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Background: The implications of removing nonrestorative sleep (NRS) and adding quantitative criteria in the most recent diagnostic criteria of insomnia disorder remain unresolved. The study was aimed to investigate how nighttime quantitative measures of sleep quality and NRS relate to daytime functioning in a general population sample. Sampling and Methods: Data of 905 subjects (mean age = 47.0 years; 64.5% females) in a population-based survey who had insomnia symptoms or NRS at least 1 night in a typical week were analyzed to evaluate their relationship with "functional impairment," "concerns/distress," and "interference with daily activities" over the past 30 days. Receiver-operating characteristic curve analysis was performed, while controlling for age and gender. Results: Moderate to severe NRS was the first-level predictor of all 3 daytime variables. Insomnia frequency ≥3 times per week and sleep onset latency ≥10–20 min were second-level predictors. Conclusions: We found that NRS was more important than insomnia symptoms in determining daytime consequences of insomnia. On the basis of our findings we express concerns whether the removal of NRS from the most recent diagnostic criteria may lead to its underrecognition, but support the quantitative criteria on insomnia frequency of at least 3 nights per week. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To explore how insomnia symptoms are hierarchically organized in individuals reporting daytime consequences of their sleep disturbances. Methods: This is a cross-sectional study conducted in the general population of the states of California, New York, and Texas. The sample included 8937 individuals aged 18years or older representative of the general population. Telephone interviews on sleep habits and disorders were managed with the Sleep-EVAL expert system and using DSM-IV and ICSD classifications. Insomnia symptoms and global sleep dissatisfaction (GSD) had to occur at least three times per week for at least threemonths. Results: A total of 26.2% of the sample had a GSD. Individuals with GSD reported at least one insomnia symptom in 73.1% of the cases. The presence of GSD in addition to insomnia symptoms considerably increased the proportion of individuals with daytime consequences related to insomnia. In the classification trees performed, GSD arrived as the first predictor for daytime consequences related to insomnia. The second predictor was nonrestorative sleep followed by difficulty resuming sleep and difficulty initiating sleep. Conclusions: Classification trees are a useful way to hierarchically organize symptoms and to help diagnostic classifications. In this study, GSD was found to be the foremost symptom in identifying individuals with daytime consequences related to insomnia. [Copyright &y& Elsevier]

Abstract: Background: Increasing evidence suggests an association between short sleep with adverse health outcomes: obesity, type 2 diabetes and hypertension. But there are few or no data on “who these short sleepers are” in the general population. Objectives: To describe short sleepers and the associated sleep disorders in young adults. Methods: Cross-sectional telephone survey in a representative sample of 1004 French young adults (25–45years old). Total sleep time (TST), insomnia, snoring, sleepiness and daytime consequences were assessed using subjective validated tools. Short sleepers were defined as sleeping <6h a weekday (sleep+nap+pauses). Sleep debt was defined as those who “sleep 90min less than the sleep they need to be in good shape.” Results: Prevalence of short sleep was 18%, insomnia 12%, and sleep debt 20% in the total group. Among short sleepers, 16% had insomnia, 45% sleep debt, and 39% neither. Short sleepers were significantly mostly males, blue collar workers and more overweight and obese compared to nonshort sleepers. Working >10h per day, smoking and drinking coffee after 5p.m. were also significantly associated with short sleep. Short sleepers had higher Epworth sleepiness scale ESS scores (7.8 vs 6.7; p =0.0058) and more sleepiness while driving (11.5% vs 2.9%; p <0.0001). Conclusion: Short sleep is highly prevalent in young adults but is not an homogeneous group, including both insomniacs and subjects with or without sleep debt. Short sleep has to be defined more precisely in order to better understand its impact on public health. [Copyright &y& Elsevier]

Abstract: Objective: The goals of this study were to estimate the prevalence of insomnia symptomatology and diagnoses in the Spanish general population and to determine if certain sleep parameters were related to specific insomnia symptoms. Methods: This is a cross-sectional telephone survey performed in the general population of Spain using a representative sample of 4065 individuals aged 15years or older. The participation rate was 87.5%. Interviews were conducted using the Sleep-EVAL system. The questions were related to sociodemographic characteristics, sleep–wake schedule, events occurring during sleep, insomnia symptoms, daytime consequences and DSM-IV diagnoses of sleep disorders. Results: Overall, 20.8% (95% C.I. 19.6–22.1%) of the sample reported at least one insomnia symptom occurring at least three nights/week. The prevalence was higher in women than in men (23.9% vs. 17.6%) and increased with age. Difficulty maintaining sleep at least three nights/week was the most prevalent symptom. DSM-IV insomnia disorder diagnoses were found in 6.4% (95% C.I. 5.6–7.1%) of the sample. Delayed bedtime and wake-up time, irregular bedtime hours and hypnagogic hallucinations were the most frequent in participants who had difficulty initiating sleep. Perception of light and “too short” sleep were the most frequent in participants who had early morning awakenings. Participants who had a non-restorative sleep were more likely to extend sleep on days off than other insomnia participants. Medical consultations in the previous year were more frequent in insomnia participants compared to participants without insomnia. One-fifth of insomnia participants were using sleep-promoting medication. Conclusions: Insomnia is frequent in Spain, affecting up to one in five individuals. Results show that insomnia is multidimensional and needs to be assessed as such. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To assess the daytime consequences in outpatients suffering from different insomnia symptoms in primary care practice. Methods: An international cross-sectional survey was conducted in 5293 outpatients complaining of sleep disturbances in primary care practice. A sleep questionnaire addressing daytime consequences, insomnia symptoms, socio-demographic characteristics, and other sleep variables was administered by 647 physicians in 10 countries. Results: Overall, 20–33% of subjects reported “severe” daytime impairments associated with sleep disturbances. Approximately 45% of patients complaining of sleep disturbances in primary care practice suffered from a combination of insomnia symptoms. Patients suffering from all insomnia symptoms reported the most severe daytime functioning impairments compared with patients suffering from initiation or maintenance insomnia only. Conversely, the majority of patients suffering from non-restorative sleep reported little daytime functioning impairments compared to the patients suffering from other combinations of insomnia symptoms. The strongest risk factor associated with “severe” daytime functioning impairments was sleep quality perception. Conclusions: Primary insomnia disturbs subjective daytime functioning. A report of combined insomnia symptoms reflected the most damaging insomnia subtype and had a negative impact on a wide range of daytime functioning consequences. [ABSTRACT FROM AUTHOR]

Abstract: Background: A chronic painful physical condition (CPPC) can be a major cause of sleep disturbances. Few community-based surveys examined the specific relationship between these two conditions. Methods: Eighteen thousand, nine hundred and eighty participants aged 15 years or older from five European countries (the United Kingdom, Germany, Italy, Portugal and Spain) and representative of approximately 206 millions Europeans were interviewed by telephone. The interview included questions about sleeping habits, health, sleep and mental disorders. Painful physical conditions were ascertained through questions about medical treatment, consultations and/or hospitalizations for medical reasons and a list of 42 diseases. A painful physical condition was considered chronic when it lasted at least six months. Insomnia symptoms were defined as difficulty initiating or maintaining sleep or non-restorative sleep, present at least three nights per week, lasting at least one month, and accompanied by daytime consequences. Results: (1) The point prevalence of at least one CPPC was set at 17.1% (95% CI: 16.5–17.6%) in the sample. (2) Difficulty initiating sleep was found in 5.1% (95% CI: 4.8–5.4%) of the sample, disrupted sleep in 7.5% (95% CI: 7.2–7.9%); early morning awakenings in 4.8% (95% CI: 7.2–7.9%) and non-restorative sleep in 4.5% (95% CI: 4.2–4.8%). (3) More than 40% of individuals with insomnia symptoms reported at least one CPPC. (4) CPPC was associated with more frequent difficulty or inability to resume sleep once awake and a shorter sleep duration. (5) In middle-aged subjects (45–64 years of age), CPPC was associated with longer insomnia duration. At any age, insomnia with CPPC was associated with a greater number of daytime consequences (average of four consequences) than in insomnia without CPPC (average of 2.3 consequences). (6) In multivariate models, CPPC, especially backaches and joint/articular diseases, were at least as importantly associated with insomnia than were mood disorders with odds ratios ranging from 4.1 to 5.0 for backaches and from 3.0 to 4.8 for joint/articular diseases. Conclusions: CPPC is associated with a worsening of insomnia on several aspects: a greater number of insomnia symptoms, more severe daytime consequences and more chronic insomnia situation. CPPC plays a major role on insomnia. Its place as major contributive factor for insomnia is as much important as mood disorders. [Copyright &y& Elsevier]