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Cited by 480Sleep and related disordersObstructive Sleep Apnea ResearchSleep and Work-Related Fatigue

Clinical correlates of insomnia in patients with chronic illness

Katz, David A., McHorney, Colleen A.·1998·Archives of Internal Medicine
DOI 10.1001/archinte.158.10.1099
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Abstract

BACKGROUND: Patients with chronic insomnia are more likely to develop affective disorders, cardiac morbidity, and other adverse health outcomes, yet many clinicians tend to trivialize the complaint of insomnia or to attribute it only to psychiatric causes. OBJECTIVES: To estimate the prevalence and longitudinal course of insomnia in patients with documented chronic medical illness and/or depression and to quantify the associations between specific chronic conditions and insomnia. METHODS: The presence of mild or severe insomnia was based on responses to a sleep questionnaire completed by 3445 patients with at least 1 of 5 physician-identified chronic conditions (hypertension, diabetes, congestive heart failure, myocardial infarction, or depression) at baseline; a subsample of 1814 patients completed follow-up questionnaires at 2 years. Using multivariate techniques, we evaluated the relationship between chronic conditions, patient-reported comorbidities, and insomnia (complaints of initiating and maintaining sleep), adjusting for sociodemographics and health habits. RESULTS: Sixteen percent of study patients had severe and 34% had mild insomnia at baseline. At 2-year follow-up, 59% (95% confidence interval, 55%-63%) of patients with mild insomnia and 83% (95% confidence interval, 78%-88%) of patients with severe insomnia at baseline still had sleep problems. Odds ratios corresponding to mild and severe insomnia for key risk factors were as follows: current depressive disorder, 2.6 and 8.2; subthreshold depression, 2.2 and 3.4; congestive heart failure, 1.6 and 2.5; obstructive airway disease, 1.6 and 1.5; back problems, 1.4 and 1.5; hip impairment, 2.2 and 2.7; and prostate problems, 1.6 and 1.4. The majority of insomnia-comorbidity associations observed at baseline persisted at 2-year follow-up. CONCLUSIONS: Patients with insomnia require follow-up, as the majority continue to be bothered by difficulty initiating and maintaining sleep. In addition to detecting affective disorders in patients with insomnia, clinicians should focus on medical conditions that disturb sleep, especially cardiopulmonary disease, painful musculoskeletal conditions, and prostate problems.

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  • The assumption that insomnia is caused by and resolved once the parent disorder is treated is untenable, considering insomnia is highly refractory after treatment of the comorbid condition.

    “The assumption that insomnia is caused by and resolved once the parent disorder is treated is untenable, considering insomnia is highly refractory after treatment of the comorbid condition [45].”

    From Non-Pharmacological Treatment of Insomnia (2012) · cites this paper as [45]

  • Insomnia rates range from 16 to 33% for those with comorbid medical conditions, such as diabetes mellitus, heart disease, and chronic back pain, and the rates range as high as 88% for those with insomnia symptoms and chronic pain.

    “Insomnia rates range from 16 to 33 % for those with comorbid medical conditions, such as diabetes mellitus, heart disease, and chronic back pain [14,45], and the rates range as high as 88 % for those with insomnia symptoms and chronic pain [46].”

    From Non-Pharmacological Treatment of Insomnia (2012) · cites this paper as [45]

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Authors
Katz, D. A., & McHorney, C. A.
Affiliations
University of Wisconsin–Madison (US)
ORCID
Venue
Archives of Internal Medicine
Publisher
American Medical Association (AMA)
Published
1998-05-25
Volume
158
Issue
10
Pages
1099
ISSN
0003-9926 (ISSN-L)
DOI
10.1001/archinte.158.10.1099
OpenAlex
W2067000030
Cited by
480
References
68
Citations by year
2026: 5 · 2025: 10 · 2024: 3 · 2023: 12 · 2022: 11 · 2021: 22 · 2020: 9 · 2019: 18 · 2018: 7 · 2017: 13 · 2016: 15 · 2015: 20 · 2014: 21 · 2013: 17 · 2012: 21
FWCI
12.60
Type
journal article
Language
en
Open access
closed
Locations
  • Archives of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
Keywords
insomnia, chronic disease, comorbidities, depression, congestive heart failure, obstructive airway disease, musculoskeletal pain, prostate diseases, sleep disorders, insomnia prevalence, cardiovascular disease
MeSH terms
Airway Obstruction, Chronic Disease, Depression, Female, Heart Failure, Humans, Sleep Initiation and Maintenance Disorders, Male, Musculoskeletal Diseases, Prostatic Diseases, Risk Factors, Severity of Illness Index, Reproducibility of Results, Multivariate Analysis

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