profile (28.6%) reported the highest mean scores on the insomnia-related distress measures (eg, sleep effort and arousal) and waking correlates (fatigue). Covariates associated with symptom cluster membership were older age for the HSW profile, greater obstructive sleep apnea severity for the MI profile, and, when adjusting for obstructive sleep apnea severity, being overweight/obese for the IRD profile. Conclusions:The heterogeneous nature of insomnia disorder is captured by this data-driven approach to identify symptom cluster profiles. The adaptation of a symptom cluster-based approach could guide tailored patient-centered management of patients presenting with insomnia, and enhance patient care. Keywords: insomnia disorder, latent profile analysis, symptom profile, symptom clusters Citation: Crawford MR, Chirinos DA, Iurcotta T, Edinger JD, Wyatt JK, Manber R, Ong JC. Characterization of patients who present with insomnia: is there room for a symptom cluster-based approach? J Clin Sleep Med. 2017;13(7):911-921. I NTRO DUCTI O NInsomnia is the experience of the difficulty falling asleep, difficulty staying asleep, or early morning awakenings. About one-third to one-half of adults complains of these symptoms. Frequently, other complaints, such as sleepiness, fatigue, and hyperarousal, will occur with nocturnal sleep disturbance. An insomnia disorder is defined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) 2 as the combination of the nocturnal sleep disturbance with one of these waking complaints at least 3 nights a week for at least 3 months. Approximately 8% to 10% of the adult population meets these criteria. 3,4Insomnia disorder is a heterogeneous condition.5 This can pose a chall...

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Insomnia Subtypes and Their Relationship to Excessive Daytime Sleepiness in Brazilian Community-Dwelling Older Adults

Abstract: Middle insomnia emerged as the insomnia subtype most strongly associated with EDS. Further research is required to clarify causal pathways underlying this cross-sectional association.

Cited by 12 publications

References 35 publications

Gender differences influence over insomnia in Korean population: A cross-sectional study

Gender differences influence over insomnia in Korean population: A cross-sectional study

Effect of Expressive Therapies on Sleep Disorders in Hyperfrequent elderly of Primary Health Care

Characterization of Patients Who Present With Insomnia: Is There Room for a Symptom Cluster-Based Approach?

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