Sleep Initiation and Maintenance Disorders: Schutte-Rodin S

Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. · Penn Sleep Centers, University of Pennsylvania Health System, Philadelphia, PA 19104, USA. · J Clin Sleep Med. · Pubmed #18853708 links to  free full text

Abstract: Insomnia is the most prevalent sleep disorder in the general population, and is commonly encountered in medical practices. Insomnia is defined as the subjective perception of difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate opportunity for sleep, and that results in some form of daytime impairment.1 Insomnia may present with a variety of specific complaints and etiologies, making the evaluation and management of chronic insomnia demanding on a clinician's time. The purpose of this clinical guideline is to provide clinicians with a practical framework for the assessment and disease management of chronic adult insomnia, using existing evidence-based insomnia practice parameters where available, and consensus-based recommendations to bridge areas where such parameters do not exist. Unless otherwise stated, "insomnia" refers to chronic insomnia, which is present for at least a month, as opposed to acute or transient insomnia, which may last days to weeks.

Gooneratne NS, Gehrman PR, Nkwuo JE, Bellamy SL, Schutte-Rodin S, Dinges DF, Pack AI. · Division of Geriatric Medicine, Center for Sleep and Respiratory Neurobiology, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia 19104, USA. · Arch Intern Med. · Pubmed #16983051 links to  free full text

Abstract: BACKGROUND: The prevalence of sleep-related breathing disorder (SRBD) and insomnia symptoms increases considerably with advancing age, but little is known about their cooccurrence and their effects on daytime functioning when present together. METHODS: Older adults with (cases, n = 99) and without (controls, n = 100) symptoms of insomnia underwent 2 nights of in-laboratory polysomnography, daytime nap, and neurobehavioral testing and completed study questionnaires. Predictors of SRBD were identified (apnea-hypopnea index [indicating number of events per hour], > or =15). Participants were divided into 4 groups--with and without insomnia and with and without SRBD--and the groups were compared on measures of daytime functioning. RESULTS: Cases had a lower rate of SRBD (29.3%) than controls (38.0%). Body mass index (calculated as weight in kilograms divided by height in meters squared) of 30 or higher, neck circumference greater than 15.5 inches, and a history of "loud snoring" or "stops breathing, chokes, or struggles for breath" were independently predictive of SRBD in participants with insomnia symptoms. Having both insomnia symptoms and SRBD was associated with significantly lower daytime functioning and longer psychomotor reaction times compared with having neither condition. CONCLUSION: Because insomnia comorbid with SRBD is associated with the greatest functional impairment, and SRBD is commonly found in the elderly population, health care providers should also consider SRBD in elderly patients with insomnia symptoms.