Fast-track articleHD-16: a new quality of life instrument specifically designed for insomnia
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.
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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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2013, Encyclopedia of SleepA two-year follow-up study on the symptoms of sleep disturbances/insomnia and their effects on daytime functioning
2012, Sleep MedicineCitation Excerpt :Objective measures revealed that insomnia patients show impairment in tasks that evaluate vigilance, working memory, and motor control [10,11]. These daytime dysfunctions attributed to insomnia are assumed to negatively affect sufferers’ quality of life (QoL), which is a measure of general daytime functioning [12,13]. We previously reported that insomnia was generally associated with depressed mood and low QoL scores in both the mental and physical component among participants from rural Japan [14,15].
Chronic insomnia, quality-of-life, and utility scores: Comparison with good sleepers in a cross-sectional international survey
2012, Sleep MedicineCitation Excerpt :In Japan there was no significant difference in any of the SF-36 dimensions or utility scores observed for treated versus untreated individuals. The results of this study are consistent with prior observations [13–16] that chronic insomnia is associated with impairment in HRQoL and lower utility scores (P < .0001 in each country) compared with good sleepers. Across all three countries, people with chronic insomnia (including those receiving treatment) reported lower SF-36 scores in each of eight domains compared with good sleepers (P < .0001), with greatest impact on the vitality, social functioning, role-emotional, and mental health dimensions.
Assessing the reliability and validity of a newly developed insomnia treatment satisfaction questionnaire (ITSAT-Q)
2010, Sleep MedicineCitation Excerpt :For the purposes of this study, treatment satisfaction was conceptualized as an accumulation of treatment experiences related specifically with pharmacotherapy [9–11]. Although questionnaires exist to assess the impact of sleep disturbances on quality of life, sleep quality, satisfaction in general and specific disease states [12–22], additional information is needed to determine which dimensions, if any, relate to treatment satisfaction for patients with insomnia and how patients perceive pharmacotherapy with respect to treatment satisfaction and the value of treatment. Given the numerous treatment options available for patients diagnosed with insomnia and the detrimental impact that symptoms have on patient lifestyle, it is important to develop a questionnaire that allows physicians and other prescribers to assess the progress of pharmacotherapy.