Days-Out-of-Role Associated With Insomnia and Comorbid Conditions in the America Insomnia Survey

Goeran Hajaka, Maria Petukhovab, Matthew D. Lakomac, Catherine Coulouvratd, Thomas Rothe, Nancy A. Sampsonb, Victoria Shahlyb, Alicia C. Shillingtonf, Judith J. Stephensong, James K. Walshh,
a Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Social Foundation Bamberg, Teaching Hospital of the University of Erlangen, Bamberg, Germany
b Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
c Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
d Sanofi-Aventis, Paris, France
e Sleep Disorders and Research Center, Henry Ford Health System, Detroit, Michigan
f Epi-Q, Oak Brook, Illinois
g HealthCore, Wilmington, Delaware
h Sleep Medicine and Research Center, St. Luke's Hospital, St. Louis, Missouri

Background

Insomnia is highly prevalent and impairing but also highly comorbid with other chronic physical/mental disorders.

Population-based research has yet to differentiate the role impairments uniquely associated with insomnia per se from those due to comorbidity.

Methods

A representative sample of 6791 adult subscribers to a large national US commercial health plan was surveyed by telephone about sleep and health.

Twenty-one conditions previously found to be comorbid with insomnia were assessed with medical/pharmacy claims data and validated self-report scales.

The Brief Insomnia Questionnaire, a fully structured, clinically validated scale, generated insomnia diagnoses according to inclusion criteria of DSM-IV-TR, ICD-10, and Research Diagnostic Criteria/International Classification of Sleep Disorders: Diagnostic and Coding Manual, Second Edition.

The World Health Organization Disability Assessment Schedule-II assessed number of days in the past 30 when health problems prevented respondents from conducting their usual daily activities.

Regression analyses estimated associations of insomnia with days-out-of-role controlling comorbidity.

Results

Insomnia was significantly associated with days-out-of-role (.90 days/month) in a gross model.

The association was reduced when controls were introduced for comorbidity (.42 days/month).

This net association did not vary with number or type of comorbid conditions but was confined to respondents 35+ years of age.

Insomnia was one of the most important conditions studied not only at the individual level, where it was associated with among the largest mean days-out-of-role, but also at the aggregate level, where it was associated with 13.6% of all days-out-of-role.

Conclusions

Insomnia has a strong net association with days-out-of-role that does not vary as a function of comorbidity.

Key Words: Comorbidity; days out of role; epidemiology; insomnia; perceived health; role disability

Fuente: Biological Psychiatry,online 1 October 2011.

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Days out of role
A modified version21 of the WHO Disability Assessment Schedule (WHO-DAS)22, 23 was used to ask respondents the number of days in the 30 days before interview (that is, beginning yesterday and going back 30 days) they were totally unable to work or carry out your normal activities because of problems with either your physical health, your mental health or your use of alcohol or drugs.