Original ArticleEffects of insomnia and sleep medication on health-related quality of life
Introduction
Insomnia is well known as a common disorder [1], [2], [3] with a prevalence of about 20% among the general population [4], [5]. Major symptoms of insomnia are poor nocturnal sleep and impaired daytime functioning during wakefulness [6]. In the 2nd edition of International Classification of Sleep Disorders (ICSD-2) [7], daytime impairment as well as nighttime sleep difficulties – difficulty initiating sleep, difficulty maintaining sleep, waking up too early or sleep that is chronically nonrestorative or poor in quality – are emphasized among the diagnostic criteria.
Reports describing clinical populations show that patients with chronic insomnia commonly complain of subjective daytime impairments including mood disturbances, concentration problems, elevated fatigue, and sleepiness [6], [8]. Regarding objective daytime impairments, these patients show impairments in tasks evaluating vigilance, working memory, and motor control [9], [10]. These various daytime dysfunctions attributable to insomnia are presumed to degrade quality of life (QOL), an evaluation of general daytime functioning [11], [12]. Reportedly, degradation of QOL, as evaluated using the standardized 36-item Short Form Health Survey of the Medical Outcomes Study (SF-36), is associated with insomnia’s severity [13]. Because QOL is a complex and multidimensional term, it can reflect the lifestyle, health status, and socio-environmental background of subjects. Although such factors should be analysed when evaluating QOL, few reports have described an association between insomnia and QOL in a general population with due consideration of these demographic factors.
Results of previous studies revealed the use of sleep medication for insomnia by approximately 5–8% of the general population [1], [14], [15]. The relative frequency among the general population of people with at least occasional use of sleep medication is approximately 3–11% [1], [16], [17]. Several studies conducted in clinical settings have revealed that the use of sleep medication improves not only sleep quality but also daytime ability to function and a sense of physical well being of patients with insomnia [18], [19]. In addition, long-term nightly pharmacologic treatment of primary insomnia with any hypnotic has been reported to enhance both mental QOL and physical QOL [20]. Contrary to those reports, others have described sleep medication as having no significant effect on next-day psychomotor performance or QOL [21], [22]. Furthermore, differences in the effects of sleep medication between mental and physical QOL among the general population have not been clarified yet.
In the series of Daisen sleep health care studies, we first reported the prevalence of restless legs syndrome (RLS) among residents in rural areas and the negative impact of the disorder on QOL [23]. Secondly, we presented data related to the influence of insomnia and sleep medication use on depressive symptoms [unpublished observations]. For the present study, we used the 8-item Short Form Health Survey of the Medical Outcomes Study (SF-8) – a simpler version of SF-36 that is nevertheless as useful as SF-36 for evaluating QOL [24], [25] – to clarify the above-described issue of the association between insomnia, sleep medication use, and QOL. This study was designed to evaluate QOL among the general population in a rural community using SF-8, particularly addressing the impact of insomnia and sleep medication use on the mental component summary (MCS) score and physical component summary (PCS) score.
Section snippets
Subjects and procedures
The ethics committees of Tottori University approved this study. All subjects gave their informed consent to take part in this investigation.
This survey was conducted as a part of the above-described Daisen sleep health care studies undertaken in a rural community in Tottori prefecture in western Japan [23]. The total population of the town was 6643 in 2004, with 5528 residents aged 20 years or older (2521 men and 3007 women). Major industries in this area are agriculture, farming, and tourism.
Sample characteristics
Demographic characteristics of the sample population are presented in Table 1. The sample comprised 1222 men (43.3%) and 1600 women (56.7%) with mean [SD] age of 57.4 [17.7] years (range 20–97 years). The mean family size in this cohort was 4.6 [1.6]: 120 subjects (4.3%) lived alone and 1210 responders (43.9%) lived with more than five family members.
Differences in scores of MCS and PCS between the insomniac group and good sleepers group
Supplementary Fig. 1 (in online supplementary material) portrays comparisons between the MCS score and the PCS scores of the insomniac group’s
Discussion
Leger et al. reported that chronic insomniacs showed lower scores of SF-36 than good sleepers in all eight domains. The more severe the insomnia symptoms were, the worse the QOL [13]. Compatible with their results, our results showed that both the MCS scores and the PCS scores were significantly lower for insomniacs than for good sleepers in the study area population.
Results of multiple logistic analysis show that depression and age are associated with the deterioration of physical QOL and
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