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
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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.
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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
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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
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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
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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