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Chronic insomnia is the most common sleep disorder among adults and is associated with a wide range of negative outcomes. This article reviews the economic consequences of the disorder and the cost effectiveness of insomnia treatments. First, the total costs of insomnia are reviewed; in aggregate these costs exceed $100 billion USD per year, with the majority being spent on indirect costs such as poorer workplace performance, increased health care utilization, and increased accident risk. Next, the deleterious impact of insomnia on quality of life and the impact of treatment on quality of life are briefly considered. Finally, ten published studies evaluating the cost effectiveness of both pharmacological and behavioral treatments for insomnia are reviewed in detail. A significant majority of studies reviewed found that the cost of treating primary and comorbid insomnia is less than the cost of not treating it. Treatments were generally found to be cost-effective using commonly employed standards, with treatment costs being recouped within 6-12 mo., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Purpose: Chronic obstructive pulmonary disease (COPD) patients may suffer from poor sleep and health-related quality of life. We hypothesized that disturbed sleep in COPD is correlated with quality of life., Methods: In 180 patients with COPD (forced expired volume in 1 second [FEV(1)] 47.6 ± 15.2% predicted, 77.8% male, aged 65.9 ± 11.7 years), we administered general (Health Utilities Index 3) and disease-specific (St George's Respiratory) questionnaires and an index of disturbed sleep (Pittsburgh Sleep Quality Index)., Results: Overall scores indicated poor general (Health Utilities Index 3: 0.52 ± 0.38), disease- specific (St George's: 57.0 ± 21.3) quality of life and poor sleep quality (Pittsburgh 11.0 ± 5.4). Sleep time correlated with the number of respiratory and anxiety symptoms reported at night. Seventy-seven percent of the patients had Pittsburg scores >5, and the median Pittsburgh score was 12. On multivariate regression, the Pittsburgh Sleep Quality Index was an independent predictor of both the Health Utilities Index 3 and the St George's scores, accounting for 3% and 5%, respectively, of the scores. Only approximately 25% of the patients demonstrated excessive sleepiness (Epworth Sleepiness Scale >9)., Conclusions: Most patients with COPD suffer disturbed sleep. Sleep quality was correlated with general and disease-specific quality of life. Only a minority of COPD patients complain of being sleepy.

We utilized well-established and validated quality of life (QoL) measures to test the validity of the Health Utilities Index (HUI) in patients with untreated sleep disorders in a cross-sectional study. We submitted a 66-question survey to 86 patients presenting to the University of Maryland Sleep Disorders Center (68 with sleep apnea, 18 with other sleep disorders). HUI mark 2 (HUI2) and HUI mark 3 (HUI3) were compared with other indices of QoL: medical short form 12 (SF-12), Epworth Sleepiness Scale (ESS), and Functional Outcomes of Sleepiness Questionnaire (FOSQ). The participants of this study were eighty-six patients presenting with untreated sleep disorders to the University Medical Center. There were no interventions. The mean age in our patients was 50.7 +/- 14.2 years with a mean body mass index of 32.9 +/- 7.6. For patients with sleep apnea, the mean respiratory disturbance index was 32.6 +/- 29.1. For all patients, the mean HUI2 score was 0.73 + 0.23, and the mean HUI3 score was 0.6 +/- 0.35 (p = 0.0066 for difference from HUI2). The mean SF-12 physical components (PC) score was 43.6 +/- 12.1, and the mean SF-12 mental components (MC) score was 49.8 identical with 40.1. The mean ESS score was 10.5 + 5.2, and the mean FOSQ score was 16.4 +/- 3.5. Significant bivariate correlations were found between HUI2 and HUI3 as well as between both of these and age, SF-12, SF-12 PC score, ESS, and FOSQ. Stepwise multivariate regression revealed significant independent correlations between HUI2 and age, SF-12 PC and the FOSQ, and between HUI3, SF-12 PC, and the FOSQ. There were no differences in HUI scores between obstructive sleep apnea (OSA) and non-OSA patients: (1) HUI3 scores are lower than HUI2 scores, (2) both HUI2 and HUI3 are correlated with other indices of QoL in sleep patients, and (3) the HUI surveys should be considered in QoL and economic impact studies in patients with sleep disorders.

BackgroundRetrospective studies have shown that statins decrease the rate and severity of exacerbations, the rate of hospitalization, and mortality in chronic obstructive pulmonary disease (COPD). We prospectively studied the efficacy of simvastatin in preventing exacerbations in a large, multicenter, randomized trial.MethodsWe designed the Prospective Randomized Placebo-Controlled Trial of Simvastatin in the Prevention of COPD Exacerbations (STATCOPE) as a randomized, controlled trial of simvastatin (at a daily dose of 40 mg) versus placebo, with annual exacerbation rates as the primary outcome. Patients were eligible if they were 40 to 80 years of age, had COPD (defined by a forced expiratory volume in 1 second [FEV1] of less than 80% and a ratio of FEV1 to forced vital capacity of less than 70%), and had a smoking history of 10 or more pack-years, were receiving supplemental oxygen or treatment with glucocorticoids or antibiotic agents, or had had an emergency department visit or hospitalization for COPD within the past year. Patients with diabetes or cardiovascular disease and those who were taking statins or who required statins on the basis of Adult Treatment Panel III criteria were excluded. Participants were treated from 12 to 36 months at 45 centers.ResultsA total of 885 participants with COPD were enrolled for approximately 641 days; 44% of the patients were women. The patients had a mean (±SD) age of 62.2±8.4 years, an FEV1 that was 41.6±17.7% of the predicted value, and a smoking history of 50.6±27.4 pack-years. At the time of study closeout, the low-density lipoprotein cholesterol levels were lower in the simvastatin-treated patients than in those who received placebo. The mean number of exacerbations per person-year was similar in the simvastatin and placebo groups: 1.36±1.61 exacerbations and 1.39±1.73 exacerbations, respectively (P=0.54). The median number of days to the first exacerbation was also similar: 223 days (95% confidence interval [CI], 195 to 275) and 231 days (95% CI, 193 to 303), respectively (P=0.34). The number of nonfatal serious adverse events per person-year was similar, as well: 0.63 events with simvastatin and 0.62 events with placebo. There were 30 deaths in the placebo group and 28 in the simvastatin group (P=0.89).ConclusionsSimvastatin at a daily dose of 40 mg did not affect exacerbation rates or the time to a first exacerbation in patients with COPD who were at high risk for exacerbations. (Funded by the National Heart, Lung, and Blood Institute and the Canadian Institutes of Health Research; STATCOPE ClinicalTrials.gov number, NCT01061671.).

Throughout the industrialized world, nearly one in five employees works some form of nontraditional shift. Such shift work is associated with numerous negative health consequences, ranging from cognitive complaints to cancer, as well as diminished quality of life. Furthermore, a substantial percentage of shift workers develop shift work disorder, a circadian rhythm sleep disorder characterized by excessive sleepiness, insomnia, or both as a result of shift work. In addition to adverse health consequences and diminished quality of life at the individual level, shift work disorder incurs significant costs to employers through diminished workplace performance and increased accidents and errors. Nonetheless, shift work will remain a vital component of the modern economy. This article reviews seminal and recent literature regarding shift work, with an eye toward real-world application in clinical and organizational settings. [ABSTRACT FROM AUTHOR]

Rationale. Previous studies have suggested that asthmatics have an increased incidence of sleep disturbances. However, these studies have been limited by reliance on population surveys or small numbers of participants. Objectives. We sought to measure sleep quality and daytime sleepiness in a cohort of symptomatic asthmatics and to measure the effects of improved asthma control on sleep quality. Methods. Data were collected in sub-study of a large multi-center randomized double-masked controlled trial of mild-moderate asthmatics evaluating the effect of low-dose theophylline on asthma control in comparison to montelukast and placebo. Each participant was administered sleep symptom questionnaires at randomization and at the final visit (6 months after randomization). These included the Pittsburgh Sleep Quality Questionnaire (PSQI) and the Epworth Sleepiness Scale (ESS). Measurements and main results. Data were available for 487 participants. Baseline mean values were: age 40 ± 15 years, 74% female, forced expiratory volume in 1 second (FEV1) 79 +16 percent predicted, Juniper Asthma Control Questionnaire (ACQ) score 2.35 ± 0.63, PSQI 7.8 ±4, and ESS 8.5 ±4.9. There were no significant differences in the PSQI or ESS between the three treatment groups. Significant correlations were found at baseline between the global PSQI score and ACQ and quality of life and marginally with lung function. Significant correlation existed between improvements in PSQI and ESS with improved asthma control and quality of life. Conclusions. Sleep disturbances are common in asthmatics and are associated with asthma control and quality of life. Clinicians caring for asthmatics may need to complete a more detailed sleep history in patients with poorly controlled asthma. In addition, low-dose theophylline does not seem to impair sleep quality in asthmatics. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease is used as an umbrella term for chronic bronchitis and emphysema and is the fourth most common cause of death in North America. Current therapies are based on reducing risk factors as there is no known cure for this disease and hence an important focus of clinical medicine has been the prevention of further decline in physical function and the enhancement of health-related quality of life. The objective of the study is to assess the relationship between the patients' reported health-related quality of life and the severity of disease as measured by clinical indicators. A prospective, nonrandomized, observational study was conducted. The population consisted of subjects presenting to the University of Maryland Medical Center and the Baltimore Veterans Administration outpatient clinic, enrolled according to a convenience, staggered sampling. The Airways obstruction Questionnaire-20, the Medical Outcomes Study short form-12 and the Health Utilities Index instruments were used, and descriptive, as well as multivariate analyses were performed using multivariate linear regression models. The chronic obstructive pulmonary disease cohort was predominantly Caucasian (64%) and male (68%). The disease-specific instrument (Airways obstruction Questionnaire-20) had weak associations with the utility scores as well as a mental component and mild association with a physical component. Results showed a mild association between the disease severity, which is based on the forced expiratory volume in 1 s value, and the health-related quality of life scores. Over a 3-month period, no change was seen in the patient-reported health-related quality of life and the change in health-related quality-of-life scores was not associated with disease severity. [ABSTRACT FROM AUTHOR]