epidemiology of non-restorative sleep in the general population
DESCRIPTION
Maurice M. Ohayon, MD, DSc, PhD Stanford Sleep Epidemiology Research Center School of Medicine, Stanford University. Epidemiology of Non-Restorative Sleep in the General Population. What is non-restorative sleep?. For DSM-IV It is one of the four insomnia symptoms - PowerPoint PPT PresentationTRANSCRIPT
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Maurice M. Ohayon, MD, DSc, PhDStanford Sleep Epidemiology Research Center
School of Medicine, Stanford University
Epidemiology of Non-Restorative Sleep in the
General Population
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What is non-restorative sleep?
For DSM-IV• It is one of the four insomnia symptoms
• It is described as a feeling the sleep is restless, light or of poor quality
For ICSD• Insomnia is described as a complaint of insufficient amount of sleep or not feeling rested after the habitual sleep period
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Non-restorative sleep
Sleep not enough Poor sleep
Prevalence: 20% to 41.7%
Prevalence: 10% to 18.1%
•Husby & Lingjaerde, 1992 Norway (Tromso)•Ohayon et al., 1997, UK•Ohayon et al., 1997,Ca (MTL)•Ohayon et al., 2001 (Europe)
•Lugaresi et al., 1983 San Marino , IT•Kageyama et al., 1997 JP•Asplund & Aberg,1998 SE (Jamtland county)•Vela-Bueno et al., 1999 ES, Madrid
Non-restorative sleep is poorly defined when using sleeping not enough or complaining of a poor sleep: the prevalence variation is too high
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Definition of NRS
NRS can be defined as : •a moderate to severe complaint of being unrefreshed upon awakening (even if the sleep duration is sufficient according to the subject) occurring at least 3 nights per week during a period of at least one month
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Sample
Targeted population:• Representative sample of the general population aged >=18 years of California, New York and Texas (66 millions inhabitants)
• Total sample: 8,937 non-institutionalized individuals
• Average participation rate: 85.3%Telephone interviews using the
Sleep-EVAL system
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Information collected by Sleep-EVAL
Socio-demographics Symptoms of sleep, psychiatric and organic
disorders Quality of life Daytime functioning
• Fatigue• Daytime sleepiness• Social functioning
Medical history• Consultations, hospitalizations, medications, diseases,
etc.
8Diagnoses collected by Sleep-EVAL
Sleep disorder diagnoses according to DSM-IV and ICSD*
Mental disorder diagnoses according to DSM-IV*
Organic diseases according to ICD-10Psychotropic consumption according to
the roster of pharmacological compounds
* Positive and differential diagnoses
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How frequent is NRS?
19%
22%21%
18%
15%
10%
15% 15%
13%
17%
11%
6%
17%
19%
17% 17%
13%
9%
0%
5%
10%
15%
20%
25%
< 25 25-34 35-44 45-54 55-64 >=65
Age groups
Female Male Total
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What is the duration of NRS?
0%
10%
20%
30%
40%
50%
60%
<= 5 months 6 to 11 months 1 to 5 years >= 5 years
Duration
Association between NRS and other insomnia symptoms
1.9%
0.5%
0.5%
DIS (11.3%)>= 3T/Wk>= 1 ms 0.1% 1.3%
2.5%
9.2%4.0%
0.4%
1.3%
4.7%
0.5%
13.1%
NRS (17%)>= 3T/Wk>= 1 ms
NA (35.5%)
>= 3T/Wk
1.6%
4.1%
No DIS, DMS, NRS and
NA (54.1%)
DMS (22%) >= 3T/Wk>= 1 ms
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57% No 43% Yes
1 or 2 awakeningsper night (78%)
>= 3 awakeningsper night (22%) Have difficulty
DIS?
NRS?
GSD?
10.1% (7.2%) 5.9% (15.2%) 50.4% (37.4%)
13.6% (14.7%) 7.3% (28.5%) 38.6% (43.9%)
9.5% (10.9%) 8.3% (31.9%) 45.6% (50.4%)
33.5% (5.9%)
40.6% (10.8%)
36.6% (9.8%)
35.5% Yes (n=3173)
64.5% No (n=5764)
Daytimeimpairment?
(48.3%) (65.1%)(36.9%) (77.5%)
Difficulty resuming sleep once awaken?
Nocturnal awakening events >= 3 nights per week?
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13What factors are associated with NRS?
Sleep/wake schedule?Mental disorders?Health factors?
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Sleep/wake schedule
Adjusted OR (95% C.I.)
Nighttime sleep duration < 5:00 0.66 (0.46-0.94) 5:00-5:59 0.72 (0.55-0.94) 6:00-6:59 1.03 (0.85-1.24) 7:00-7:59 0.95 (0.80-1.13) 8:00-8:59 1.00 >=9:00 1.47 (1.12-1.92)
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Sleep/wake schedule
Adjusted OR
(95% C.I.)
Sleep latency
<= 15 min. 1.00 16-30 min. 1.39 (1.23-1.57) 31-60 min. 3.04 (2.57-3.59) >60 min. 4.79 (3.84-5.98)
Extra sleep on weekend and days off
0 minute 1.00 <= 60 min. 0.76 (0.64-0.90) 61 min. to 2 hrs 0.90 (0.77-1.05) >2 hrs to 3 hrs 1.12 (0.91-1.38) > 3 hrs 1.45 (1.17-1.79)
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NRS: Association with mental disorders
Odds ratio (95% CI)*
DIS/DMS no NRS NRS
Major depressive disorder 1.9 (1.5-2.4) 4.3 (3.3-5.5)
Bipolar disorder 1.8 (1.2-2.8) 3.2 (2.0-5.1)
Anxiety disorder 1.4 (1.2-1.7) 2.1 (1.7-2.5)
*Reference: no insomnia subjectsAdjusted for age and gender
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Physical Diseases
Odds ratio (95% CI)*
DIS/DMS no NRS NRS
Hypertension 1.6 (1.5-1.8) 1.4 (1.2-1.6)
Diabetes 1.6 (1.3-2.1) 2.8 (1.9-3.9)
Upper airway disease 1.9 (1.5-2.4) 2.0 (1.6-2.8)
Heart disease 3.3 (2.8-4.0) 2.2 (1.8-2.8)
Chronic pain 3.2 (2.8-3.5) 4.0 (3.5-4.6)
Other disease 1.7 (1.4-1.9) 2.1 (1.7-2.5)
Any disease 2.6 (2.4-2.8) 2.8 (2.6-3.1)
*Reference: no insomnia subjectsAdjusted for age and gender
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Daytime consequences
CognitionMoodFatigueSleepinessMedical consultations for sleep
problemsUse of sleep medication
19Is NRS causing more cognitive difficulties?
45.0
20.7
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
50.0
NRS DIS or DMS (NO-NRS)
Pe
rce
nta
ge
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IS NRS causing more mood changes?
18.5
6.5
19.1
6.6
15.1
37.6
0
5
10
15
20
25
30
35
40
NRS DIS or DMS (NO-NRS)
Pe
rce
nta
ge
Anxious mood
Depressive mood
Irritable mood
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Is NRS causing more daytime sleepiness?
14.8%
4.6%
20.7%
12.3%
31.5% 30.8%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
Moderate Severe
Daytime Sleepiness
No insomnia
DIS/DMS no NRS
NRS
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Negative impacts
13.3%
9.9%8.1%
37.4%
29.8%
33.8%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
Family relationships Social relationships Work
DIS/DMS no NRS NRS
23Consultations & medication for sleep problems
15.4
8.0
14.0
10.9
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
NRS DIS or DMS (NO-NRS)
Pe
rce
nta
ge
Consultations for sleepproblemsUse of sleep medication
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Duration of sleep medication intake
0
5
10
15
20
25
30
35
40
45
50
NRS DIS or DMS (NO-NRS)
Pe
rce
nta
ge
<= 1 month 1 to 12 months 1 to 5 years >= 5 years
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Conclusions
NRS is a symptom that must be taken seriously for several reasons: • Excessive daytime sleepiness more frequent in NRS• Mood swings and cognitive impairments more frequent in NRS
• NRS more likely to seek help for their sleep problems • Therefore, the societal costs are important in terms of decreased productivity and diminished quality of life