What are the contributing factors for insomnia in the general population?
Introduction
Although widely studied in the general population [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], insomnia lacks a standard by which to recognize its presence. As a consequence, it is difficult to compare results among countries and to determine the value of insomnia symptomatology to improve its recognition in clinical settings. The definition of insomnia symptoms has greatly varied, as has the number of symptoms assessed, their duration, and their association with sleep/mental disorders. Indeed, some studies used only the reports of difficulty initiating (DIS) or maintaining sleep (DMS) as insomnia symptoms [2], [5], [8], [11]. Others also used a frequency [1], [3], [13], [21], [22], [23], [24], [25] or an intensity scale [6], [7], [9], [12], [14] to determine the presence of insomnia. It is therefore almost impossible to compare the results of these studies. Foremost, an important problem remains: we do not know what the weight of these symptoms is in the diagnosis of sleep or mental disorders. The reported high prevalence of insomnia in these studies suggests that many of the subjects may have been without a true disorder. Furthermore, a part of the population is probably missing because these individuals failed to report insomnia symptoms [19].
From 1993 to 1999, 24,600 subjects from six European countries were extensively questioned about their sleeping habits and sleep/mental disorders. The goal was to tighten the definition of insomnia symptoms in order to increase its recognition in the general population and its associated sleep and mental disorders.
Section snippets
Subjects
This study included 24,600 subjects, representative of the general population aged 15 years and older from France (n=5622), the UK (n=4972), Germany (n=4115), Italy (n=3970), Portugal (n=1856), and Spain (n=4065). These six countries totaled 251,405,391 inhabitants of the European community.
The methodology was the same in each country. The samples were drawn using a two-stage procedure. At the first stage, the sample was chosen according to the geographic distribution of the country as per the
Results
Overall, 24,600 subjects were included in the analyses. Six different strategies were used to analyze the data:
Discussion
This is the first large-scale epidemiological study (N=24,600) that attempts to delineate the importance of insomnia symptoms in relationship to sleep and mental disorders.
Conclusion
This is the first attempt to redefine insomnia recognition through a very large sample of the general population. New decision trees to improve classifications such as DSM-IV or ICSD were described and tested through the large set of variables collected in six European countries. Insomnia is a prevalent pathology in the general population that may cause severe consequences in daily life. Increasing accuracy of insomnia symptomatology identification will help clinicians to recognize pathological
Acknowledgements
This research was supported by the Fond de la Recherche en Santé du Quebec (FRSQ, grant #971067) and by an unrestricted educational grant Sanofi-Synthelabo group. The collaboration of Prof. Robert G. Priest (University of London, England), Prof. Jürgen Zulley (University of Regensburg, Germany), Prof. Salvatore Smirne (State University and Istituto Scientifico San Raffaele, Italy), Prof. Teresa Paiva (Hospital de Sta. Maria, Portugal), and Dr. Teresa Sagales (Hospital General Univ. Vall
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