SLEEP 2011 Abstract Supplement

B. Clinical Sleep Science III. Sleep Disorders – Insomnia
according to diagnostic criteria, including a minimum symptom duration
of greater than 1 month. Participants were categorized as follows:
No Insomnia (symptoms less than or equal to 1 night/week), Moderate
Insomnia (symptoms 2-4 nights/week) or Severe Insomnia (symptoms
greater than or equal to 5 nights/week). National register and medical
records were used to identify incident cases of HTN, diabetes and IHD
at least one year following the insomnia assessment (mean follow-up
duration = 4.4 ±0.6 yrs). Only participants with a negative history of all
3 cardiometabolic outcomes at baseline were included in the analyses.
Logistic regression was used to predict the odds of incident disease according
to insomnia symptom categories, after adjusting for age, sex and
occupational status.
Results: Severe insomnia was associated with an increased risk for all 3
outcomes (HTN OR=1.35, CI: 1.23-1.49; diabetes OR=1.42, CI: 1.04-
1.94; and IHD OR=1.57, CI: 1.08-2.27). Severe insomnia remained
prospectively associated with increased risk for incident hypertension
(OR=1.20, CI: 1.08-1.33) after additional adjustment for health behaviors
and medical co-morbidities.
Conclusion: These results suggest that severe insomnia may be a novel
biobehavioral risk factor for cardiometabolic disease, especially hypertension.
If this relationship is shown to be causal, effective treatment
of insomnia may represent a promising therapeutic target for primary
prevention of cardiometablic disease.
Support (If Any): Support for the first author was provided by R01
HL104607.
0501
PHYSICAL AND MENTAL HEALTH FACTORS ASSOCIATED
WITH INSOMNIA PERSISTENCE, PARTIAL REMISSION
AND FULL REMISSION IN THE GENERAL POPULATION: A
LONGITUDINAL STUDY
Vgontzas AN 1 , Fernandez-Mendoza J 1 , Singareddy R 1 , Liao D 2 ,
Calhoun S 1 , Kritikou I 1 , Basta M 1 , Karataraki M 1 , Bixler EO 1
1
Psychiatry, Penn State College of Medicine, Hershey, PA, USA,
2
Public Health Services, Penn State College of Medicine, Hershey, PA,
USA
Introduction: Few population-based, longitudinal studies have examined
the rates of insomnia persistence and remission, whereas there is no
study that has examined risk factors associated with persistent insomnia.
We examined the rates and risk factors of persistent, partially remitted
and fully remitted insomnia in a sample of the general population.
Methods: From a random, general population sample of 1741 adults of
the Penn State Cohort, 1395 were followed-up after 7.5 years. In this
study we included those with normal sleep at baseline and follow-up (n
= 590) and those who were insomniacs at baseline (n = 149) and developed
into persistent (n = 65), partially remitted (n = 47), or fully remitted
insomnia (n = 37). Medical and sleep history and MMPI-2 testing were
obtained at baseline, and sleep history also at follow-up.
Results: The rates of persistent insomnia, partial remission, and full
remission were 44.0%, 30.0%, and 26.0%, respectively. Mental health
problems at baseline were strongly associated with persistent insomnia
as compared to normal sleep (OR =12.2) and to a lesser degree compared
to remitted insomnia (OR=3.10), whereas physical health problems
predicted full remission. Persistent and partially remitted insomniacs
showed higher elevations in all personality scales when compared to
normal sleepers, whereas in remitted insomniacs only two scales were
significantly higher.
Conclusion: Insomnia is a chronic and persistent disorder with a rather
low rate of full remission. Mental health problems are strong predictors
of insomnia persistence or partial remission. Early detection of insomnia
should be a focus of our public health policies.
0502
NATURAL HISTORY OF POOR SLEEP: A POPULATION-
BASED, 7.5 YEARS LONGITUDINAL STUDY
Fernandez-Mendoza J 1 , Vgontzas AN 1 , Liao D 2 , Singareddy R 1 ,
Calhoun S 1 , Kritikou I 1 , Basta M 1 , Karataraki M 1 , VelaBueno A 1 ,
Bixler EO 1
1
Psychiatry, Penn State College of Medicine, Hershey, PA, USA,
2
Public Health Services, Penn State College of Medicine, Hershey, PA,
USA
Introduction: Poor sleep is thought to precede the development of
chronic insomnia. However, none of the available population-based,
longitudinal studies have examined risk factors of the natural history
of poor sleep.
Methods: From a random, general population sample of 1741 adults of
the Penn State Cohort, 1395 were followed-up after 7.5 years. In this
study we included those with poor sleep at baseline (n = 403) who remained
poor sleepers (n = 155), switched to normal sleep (n = 180), or
developed chronic insomnia (n = 68). Medical and sleep history, 8-hour
PSG, and MMPI-2 testing were obtained at baseline, and sleep history
also at follow-up.
Results: The rates of persistent poor sleep, remitted poor sleep, and poor
sleep with incident insomnia were 39%, 44%, and 17%, respectively.
Male gender, middle-age, allergy/asthma, heart disorder, ulcer, and
depression increased significantly the odds of persistent poor sleep as
compared to remission, whereas female gender, family history of sleep
problems, young age, and caffeine consumption increased the odds of
poor sleepers developing insomnia. Poor sleepers who developed insomnia
also showed higher elevations in 6 personality scales when compared
to remitted poor sleepers, whereas in persistent poor sleepers only
2 scales were significantly higher.
Conclusion: These data suggest that the large majority of poor sleepers
either get better or stay the same, whereas only a small percentage of
them develop chronic insomnia. Persistent poor sleep is associated with
physical and /or mental health problems, whereas emotional distress is
of primary importance in those developing into chronic insomnia. Treatment
of underlying health problems may reduce persistent poor sleep,
whereas addressing maladaptive personality traits may prevent the development
of chronic insomnia.
0503
THE EFFECTS OF INSOMNIA TREATMENT ON SLEEP
INSTABILITY: IS SLEEP STABILIZATION AN IMPORTANT
TREATMENT TARGET?
Sanchez-Ortuno M 1 , Edinger JD 2,3
1
University of Murcia, Murcia, Spain, 2 VA Medical Center, Durham,
NC, USA, 3 Duke University Medical Center, Durham, NC, USA
Introduction: Night-to-night sleep variability is considered a frustrating
component of the insomnia experience. Therefore, stabilization of sleep
could be regarded as a desirable insomnia treatment endpoint. However,
few studies have addressed whether sleep instability decreases with
behavioral or pharmacologic treatments or whether reduced variability
relates to other clinically important outcomes. This study evaluated the
effects of cognitive-behavioral therapy (CBT) on sleep instability across
primary (PI) and comorbid (CI) insomnia subgroups, and explored the
relationship of sleep instability and perceived sleep quality at the posttreatment
time point.
Methods: Participants were insomnia sufferers (n=41, 6 women,
mean(SD) age 54(14) years) randomized to CBT in a larger clinical trial.
Twenty individuals met criteria for PI, whereas 21 had CI associated
with psychiatric disorders. Before and after treatment, intra-individual
instability of sleep onset latency (SOL), wake after sleep onset (WASO),
total sleep time (TST) and sleep efficiency (SE), derived from diary
as well as from actigraphy, was assessed by squaring the differences
between successive nights over a 2-week period. Treatment effects on
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