Elsevier

Sleep Medicine

Volume 13, Issue 1, January 2012, Pages 43-51
Sleep Medicine

Original Article
Chronic insomnia, quality-of-life, and utility scores: Comparison with good sleepers in a cross-sectional international survey

https://doi.org/10.1016/j.sleep.2011.03.020Get rights and content

Abstract

Background

Chronic insomnia has a recognized impact on health-related quality-of-life (HRQoL) but data on utility scores across countries are lacking. The objective of the present study was to assess health related quality of life (HRQoL) and utility scores in individuals from three different countries (USA, France, and Japan), comparing sufferers of chronic insomnia to good sleepers.

Methods

A cross-sectional survey (SLEEPI-i) of 4067 persons in the US (n = 1298; 478 good sleepers and 820 patients with insomnia), France (n = 1858; 998 good sleepers and 860 patients with insomnia) and Japan (n = 911; 506 good sleepers and 405 patients with insomnia). Enrollment and data collection using consumer panels were web-based in the US and France, and gathered via a postal survey in Japan. People with chronic insomnia (>6 months) were selected based on Insomnia Severity Index scores (ISI). Severity of insomnia was assessed using the ISI score and HRQoL was assessed using the self-administered Short-Form SF-36 Health Survey. Utility scores were derived using the algorithm developed by Brazier et al. Multivariate analyses were used to adjust for potential confounding factors.

Results

In all countries, people with chronic insomnia (40% treated) reported lower SF-36 scores in each of eight domains compared with good sleepers (P < .0001). Chronic insomnia was associated with significantly lower utility scores compared with good sleepers (mean scores 0.63 versus 0.72 in the US, 0.57 versus 0.67 in France, and 0.67 versus 0.77 in Japan, P < .0001).

Conclusions

This survey suggests that chronic insomnia is associated with significant impairment of HRQoL and decreased utilities across the different geographical regions studied.

Introduction

Insomnia is defined as difficulty initiating sleep, difficulty maintaining sleep, morning awakening, or sleep that is chronically non-restorative or poor in quality associated with daytime impairment such as fatigue, memory impairment, social or vocational dysfunction, or mood disturbance [1], [2]. Chronic insomnia (with a duration of at least 1 month) is the most prevalent sleep disorder in the general population and is reported by 20–30% of adults. It is shown that insomnia increases with age and is more prevalent in women than in men [3], [4], [5], [6].

Chronic insomnia not only interferes with an individual’s health [2], but also confers a substantial socio-economic burden, given associations with falls and other accidents [7], decreased cognitive functioning, health-related quality of life (HRQoL) [8], increased absenteeism [9], [10], and increased utilization of medical resources [10], [11], [12]. Yet research on this issue has been limited [2]. Previous studies using the 36-item Short Form Health Survey of the Medical Outcomes Study (SF-36) reported that insomnia was associated with a negative impact across all dimensions of HRQoL, increasing with severity of disease [13], [14], [15], [16]. However, to our knowledge, there is no multi-country study of HR-QOL and utilities in insomnia.

The concepts of quality-adjusted life years (QALYS) and utilities are the basis for expressing the burden of disease and evaluating the cost effectiveness of therapeutic interventions. QALYs, the product of the average years of life that remain for the patient and the utility of those years based on associated HRQoL, is commonly used for comparative cost effectiveness analyses [18]. Utility measurement is a method of determining an individual’s preference for a certain outcome represented by a quantitative score: from perfect health (1) to death (0). Given the importance of understanding common patient characteristics independent of their cultural expression [18], [19], [20], and that the prevalence of insomnia varies between countries [21], this cross-sectional survey was performed in the USA, France, and Japan to obtain information relating to HRQoL and utility scores in people with chronic insomnia in different countries.

Section snippets

Design

SLEEPi (Study Linking European–US–Japanese Economic Perceptions in Insomnia – internet-based) was a cross-sectional, web- and paper-based questionnaire survey in three industrialized countries (the US, France, and Japan).

Participants

Participants were recruited on-line in the USA and France from the Harris Poll and Ciao (France only) market research panels, consisting of individuals who had voluntarily registered and agreed to regularly complete research surveys on a variety of topics. Between December 2005

Population characteristics

Fig. 2 shows the flow of participants in the study. The study population comprised 4067 individuals, of whom 2085 (48.7%) had chronic insomnia; 832 (39.9%) patients with insomnia were currently treated.

Demographic and clinical characteristics of participants with chronic insomnia and good sleepers are summarized by country in Table 1. The proportion of older respondents (>60 years) with chronic insomnia was higher in the US and Japanese cohorts (35% and 39%, respectively) than the French cohort

Discussion

The results of this study are consistent with prior observations [13], [14], [15], [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

Author contributions

  • Pr. Léger had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

  • Study concept and design

  • Léger, Morin, Uchiyama, Kobayashi, Cure, Walsh.

  • Acquisition of data

  • Cure, Hakimi

  • Analysis and interpretation of data

  • Léger, Morin, Uchiyama, Cure, Walsh.

  • Drafting of the manuscript

  • Léger, Hakimi.

  • Critical revision of the manuscript for important intellectual content

  • Léger, Morin, Uchiyama, Cure, Walsh.

  • Statistical expertise

  • Cure.

Financial disclosures

Pr. Léger reports that he has received honoraria from Sanofi Aventis as scientific advisor. Dr. Morin reports that he has received honoraria and/or Grant support from Sanofi Aventis as scientific advisor. Dr. Uchiyama reports that he has received honoraria and/or Grant support from Sanofi Aventis as scientific advisor. Dr. Hakimi, reports that he was an employee of Sanofi-Aventis. Ms. Cure reports that she has received Grant support from Sanofi-Aventis. Dr. Walsh reports that his institution

Funding/support

This research was funded by sanofi-aventis recherche and développement, Paris, France, which manufactures zolpidem and zopiclone.

Role of the sponsor

Sanofi-Aventis employees worked collaboratively with the investigators in designing the study and interpreting the data and were involved in the conduct of the study, including the collection, management, and initial analysis of the data. Sanofi-Aventis employees provided comments on the manuscript, but the writing committee made final decisions on the interpretation of study results and contents of the manuscript.

Previous presentation

Preliminary data was presented at the 14th Annual Conference of the International Society for Quality of Life Research, October 10–13, 2007, Toronto, ON, Canada.

Conflict of interest

The ICMJE Uniform Disclosure Form for Potential Conflict of interest associated with this article can be viewed by clicking on the following link: doi:10.1016/j.sleep.2011.03.020.

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Acknowledgment

We thank the patients for their participation in this survey.

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