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Cited by 776Sleep and related disordersObstructive Sleep Apnea ResearchSleep and Work-Related Fatigue

Insomnia with objective short sleep duration: The most biologically severe phenotype of the disorder

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Vgontzas, Alexandros N., Fernandez-Mendoza, Julio, Liao, Duanping, Bixler, Edward O.·2013·Sleep Medicine Reviews
DOI 10.1016/j.smrv.2012.09.005PMC PMC3672328
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Abstract

Until recently, the association of chronic insomnia with significant medical morbidity was not established and its diagnosis was based solely on subjective complaints. We present evidence that insomnia with objective short sleep duration is the most biologically severe phenotype of the disorder, as it is associated with cognitive-emotional and cortical arousal, activation of both limbs of the stress system, and a higher risk for hypertension, impaired heart rate variability, diabetes, neurocognitive impairment, and mortality. Also, it appears that objective short sleep duration is a biological marker of genetic predisposition to chronic insomnia. In contrast, insomnia with objective normal sleep duration is associated with cognitive-emotional and cortical arousal and sleep misperception but not with signs of activation of both limbs of the stress system or medical complications. Furthermore, the first phenotype is associated with unremitting course, whereas the latter is more likely to remit. We propose that short sleep duration in insomnia is a reliable marker of the biological severity and medical impact of the disorder. Objective measures of sleep obtained in the home environment of the patient would become part of the routine assessment of insomnia patients in a clinician's office setting. We speculate that insomnia with objective short sleep duration has primarily biological roots and may respond better to biological treatments, whereas insomnia with objective normal sleep duration has primarily psychological roots and may respond better to psychological interventions alone.

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  • Sleep disturbance and extremes of sleep duration affect risk factors of inflammatory disease and contribute to all-cause mortality.

    “Research has demonstrated that sleep disturbance (i.e. insomnia) and extremes of sleep durations affect risk factors of inflammatory disease and contribute to all-cause mortality [18,22].”

    From Sleep and Nutrition Interactions: Implications for Athletes (2019) · cites this paper as [22]

  • Short sleep duration (<5 h) with insomnia complaints may mark a more severe form of insomnia disorder.

    “Insomnia complaints with short sleep duration (o5 h) may represent a more severe phenotype of insomnia disorder (Vgontzas and Fernandez-Mendoza et al, 2013).”

    From Sleep health: Reciprocal regulation of sleep and innate immunity (2017) · cites this paper as Vgontzas and Fernandez-Mendoza et al, 2013

  • Polysomnography is of limited help in confirming or ruling out insomnia in case-control studies.

    “polysomnography provides little information to confirm or exclude insomnia in a study of patients with insomnia and controls, with similar findings found in a large multicenter field trial (for a review, see (Vgontzas and Fernandez-Mendoza et al, 2013)).”

    From Sleep health: Reciprocal regulation of sleep and innate immunity (2017) · cites this paper as Vgontzas and Fernandez-Mendoza et al, 2013

  • Insomnia complaints combined with short sleep duration are thought to be particularly harmful for health outcomes.

    “insomnia complaints when combined with short sleep duration are thought to be particularly caustic for health outcomes (Vgontzas et al, 2009(Vgontzas et al, , 2013;;Irwin, 2015).”

    From Sleep health: Reciprocal regulation of sleep and innate immunity (2017) · cites this paper as Vgontzas et al, 2013

  • Increases in urinary catecholamine and metabolite levels are more likely in insomnia patients with short sleep duration, similar to greater inflammatory biomarker activation in this severe phenotype.

    “increase in urinary catecholamine and levels of their metabolites are more likely to occur in those insomnia patients who also report short sleep duration, a pattern similar to the greater activation of inflammatory biomarkers in this more severe phenotype”

    From Sleep health: Reciprocal regulation of sleep and innate immunity (2017) · cites this paper as Vgontzas et al, 2013

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Authors
Vgontzas, A. N., Fernandez-Mendoza, J., Liao, D., & Bixler, E. O.
Affiliations
Pennsylvania State University (US)
Corresponding author
Vgontzas, Alexandros N.
ORCID
Venue
Sleep Medicine Reviews
Publisher
Elsevier BV
Published
2013-08
Volume
17
Issue
4
Pages
241-254
ISSN
1087-0792 (ISSN-L)
DOI
10.1016/j.smrv.2012.09.005
PMC
PMC3672328
OpenAlex
W2156990703
Cited by
776
References
148
Citations by year
2026: 60 · 2025: 66 · 2024: 66 · 2023: 83 · 2022: 67 · 2021: 77 · 2020: 61 · 2019: 67 · 2018: 61 · 2017: 44 · 2016: 32 · 2015: 40 · 2014: 37 · 2013: 14
FWCI
6.82
Type
journal article
Language
en
Open access
Locations
  • Sleep Medicine Reviews (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • University of Pittsburgh
  • U.S. Public Health Service (R01 51931, R01 64415, R01 40916)
  • National Heart, Lung, and Blood Institute (R01HL040916, R01HL064415, R01HL051931)
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
chronic insomnia, insomnia phenotypes, cortical arousal, sleep misperception, hypertension, heart rate variability, diabetes mellitus, neurocognitive impairment, mortality, genetic susceptibility, insomnia remission, home sleep monitoring
MeSH terms
Humans, Hypertension, Sleep Initiation and Maintenance Disorders, Phenotype, Sleep, Time Factors, Polysomnography

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