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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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Anxiety and Insomnia: An Overview
Carney, C. E., & Edinger, J. D. (2010) · Springer eBooks · doi:10.1007/978-1-4419-1434-7_1 · Cited by 1
Bazan, L. F., Roth, T. G., & Drake, C. L. (2011) · Humana Press eBooks · doi:10.1007/978-1-60761-735-8_14 · Cited by 1
Quality and Quantity of Sleep Study and its Relationship to the Performance of LPGA Tour Players
Lopez, M. E. (2012) · Scholarly Commons (Embry–Riddle Aeronautical University) · Cited by 1
A prospective study of asthma and subsequent use of hypnotics in young adults
Karlstad, Ø., Tverdal, A., Skurtveit, S., Nafstad, P., & Furu, K. (2011) · Pharmacoepidemiology and Drug Safety · doi:10.1002/pds.2101 · Cited by 2
“Use of medications: How often in the course of the last 4 weeks have you taken the following medicines? Sleeping pills Five alternatives for each medication listed: Never (1); Daily (2); Every week, but not every day (3); less often than every week (4); Not taken during the last 4 weeks (5) 11⁄4 not used; 2–51⁄4 used…”
BackgroundMethodInfluentialLate life insomnia: A brief review
Singh, P., Tiwari, S., & Pandey, N. M. (2014) · Journal of Geriatric Mental Health · doi:10.4103/2348-9995.152425 · Cited by 1
Long-Term Pharmacotherapy in the Management of Chronic Insomnia
Krystal, A. D., Rogers, S., & Fitzgerald, M. A. (2006) · The Journal for Nurse Practitioners · doi:10.1016/j.nurpra.2006.08.003 · Cited by 1
Insomnia: assessment and treatment review
Qazi, F. M., & Schluederberg, E. A. (2012) · Osteopathic Family Physician · doi:10.1016/j.osfp.2012.03.002 · Cited by 1
Ancoli‐Israel, S., & Neubauer, D. N. (2015) · Cited by 1
Bhatia, M., & Sharma, M. (2009) · Indian Journal of Sleep Medicine · doi:10.5005/ijsm-4-4-125 · Cited by 1
Socioeconomic Impact of Insomnia
Léger, D. (2016) · doi:10.3109/9781420080803-5 · Cited by 1
Kim, M. (2010) · Korean Journal of Health Psychology · doi:10.17315/kjhp.2010.15.4.002 · Cited by 1
No Need to Count Sheep: Investigating an Online Insomnia Intervention among Older Adults
Johanson, K. A., Bohlen, A. J., & Feliciano, L. (2018) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2018.01.189 · Cited by 1
“…risk of developing cardiovascular and pulmonary disease, arthritis, chronic pain, breathing problems, and physical disability (Foley, Monjan, Brown, & Simonsick, 1995; Foley, AncoliIsrael, Britz, & Walsh, 2004; Jordan, Bernard, Callahan, Kincade, Konrad, & DeFriese, 2000; Katz & McHorney, 1998).”
Bonnet, M. H., & Arand, D. L. (2011) · Elsevier eBooks · doi:10.1016/b978-1-4377-1703-7.10010-6 · Cited by 1
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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