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Clinical Correlates of Insomnia in Patients With Chronic Illness
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 [45].”
From Non-Pharmacological Treatment of Insomnia (2012) · cites this paper as [45]
In the citing paper
“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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“In several studies, insomniacs reported decreased quality of life on virtually all dimensions of the 36-item Short Form Health Survey of the Medical Outcomes Study (SF-36), which assesses 8 domains: (1) physical functioning; (2) role limitation due to physical health problems (role physical); (3) bodily pain; (4) gene…”
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Comparative Meta-Analysis of Pharmacotherapy and Behavior Therapy for Persistent Insomnia
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Self-citationInsomnia in Ischemic Stroke Patients
Leppävuori, A., Pohjasvaara, T., Vataja, R., Kaste, M., & Erkinjuntti, T. (2002) · Cerebrovascular Diseases · doi:10.1159/000064737 · Cited by 241
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Sleep disturbance in mental health problems and neurodegenerative disease
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“However, comorbid medical conditions, 23 psychiatric illness, 24 and working night shifts or rotating shifts all represent independent risk factors for insomnia.”
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“Data from several studies have suggested an age by ethnicity interaction in insomnia prevalence, with middle-aged AAs having higher rates than CAs (Karacan et al., 1976; Katz & McHorney, 1998; Lichstein et al., 2004).”
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Efficacy of two behavioral treatment programs for comorbid geriatric insomnia.
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Prospective Associations of Insomnia Markers and Symptoms With Depression
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Insomnia and Absenteeism at Work. Who Pays the Cost?
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Factor structure and measurement invariance of the Women's Health Initiative Insomnia Rating Scale.
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Suicidal Ideation in Outpatients With Chronic Musculoskeletal Pain
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“is consistent with the existing literature.(2,13,48) This strongly highlights the need for future research to include more thorough measures of suicidality.”
ResultPoor sleep predicts symptoms of depression and disability retirement due to depression
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“Individuals reporting disturbed sleep are more likely to report emotional distress and recurrent health problems (Morin and Gramling, 1989; Katz and McHorney, 1998; Edinger et al., 2000).”
BackgroundSleep disturbances among methadone maintained patients
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Secondary insomnia: diagnostic challenges and intervention opportunities
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“Persistent primary insomnia is associated with serious psychiatric and medical morbidities, as well as economic implications including loss of productivity, work-related accidents and absenteeism [101–104].”
BackgroundEvolution of insomnia: current status and future direction
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“In a large scale study of the prevalence and longitudinal course of insomnia in patients with documented chronic medical illness and/or depression, over 15% of all patients (n= 3445) had severe insomnia and 34% had mild insomnia at baseline [10].”
BackgroundCorrelates and consequences of chronic insomnia
Thase, M. E. (2005) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2004.09.006 · Cited by 104
“Sleep disturbances may precede the onset of psychiatric illness [43] including depression [44,45] or be comorbid with medical illnesses [46].”
BackgroundNajib, J. S. (2006) · Clinical Therapeutics · doi:10.1016/j.clinthera.2006.04.014 · Cited by 105
Sleep disorders in substance abusers: how common are they?
Mahfoud, Y., Talih, F. R., Streem, D. W., & Budur, K. S. (2009) · PubMed Central · Cited by 104
The course of insomnia over one year: a longitudinal study in the general population in Sweden
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Phillips, B. A., & Mannino, D. M. (2005) · SLEEP · doi:10.1093/sleep/28.8.965 · Cited by 103
“Does insomnia kill? SLEEP 2005;28(8):965-971.”
Smith, M. T., Perlis, M. L., Chengazi, V., Pennington, J., Soeffing, J. P., Ryan, J. M., & Giles, D. E. (2002) · SLEEP · doi:10.1093/sleep/25.3.325 · Cited by 101
Pharmacotherapy Treatment Options for Insomnia: A Primer for Clinicians
Asnis, G. M., Thomas, M., & Henderson, M. (2015) · International Journal of Molecular Sciences · doi:10.3390/ijms17010050 · Cited by 103
“Unfortunately, insomnia frequently becomes chronic in many patients, lasting over 2 years [52].”
BackgroundStress-related sleep disturbance and polysomnographic response to caffeine
Drake, C. L., Jefferson, C., Roehrs, T., & Roth, T. G. (2006) · Sleep Medicine · doi:10.1016/j.sleep.2006.03.019 · Cited by 103
“These findings suggest why multiple stressors across an array of categories such as medical or psychiatric disease and psychosocial stress may trigger chronic insomnia in some individuals but not others [31–33].”
BackgroundPrevalence and severity of insomnia in chronic low back pain patients
Bahouq, H., Allali, F., Rkain, H., Hmamouchi, I., & Hajjaj-Hassouni, N. (2012) · Rheumatology International · doi:10.1007/s00296-012-2550-x · Cited by 96
Characteristics of sleep in patients with stable heart failure versus a comparison group
Redeker, N. S., & Stein, S. (2006) · Heart & Lung · doi:10.1016/j.hrtlng.2005.10.007 · Cited by 95
(2009) · PubMed · Cited by 93
New developments in cognitive behavioral therapy as the first-line treatment of insomnia
Siebern, A. T., & Manber (2011) · Psychology Research and Behavior Management · doi:10.2147/prbm.s10041 · Cited by 99
Ødegård, S. S., Sand, T., Engstrøm, M., Zwart, J., & Hagen, K. (2013) · The Journal of Headache and Pain · doi:10.1186/1129-2377-14-24 · Cited by 91
“Indeed, several other painful conditions are linked to poor sleep [7-9].”
BackgroundSilva, G. E., An, M., Goodwin, J. L., Shahar, E., Redline, S. S., Resnick, H. E., Baldwin, C. M., & Quan, S. F. (2009) · SLEEP · doi:10.1093/sleep/32.8.1049 · Cited by 90
Tan, M. L. M., Idris, D. B., Teo, L. W., Loh, S. Y., Seow, G. C., Chia, Y. Y., & Tin, A. S. (2014) · Asia-Pacific Journal of Oncology Nursing · doi:10.4103/2347-5625.135817 · Cited by 90
“Kartz and McHorney also reported similar result that pain from OA is the common cause for insomnia.([28]) Moreover, this study found that both disease groups of OA and DM have significant financial impact as this was the common problem encountered by most patients with chronic diseases.”
ResultZhang, J., Lamers, F., Hickie, I. B., He, J.-P., Feig, E. H., & Merikangas, K. R. (2013) · SLEEP · doi:10.5665/sleep.2624 · Cited by 88
Non-Pharmacological Treatment of Insomnia
Siebern, A. T., Suh, S., & Nowakowski, S. (2012) · Neurotherapeutics · doi:10.1007/s13311-012-0142-9 · Cited by 88
“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].”
BackgroundAging, circadian rhythms and depressive disorders: a review.
Costa, I. C., Carvalho, H. N., & Fernandes, L. P. N. S. (2013) · Europe PMC (PubMed Central) · Cited by 90
Metadata
- Authors
- Katz, D. A., & McHorney, C. A.
- Affiliations
- University of Wisconsin–Madison (US)
- 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)
- 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 (medical) › 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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