Elsevier

Sleep Medicine

Volume 6, Issue 3, May 2005, Pages 191-198
Sleep Medicine

Fast-track article
HD-16: a new quality of life instrument specifically designed for insomnia

https://doi.org/10.1016/j.sleep.2005.03.013Get rights and content

Abstract

Background and purpose

To design a new quality of life (QoL) instrument specifically for insomnia.

Patients and methods

Based on severe insomniacs' interviews, we have built a new quality of life scale that has been tested in one group of 240 severe insomniacs, in one group of 422 mild insomniacs and in one group of 391 good sleepers. Ten steps led to the construction of a specific QoL scale.

Results

Five dimensions have been validated as both relevant and independent from each other. Sixteen items out of the 43 initially tested were retained and significantly different within the groups in each dimension. Based on the 16 items selected, we called the scale Hotel Dieu 16 (HD-16). We have therefore verified the score's specificity (correlation score of +0.36) and the reliability of the scale (Cronbach coefficient α=0.78).

Conclusion

HD-16 may be used as a focused instrument to better assess an insomniac's quality of life.

Introduction

Epidemiological studies have shown that insomnia is a very common disease in the general population, affecting between 9 and 15% of adults [1], [2], [3]. In addition to disturbed sleep, insomnia is defined as having a negative impact on daytime functions. In the International Classification of Sleep Disorders (ICSD) [4], ‘insomnia is always associated with a complaint of decreased functioning during wakefulness’. In the Diagnostic and Statistical manual of mental Disorders IV (DSM-IV) [5] insomnia is ‘serious enough to induce severe fatigue, irritability or disability in daytime functioning’ and is ‘frequently accompanied by non-specific symptoms such as mood disorders, memory troubles or lack of concentration’.

However, previous studies which have evaluated the daytime impact of insomnia with objective parameters, such as multiple sleep latency tests [6] failed to demonstrate objective impairment of insomniacs during the day, despite the fact that, subjectively, insomniacs complained of impaired daytime functioning.

Hence, recent studies have concentrated on evaluating the impact of insomnia while other instruments have targeted more subjective dimensions including the perceptions by insomniacs of both nighttime and daytime performance. This may be achieved with the quality of life (QoL) instruments. QoL is a complex and multidimensional term that has been defined as “a concept encompassing a broad range of physical and psychological characteristics and limitations which describe an individual's ability to function and to derive satisfaction from doing so” [7]. It includes the following domains: physical (the ability to conduct activities of daily living), psychological (or emotional) and social (interactions with family, friends and community). Insomnia may affect all three of these domains. Several studies have now used the SF-36, a generic and well-validated QoL instrument, to assess an impaired QoL in insomniacs [8], [9], [10], [11], [12]. Other generic scales such as the Nottingham Health Profile (NHP) and the Sickness Impact Profile (SIP) have also been used [13]. Both have shown that insomnia impaired QoL similarly with chronic disease such as hypertension or chronic obstructive pulmonary disease [13]. However, there is, until now, a lack of specific instruments assessing QoL disturbances in insomniacs after controlling for comorbid illnesses and reflecting the degree of severity of insomnia.

In many other chronic diseases, it has been shown that a disease-focused QoL instrument was useful to accurately evaluate its impact on the daily lives of patients and to show the efficacy of some treatments [14], [15]. We also believe that in the field of insomnia there is a need for specific instruments to better encompass the QoL of patients. The objective of the present study was to build a new QoL instrument specifically designed for insomniacs.

Section snippets

Subjects and controls

The SOFRES, a French poll institute, selected the subjects for study. The SOFRES regularly surveys a group of 11,372 individuals representing the French general population. Initially, each individual received a first questionnaire (Q1) assessing insomnia based on the DSM-IV and ICSD criteria [4], [5]. The SOFRES methodology and the questionnaire used in epidemiological surveys to select groups of mild and severe insomniacs have been previously described and published [2], [9]. Severe insomniacs

Subjects and controls

Of the 8625 individuals who responded to the poll (76%), 690 were classified as severe insomniacs (8.1%).

A group of 700 persons with mild insomnia (MI) and a group of 600 good sleepers (GS) were statistically matched by age, sex, occupation, location and marital status.

Questionnaire

Seventy-eight percent of severe insomniacs (538 individuals), 81% of others (1060 individuals, of which 614 mild insomniacs and 446 good sleepers) responded to Q2. Persons with psychiatric disorders according to DSM-IV minimum

Discussion

In this study, based on the testimonies of severe insomniacs, we investigated whether it was possible to propose a new QoL instrument focused on insomnia. We carefully designed, following the recommendations of the European regulatory issues on quality of life assessment [16], a short and simple instrument, the HD-16, which differentiated severe insomniacs from mild insomniacs and good sleepers. We believe that this instrument is a new step toward understanding the consequences of insomnia in

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