RESUMEN
Over the last few decades, there has been an increasing recognition for seagrasses' contribution to the functioning of nearshore ecosystems and climate change mitigation. Nevertheless, seagrass ecosystems have been deteriorating globally at an accelerating rate during recent decades. In 2017, research into the condition of eelgrass (Zostera marina) along the eastern coast of James Bay, Canada, was initiated in response to reports of eelgrass decline by the Cree First Nations of Eeyou Istchee. As part of this research, we compiled and analyzed two decades of eelgrass cover data and three decades of eelgrass monitoring data (biomass and density) to detect changes and assess possible environmental drivers. We detected a major decline in eelgrass condition between 1995 and 1999, which encompassed the entire east coast of James Bay. Surveys conducted in 2019 and 2020 indicated limited changes post-decline, for example, low eelgrass cover (<25%), low aboveground biomass, smaller shoots than before 1995, and marginally low densities persisted at most sites. Overall, the synthesized datasets show a 40% loss of eelgrass meadows with >50% cover in eastern James Bay since 1995, representing the largest scale eelgrass decline documented in eastern Canada since the massive die-off event that occurred in the 1930s along the North Atlantic coast. Using biomass data collected since 1982, but geographically limited to the sector of the coast near the regulated La Grande River, generalized additive modeling revealed eelgrass meadows are affected by local sea surface temperature, early ice breakup, and higher summer freshwater discharge. Our results caution against assuming subarctic seagrass ecosystems have avoided recent global declines or will benefit from ongoing climate warming.
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Ecosistema , Zosteraceae , Cambio Climático , Biomasa , TemperaturaRESUMEN
Importance: Insomnia is a significant public health problem, but there is little information on its natural history. Objective: To assess the incidence, persistence, and remission rates of insomnia over a 5-year naturalistic follow-up period. Design, Setting, and Participants: This cohort study included participants with and without sleep problems selected from the adult population in Canada from August 2007 to June 2014. Participants completed an annual survey about their sleep and health status for 5 consecutive years. Exposure: Using validated algorithms, participants were classified at each assessment as being good sleepers (n = 1717), having an insomnia disorder (n = 538), or having subsyndromal insomnia (n = 818). Main Outcomes and Measures: Survival analyses were used to derive incidence rates of new insomnia among the subgroup of good sleepers at baseline and persistence and remission rates among those with insomnia at baseline. Sleep trajectories were examined by looking at year-person transitions between each consecutive year summed over the 5-year follow-up period. All inferential analyses were weighted according to normalized sampling weights. Results: The sample included 3073 adults (mean [SD] age, 48.1 [15.0] years; range, 18.0-95.0 years; 1910 [62.2%] female). Overall, 13.9% (95% CI, 11.0%-17. 5%) of initial good sleepers developed an insomnia syndrome during the 5-year follow-up period, and incidence rates were higher among women than among men (17.6% [95% CI, 13.6%-22.7%] vs 10.1% [95% CI, 6.6%-15.3%; χ2 = 4.43; P = .03). A total of 37.5% (95% CI, 32.6%-42.5%) of participants with insomnia at baseline reported insomnia persisting at each of the 5 annual follow-up times. For subsyndromal insomnia, rates were 62.5% at 1 year to 26.5% at 5 years. For syndromal insomnia, rates were 86.0% at 1 year to 59.1% at 5 years. Conversely, remission rates among those with subsyndromal insomnia were almost double the rates among those with an insomnia syndrome at 1 year (37.5% [95% CI, 31.7%-44.0%] vs 14.0% [95% CI, 9.3%-20.8%]), 3 years (62.7% [95% CI, 56.7%-68.7%] vs 27.6% [95% CI, 20.9%-35.9%]), and 5 years (73.6% [95% CI, 68.0%-78.9%%] vs 40.9% [95% CI, 32.7%-50.4%]). Yearly trajectories showed that individuals who were good sleepers at baseline were 4.2 (95% CI, 3.51-4.89) times more likely to stay good sleepers in the subsequent year, but once they developed insomnia, they were equally likely to report symptoms (47% probability) than to return to a good sleeper status (53% probability) 1 year later. Similarly, those with an insomnia syndrome at any given assessment were more likely (adjusted odds ratio, 1.60; 95% CI, 1.19-2.60) to remain in that status (persistence) than to improve (remittance) at the next assessment; even among those who improved, the odds of relapse were greater (adjusted odds ratio, 2.04; 95% CI, 1.23-3.37) than those to improve in the following year. Conclusions and Relevance: The findings suggest that insomnia is often a persistent condition. Considering the long-term adverse outcomes associated with persistent insomnia, these findings may have important implication for the prognosis and management of insomnia.
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Trastornos del Inicio y del Mantenimiento del Sueño/epidemiología , Trastornos del Inicio y del Mantenimiento del Sueño/fisiopatología , Tasa de Supervivencia , Evaluación de Síntomas/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Canadá/epidemiología , Estudios de Cohortes , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Remisión Espontánea , Encuestas y Cuestionarios , Factores de Tiempo , Adulto JovenRESUMEN
STUDY OBJECTIVES: The study objectives were to examine accidental risks associated with insomnia or hypnotic medications, and how these risk factors interact with sex and age. METHODS: A population-based sample of 3,413 adults (Mage = 49.0 years old; 61.5% female), with or without insomnia, were surveyed annually for five consecutive years about their sleep patterns, sleep medication usage, and road collisions. RESULTS: There was a significant risk of reporting road collisions associated with insomnia (hazard ratio [HR] = 1.20; 95% confidence interval [CI] = 1.00-1.45) and daytime fatigue (HR = 1.21; 95% CI = 1.01-1.47). Insomnia and its daytime consequences were perceived to have played some contributory role in 40% of the reported collisions. Both chronic (HR = 1.50; 95% CI = 1.17-1.91) and regular use of sleep medications (HR = 1.58; 95% CI = 1.16-2.14) were associated with higher accidental risks, as well as being young female with insomnia and reporting excessive daytime sleepiness. CONCLUSIONS: Both insomnia and use of sleep medications are associated with significant risks of road collisions, possibly because of or in association with some of their residual daytime consequences (i.e. fatigue and poor concentration). The findings also highlight a new group of at-risk patients, i.e. young women reporting insomnia and excessive daytime sleepiness.
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Trastornos de Somnolencia Excesiva , Trastornos del Inicio y del Mantenimiento del Sueño , Adulto , Estudios de Cohortes , Femenino , Humanos , Hipnóticos y Sedantes/efectos adversos , Masculino , Persona de Mediana Edad , Sueño , Trastornos del Inicio y del Mantenimiento del Sueño/epidemiologíaRESUMEN
STUDY OBJECTIVES: Chronic insomnia tends to "wax and wane" over lifetime. The presence of residual insomnia symptoms is common, especially among naturally remitted individuals. This study aims to examine the features of these residual symptoms and their potential association with future relapse. METHODS: A population-based data set on the natural history of insomnia was used for this secondary analysis. Residual insomnia symptoms were investigated in those who had insomnia symptoms/syndrome at baseline and achieved full remission (according to predetermined diagnostic algorithm) within the following 1 year. Cox regressions were used to determine the hazard ratio (HR) of each residual symptom for predicting relapse in the next 4 years. The nature and severity of residual symptoms were examined with an extended version of the Insomnia Severity Index (ISI), which incorporates additional items on sleep quality and specific sleep-related daytime impairments (on daytime fatigue, cognitive functioning, mood, interpersonal relationship, and daily activities). In addition, the presence of depressive symptoms and medical conditions were controlled for in investigating risks of insomnia relapse. RESULTS: A total of 434 participants were included in this study (age ranges from 18 to 94; 65.9% female); 248 of them had relapsed within 4 years. The response rate ranged from 78% to 83%. The most frequently reported residual symptoms with at least moderate severity (ISI items ≥2 on 0-4 ISI item scale) were poor "Quality of sleep" (39.2 %), followed by "difficulty maintaining sleep" (DMS; 27%). The most common residual daytime impairments related to insomnia were fatigue (24.7 %), mood disturbances (23%) and cognitive disturbances (22.6%). After controlling for baseline insomnia and depression severity and concurrent physical diseases, impairments of cognition (HR = 1.46), poor quality of sleep (HR = 1.43), disturbed mood (HR = 1.39), being female (HR = 1.36), DMS (HR = 1.35), and fatigue (HR = 1.24) were significantly associated with insomnia relapse in the next 4 years. Moreover, residual poor sleep quality and daytime insomnia symptoms were independent of DMS in predicting relapse. Subgroup regressions according to sex showed that for male participants, residual cognition impairments (HR = 1.98) was the most significant predictors of future relapse, whereas residual DMS (HR = 1.46) significantly predicted relapse for women only. CONCLUSION: A wide range of residual symptoms exists in individuals with naturally remitted insomnia. Notably, residual DMS is the most common residual nighttime symptom and the only nighttime symptom associated with insomnia relapse. Additionally, perceived poor sleep quality and cognitive, mood, and somatic impairments attributed to sleep disturbances are also related to future relapse. Attention to these residual symptoms when initiating insomnia treatment is warranted to minimize future relapse.
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Afecto/fisiología , Depresión/psicología , Fatiga/psicología , Trastornos del Inicio y del Mantenimiento del Sueño/fisiopatología , Trastornos del Inicio y del Mantenimiento del Sueño/terapia , Sueño/fisiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Cognición/fisiología , Progresión de la Enfermedad , Femenino , Humanos , Relaciones Interpersonales , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Recurrencia , Factores de Riesgo , Adulto JovenRESUMEN
Study Objectives: There is little information about familial aggregation of insomnia; however, this type of information is important to (1) improve our understanding of insomnia risk factors and (2) to design more effective treatment and prevention programs. This study aimed to investigate evidence of familial aggregation of insomnia among first-degree relatives of probands with and without insomnia. Methods: Cases (n = 134) and controls (n = 145) enrolled in a larger epidemiological study were solicited to invite their first-degree relatives and spouses to complete a standardized sleep/insomnia survey. In total, 371 first-degree relatives (Mage = 51.9 years, SD = 18.0; 34.3% male) and 138 spouses (Mage = 55.5 years, SD = 12.2; 68.1% male) completed the survey assessing the nature, severity, and frequency of sleep disturbances. The dependent variable was insomnia in first-degree relatives and spouses. Familial aggregation was claimed if the risk of insomnia was significantly higher in the exposed (relatives of cases) compared to the unexposed cohort (relatives of controls). The risk of insomnia was also compared between spouses in the exposed (spouses of cases) and unexposed cohort (spouses of controls). Results: The risk of insomnia in exposed and unexposed biological relatives was 18.6% and 10.4%, respectively, yielding a relative risk (RR) of 1.80 (p = .04) after controlling for age and sex. The risk of insomnia in exposed and unexposed spouses was 9.1% and 4.2%, respectively; however, corresponding RR of 2.13 (p = .28) did not differ significantly. Conclusions: Results demonstrate evidence of strong familial aggregation of insomnia. Additional research is warranted to further clarify and disentangle the relative contribution of genetic and environmental factors in insomnia.
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Familia , Trastornos del Inicio y del Mantenimiento del Sueño/epidemiología , Trastornos del Inicio y del Mantenimiento del Sueño/genética , Adulto , Estudios de Casos y Controles , Estudios de Cohortes , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Factores de Riesgo , Trastornos del Inicio y del Mantenimiento del Sueño/diagnóstico , Trastornos del Sueño-Vigilia/diagnóstico , Trastornos del Sueño-Vigilia/epidemiología , Trastornos del Sueño-Vigilia/genética , Esposos , Encuestas y CuestionariosRESUMEN
Erosion and sedimentation in water courses represent a major and costly problem everywhere on the planet. Perception of local actors of the state of the river can be a useful source of information to document the river's changes. The main objective of this study consists of understanding how multiple data sources can be used for identifying the most sensitive areas subject to erosion and sedimentation in a watershed. To achieve our objective we combined three complementary methods: conducting interviews, estimating the most sensitive soil loss areas using the Revised Universal Soil Loss Equation for Application in Canada (RUSLEFAC) and taking measurements of environmental variables (turbidity, deposition rate, particle size, water quality, rainfall). The information gathered from the interviews allowed us to determine which areas were the most affected (e.g., either erosion or deposition). However, we observed that there were some differences between the areas identified by the participants and those obtained from the RUSLEFAC and in situ measurements. Among these differences, participants identified sites which were the results of misuse or bad practices (e.g., ATV). By contrast sensitive sites for erosion, as identified using RUSLEFAC, are instead areas of steep slopes, located near the river without forest cover. The in situ measurements were very helpful in establishing background values for turbidity but also for comparing quantitative information (e.g., particle size) with what was reported in the interviews.
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Monitoreo del Ambiente , Sedimentos Geológicos/química , Percepción , Ríos/química , Suelo/química , Conservación de los Recursos Naturales , Ecosistema , Modelos Teóricos , Nuevo BrunswickRESUMEN
BACKGROUND: Shift work disorder involves insomnia and/or excessive sleepiness associated with the work schedule. The present study examined the impact of insomnia on the perceived physical and psychological health of adults working on night and rotating shift schedules compared to day workers. METHODS: A total of 418 adults (51% women, mean age 41.4 years), including 51 night workers, 158 rotating shift workers, and 209 day workers were selected from an epidemiological study. An algorithm was used to classify each participant of the two groups (working night or rotating shifts) according to the presence or absence of insomnia symptoms. Each of these individuals was paired with a day worker according to gender, age, and income. Participants completed several questionnaires measuring sleep, health, and psychological variables. RESULTS: Night and rotating shift workers with insomnia presented a sleep profile similar to that of day workers with insomnia. Sleep time was more strongly related to insomnia than to shift work per se. Participants with insomnia in the three groups complained of anxiety, depression, and fatigue, and reported consuming equal amounts of sleep-aid medication. Insomnia also contributed to chronic pain and otorhinolaryngology problems, especially among rotating shift workers. Work productivity and absenteeism were more strongly related to insomnia. CONCLUSION: The present study highlights insomnia as an important component of the sleep difficulties experienced by shift workers. Insomnia may exacerbate certain physical and mental health problems of shift workers, and impair their quality of life.
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Trastornos del Inicio y del Mantenimiento del Sueño/etiología , Tolerancia al Trabajo Programado/fisiología , Absentismo , Adulto , Ansiedad/epidemiología , Ansiedad/etiología , Depresión/epidemiología , Depresión/etiología , Eficiencia/fisiología , Fatiga/epidemiología , Fatiga/etiología , Femenino , Estado de Salud , Humanos , Masculino , Escalas de Valoración Psiquiátrica , Calidad de Vida , Trastornos del Inicio y del Mantenimiento del Sueño/epidemiología , Encuestas y CuestionariosRESUMEN
OBJECTIVES: To estimate the prevalence of insomnia and examine its correlates (for example, demographics and physical and mental health) and treatments. METHODS: A sample of 2000 Canadians aged 18 years and older responded to a telephone survey about sleep, health, and the use of sleep-promoting products. Respondents with insomnia were identified using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, and the International Classification of Diseases, Tenth Edition, criteria. RESULTS: Among the sample, 40.2% presented at least 1 symptom of insomnia (that is, trouble falling or staying asleep, or early morning awakening) for a minimum of 3 nights per week in the previous month, 19.8% were dissatisfied with their sleep, and 13.4% met all criteria for insomnia (that is, presence of 1 insomnia symptom 3 nights or more per week for at least 1 month, accompanied by distress or daytime impairment). Insomnia was associated with female sex, older age, and poorer self-rated physical and mental health. Thirteen per cent of respondents had consulted a health care provider for sleep difficulties once in their lifetime. Moreover, 10% had used prescribed medications for sleep in the previous year, 9.0% used natural products, 5.7% used over-the-counter products, and 4.6% used alcohol. There were differences between French- and English-speaking adults, with the former group presenting lower rates of insomnia (9.5%, compared with 14.3%) and consultation (8.7%, compared with 14.4%), but higher rates of prescribed medications (12.9%, compared with 9.3%) and the use of natural products (15.6%, compared with 7.4%). CONCLUSIONS: Insomnia is a prevalent condition, although few people seek professional consultation for this condition. Despite regional differences in the prevalence and treatments used to manage insomnia, prescribed medications remain the most widely used therapeutic option.
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Trastornos del Inicio y del Mantenimiento del Sueño/epidemiología , Trastornos del Inicio y del Mantenimiento del Sueño/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Canadá/epidemiología , Canadá/etnología , Comorbilidad , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Derivación y Consulta , Trastornos del Inicio y del Mantenimiento del Sueño/diagnóstico , Adulto JovenRESUMEN
Isodar theory can help to unveil the fitness consequences of habitat disturbance for wildlife through an evaluation of adaptive habitat selection using patterns of animal abundance in adjacent habitats. By incorporating measures of disturbance intensity or variations in resource availability into fitness-density functions, we can evaluate the functional form of isodars expected under different disturbance-fitness relationships. Using this framework, we investigated how a gradient of forest harvesting disturbance and differences in resource availability influenced habitat quality for snowshoe hares (Lepus americanus) and red-backed voles (Myodes gapperi) using pairs of logged and uncut boreal forest. Isodars for both species had positive intercepts, indicating reductions to maximum potential fitness in logged stands. Habitat selection by hares depended on both conspecific density and differences in canopy cover between harvested and uncut stands. Fitness-density curves for hares in logged stands were predicted to shift from diverging to converging with those in uncut forest across a gradient of high to low disturbance intensity. Selection for uncut forests thus became less pronounced with increasing population size at low levels of logging disturbance. Voles responded to differences in moss cover between habitats which reflected moisture availability. Lower moss cover in harvested stands either reduced maximum potential fitness or increased the relative rate of decline in fitness with density. Differences in vole densities between harvested and uncut stands were predicted, however, to diminish as populations increased. Our findings underscore the importance of accounting for density-dependent behaviors when evaluating how changing habitat conditions influence animal distribution.
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Arvicolinae , Ecosistema , Liebres , Modelos Biológicos , Animales , Agricultura Forestal , Dinámica Poblacional , QuebecRESUMEN
INTRODUCTION: Despite the high prevalence of insomnia, there is little information about its incidence and risk factors. This study estimated the incidence of insomnia and examined potential risk factors in a cohort of good sleepers followed over a one-year period. METHODS: Participants were 464 good sleepers who completed 3 postal evaluations over a one-year period (i.e., baseline, 6 months, and 12 months). Questionnaires assessed sleep, psychological and personality variables, stressful life events and coping skills, and health-related quality of life. Participants were categorized into 3 subgroups: (a) good sleepers (i.e., participants who remained good sleepers at the 3 assessments), (b) insomnia symptoms incident cases (i.e., developed insomnia symptoms either at 6- or 12-month follow-up), and (c) insomnia syndrome incident cases (i.e., developed an insomnia syndrome either at 6- or 12- month follow-up). RESULTS: One-year incidence rates were 30.7% for insomnia symptoms and 7.4% for insomnia syndrome. These rates decreased to 28.8% and 3.9% for those without prior lifetime episode of insomnia. Compared to good sleepers and insomnia symptoms incident cases, insomnia syndrome incident cases presented a premorbid psychological vulnerability to insomnia, characterized by higher depressive and anxiety symptoms, lower extraversion, higher arousability, and poorer self-rated mental health at baseline. They also presented a higher level of bodily pain and a poorer general health. Five variables were associated with a new onset of an insomnia syndrome: previous episode of insomnia, positive family history of insomnia, higher arousability predisposition, poorer self-rated general health, and higher bodily pain. CONCLUSION: The one-year insomnia incidence rate was very high and several psychological and health factors were associated with new onset insomnia. Improved knowledge about the nature of these predisposing factors would be helpful to guide the development of effective public health prevention and intervention programs to promote better sleep quality.
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Trastornos del Inicio y del Mantenimiento del Sueño/epidemiología , Adaptación Psicológica , Adulto , Trastornos de Ansiedad/epidemiología , Trastornos de Ansiedad/psicología , Nivel de Alerta , Actitud Frente a la Salud , Comorbilidad , Estudios Transversales , Trastorno Depresivo/epidemiología , Trastorno Depresivo/psicología , Femenino , Encuestas Epidemiológicas , Humanos , Incidencia , Acontecimientos que Cambian la Vida , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Dolor/epidemiología , Dolor/psicología , Calidad de Vida/psicología , Quebec , Recurrencia , Factores de Riesgo , Trastornos del Inicio y del Mantenimiento del Sueño/psicología , SíndromeRESUMEN
BACKGROUND: Despite a paucity of data on efficacy and safety of natural (herbal and dietary) products, their use appears to be widespread. This study aimed at examining the frequency of natural products' use for sleep and their correlates in a population-based sample. METHODS: A randomly selected sample of adults (n=997; 59.9% women) from the province of Quebec completed a postal survey on sleep, use of sleep-promoting products (natural products, prescribed medication, over-the-counter medication and alcohol), physical and mental health, lifestyle habits and demographics. RESULTS: A total of 18.5% of participants reported having used natural products as sleep aids in the past 12months, with chamomile being the most popular product. Participants who exclusively used natural products as sleep aids (10.3% of the sample) were predominantly females, younger and had a higher educational level than those using prescribed medications. Natural products users reported engaging in more health-promoting behaviors than the nonusers of sleep aids and, despite the presence of subthreshold insomnia symptoms (mean Insomnia Severity Index score=9.33), they tended to perceive themselves as healthier when compared with prescribed medication users and nonusers of sleep aids. CONCLUSIONS: The use of natural products as sleep aids is a common practice. Often associated with a general health-promoting lifestyle, it may reflect the common perception that natural products are necessarily beneficial for sleep and without risks.
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Conocimientos, Actitudes y Práctica en Salud , Naturopatía/estadística & datos numéricos , Fitoterapia/estadística & datos numéricos , Trastornos del Sueño-Vigilia/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Encuestas de Atención de la Salud , Estado de Salud , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , Quebec , Adulto JovenRESUMEN
BACKGROUND: Despite its high prevalence, little information is available about the natural history of insomnia. The extent to which episodes of insomnia will persist or remit over time is difficult to predict. We examined the natural history of insomnia and describe the most common trajectories over 3 years. METHODS: Three hundred eighty-eight adults (mean [SD] age, 44.8 [13.9] years; 61% women) were selected from a larger population-based sample on the basis of the presence of insomnia at baseline. They completed standardized sleep/insomnia questionnaires at 3 annual follow-up assessments. For each follow-up assessment, participants were classified into 1 of 3 groups (individuals with an insomnia syndrome, individuals with insomnia symptoms, and individuals with good sleep) on the basis of algorithms using standard diagnostic criteria for insomnia. Rates of persistent insomnia, remission, and relapse were computed for each group. RESULTS: Of the study sample, 74% reported insomnia for at least 1 year (2 consecutive assessments) and 46% reported insomnia persisting over the entire 3-year study. The course of insomnia was more likely to be persistent in those with more severe insomnia at baseline (ie, insomnia syndrome) and in women and older adults. Remission rate was 54%; however, 27% of those with remission of insomnia eventually experienced relapse. Individuals with subsyndromal insomnia at baseline were 3 times more likely to remit than worsen to syndrome status, although persistence was the most frequent course in that group as well. CONCLUSION: These findings indicate that insomnia is often a persistent condition, in particular when it reaches the diagnostic threshold for an insomnia disorder.
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Trastornos del Inicio y del Mantenimiento del Sueño/diagnóstico , Trastornos del Inicio y del Mantenimiento del Sueño/epidemiología , Adulto , Progresión de la Enfermedad , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Prevalencia , Recurrencia , Remisión Espontánea , Factores de Riesgo , Encuestas y CuestionariosRESUMEN
BACKGROUND AND PURPOSE: Insomnia is a highly prevalent problem that is associated with increased use of health care services and products, as well as functional impairments. This study estimated from a societal perspective the direct and indirect costs of insomnia. PARTICIPANTS AND METHODS: A randomly selected sample of 948 adults (mean age = 43.7 years old; 60% female) from the province of Quebec, Canada completed questionnaires on sleep, health, use of health-care services and products, accidents, work absences, and reduced productivity. Data were also obtained from the Quebec government administered health insurance board regarding consultations and hospitalizations. Participants were categorized as having insomnia syndrome, insomnia symptoms or as being good sleepers using a standard algorithm. Frequencies of target cost variables were obtained and multiplied by unit costs to generate estimates of total costs for the adult population of the province of Quebec. RESULTS: The total annual cost of insomnia in the province of Quebec was estimated at $6.6 billion (Cdn$). This includes direct costs associated with insomnia-motivated health-care consultations ($191.2 million) and transportation for these consultations ($36.6 million), prescription medications ($16.5 million), over the-counter products ($1.8 million) and alcohol used as a sleep aid ($339.8 million). Annual indirect costs associated with insomnia-related absenteeism were estimated at $970.6 million, with insomnia-related productivity losses estimated at $5.0 billion. The average annual per-person costs (direct and indirect combined) were $5,010 for individuals with insomnia syndrome, $1431 for individuals presenting with symptoms, and $421 for good sleepers. CONCLUSIONS: This study suggests that the economic burden of insomnia is very high, with the largest proportion of all expenses (76%) attributable to insomnia-related work absences and reduced productivity. As the economic burden of untreated insomnia is much higher than that of treating insomnia, future clinical trials should evaluate the cost-benefits, cost-utility, and cost-effectiveness of insomnia therapies.
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Costos de la Atención en Salud/estadística & datos numéricos , Trastornos del Inicio y del Mantenimiento del Sueño/economía , Absentismo , Accidentes/economía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Bebidas Alcohólicas/economía , Análisis Costo-Beneficio/estadística & datos numéricos , Costos de los Medicamentos/estadística & datos numéricos , Eficiencia , Femenino , Encuestas Epidemiológicas , Hospitalización/economía , Humanos , Masculino , Persona de Mediana Edad , Quebec , Derivación y Consulta/economía , Trastornos del Inicio y del Mantenimiento del Sueño/terapia , Encuestas y Cuestionarios , Adulto JovenRESUMEN
OBJECTIVE: This study examined the relationship of psychological and health-related quality of life variables to insomnia in a population-based sample. METHODS: Data were derived from a longitudinal epidemiological study assessing the natural history of insomnia. The present results are based on the first of four postal evaluations conducted over a 2-year period. Participants (n=953) completed questionnaires assessing sleep, psychological and personality variables, and health-related factors. Participants were categorized into three sleep status subgroups using an algorithm based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision and International Classification of Diseases, 10th Edition diagnostic criteria for insomnia: (1) insomnia syndrome (n=147), (2) insomnia symptoms (n=308), and (3) good sleepers (n=493). RESULTS: Compared to individuals with insomnia symptoms and good sleepers, individuals with insomnia syndrome presented lower quality of life and higher scores on measures of depression, anxiety, neuroticism, extraversion, arousal predisposition, stress perception, and emotion-oriented coping. The same pattern was observed for individuals with insomnia symptoms in comparison with good sleepers. An ordinal logistic regression analysis showed that the presence of a past episode of insomnia, higher depressive symptoms, and lower scores on the 12-item Short Form Health Survey vitality and role physical subscales were the most useful variables to predict subgroups membership. CONCLUSION: The findings indicate that insomnia is associated with increased psychological symptomatology and perceived stress, higher predisposition to arousal, and more impairment of health quality. Longitudinal follow-ups are now being conducted to assess the relative contribution of those variables in the development and natural course of insomnia.
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Estado de Salud , Calidad de Vida/psicología , Trastornos del Inicio y del Mantenimiento del Sueño/epidemiología , Trastornos del Inicio y del Mantenimiento del Sueño/psicología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Ansiedad/diagnóstico , Ansiedad/epidemiología , Áreas de Influencia de Salud , Depresión/diagnóstico , Depresión/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Trastornos de la Personalidad/diagnóstico , Trastornos de la Personalidad/epidemiología , Vigilancia de la Población/métodos , Quebec/epidemiología , Encuestas y CuestionariosRESUMEN
STUDY OBJECTIVES: To examine the rates of family history of insomnia in a population-based sample composed of self-defined good sleepers and individuals with insomnia and compare individuals with and without family history of insomnia on several characteristics presumably associated with insomnia. DESIGN: Cross-sectional comparisons of self-defined good sleepers and individuals with insomnia selected from a larger epidemiologic study using a randomly selected sample of 2001 adults of the province of Quebec in Canada. PARTICIPANTS: Nine hundred fifty-three adults (60.3% women; mean age = 43.9 years) completed several postal questionnaires, including a survey of past and current history of insomnia/sleep disorders for self and first-degree relatives. Participants were classified as good sleepers, individuals with insomnia symptoms, or individuals with an insomnia syndrome. INTERVENTIONS: N/A. RESULTS: Of the total sample, 34.9% reported at least 1 first-degree relative with past or current insomnia. The mother was the most frequently afflicted first-degree relative with insomnia (19.7%). Family history rates of insomnia were not significantly different when individuals with current insomnia symptoms or syndrome were compared with self-defined good sleepers. However, significant group differences emerged when good sleepers were subdivided according to the presence or absence of past personal history of insomnia. Individuals with past or current insomnia were significantly more likely to report a family history of insomnia than were good sleepers who had never experienced insomnia in the past (39.1% vs 29.0%). Participants with a family history of insomnia endorsed higher scores on measures of insomnia severity, anxiety symptomatology, and arousal predisposition. CONCLUSIONS: These findings provide additional evidence about the potential role of both family and personal history of insomnia as predisposing factors to insomnia. Longitudinal family studies are needed to further examine the relative contribution of genetic and environmental factors in the genesis and heritability of insomnia.
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Trastornos del Inicio y del Mantenimiento del Sueño/genética , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Trastornos de Ansiedad/epidemiología , Trastornos de Ansiedad/genética , Nivel de Alerta/genética , Estudios Transversales , Femenino , Encuestas Epidemiológicas , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Quebec , Trastornos del Inicio y del Mantenimiento del Sueño/epidemiología , Encuestas y CuestionariosRESUMEN
The data obtained with two forms of the Impact of Event Scale were compared, one referring to a BRCA1/2 test result (IES-T) and another to cancer (IES-C). The sample consisted of 272 women with a family history suggestive of a BRCA1/2 mutation who underwent genetic testing and received results: noncarrier, carrier, or inconclusive. Globally, mean scores on the IES-C form were higher than those obtained on the IES-T form. Among carriers of a BRCA1/2 mutation, mean scores on the two forms were similar and agreement was good, as measured by the intraclass correlation coefficient (.83; 95% 95% CI=.72, .91). Agreement between the forms was poor to fair among noncarriers (ICC= .38; CI= .15, .57) and women with an inconclusive result (ICC= .40; 95% CI= .26, .52). Having had cancer increased total scores but had little influence on agreement between scores on forms. These findings highlight the importance of carefully selecting the form of the Impact of Event Scale in the context of genetic testing for breast cancer susceptibility.
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Neoplasias de la Mama/genética , Neoplasias de la Mama/psicología , Depresión/diagnóstico , Depresión/etiología , Acontecimientos que Cambian la Vida , Encuestas y Cuestionarios , Adulto , Demografía , Femenino , Genes BRCA2 , Predisposición Genética a la Enfermedad , Humanos , Persona de Mediana Edad , Mutación Puntual/genéticaRESUMEN
STUDY OBJECTIVES: Insomnia is a prevalent health complaint that often remains untreated. Several interventions are efficacious but they are not widely available. This study evaluated the efficacy of a self-help behavioral intervention for insomnia. DESIGN: The study used a 2 (conditions; self-help treatment, no treatment control) x 3 (assessments; pretreatment, posttreatment, 6-month follow-up) mixed factorial design. SETTING: This study was part of a larger epidemiologic study conducted with a randomly selected sample of 2001 adults of the province of Quebec in Canada. PARTICIPANTS: One-hundred ninety-two adults (n = 127 women, 65 men; mean age, 46 years) with insomnia, selected from a larger community-based epidemiologic sample, were randomly assigned to self-help treatment (n = 96) or no-treatment control (n = 96). INTERVENTIONS: The self-help intervention included 6 educational booklets mailed weekly to participants and providing information about insomnia, healthy sleep practices, and behavioral sleep scheduling and cognitive strategies. MEASUREMENTS AND RESULTS: Participants completed sleep diaries and questionnaires at pretreatment, posttreatment, and 6-month follow-up. Significant but modest improvements were obtained on subjective sleep parameters for treatment but not control participants. Treated participants averaged nightly gains of 21 minutes of sleep and a reduction of 20 minutes of wakefulness, with a corresponding increase of 4% in sleep efficiency. Improvements were also obtained on measures of insomnia severity (Insomnia Severity Index) and of sleep quality (Pittsburgh Sleep Quality Index), and those changes were maintained at follow-up. CONCLUSIONS: A self-help behavioral intervention was effective in alleviating a broad range of insomnia symptomatology in a community sample. Self-help may be a promising approach to make effective intervention more widely available.
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Autoeficacia , Trastornos del Inicio y del Mantenimiento del Sueño/terapia , Adulto , Anciano , Actitud Frente a la Salud , Demografía , Femenino , Conductas Relacionadas con la Salud , Humanos , Masculino , Registros Médicos , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Trastornos del Inicio y del Mantenimiento del Sueño/diagnóstico , Encuestas y CuestionariosRESUMEN
This article explores the efficacy of sequential treatment involving medication and cognitive behavioral treatment (CBT) for insomnia. In a multiple baseline across-subjects design, 6 participants with primary chronic insomnia received 1 of the following treatment sequences: (a) concurrent combination of medication and CBT for the 10-week treatment duration (Combined); (b) medication for the first 5 weeks, with introduction of CBT at week 4 and medication withdrawal after the 5th week resulting in treatment overlap during weeks 4 and 5 (Overlapping: Medication --> Combined --> CBT); and (c) medication alone for the first 5 weeks followed by CBT alone for an additional 5 weeks (Medication --> CBT). Each sequence led to significant sleep improvements, but these improvements occurred at different times during the intervention. Participants in the Combined and in the Overlapping sequences improved their sleep during the 1st phase of treatment, whereas those in the Medication --> CBT sequence improved mostly during the 2nd phase of treatment. These preliminary results suggest that a sequential treatment is effective for chronic insomnia. In addition, the results suggest that sleep improvements are more likely to emerge when CBT is introduced, with an Overlapping sequence showing a slight advantage over the other sequences. Additional clinical trials should be conducted with larger samples to replicate these preliminary findings.
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Terapia Cognitivo-Conductual/métodos , Trastornos del Inicio y del Mantenimiento del Sueño/terapia , Adulto , Compuestos de Azabiciclo , Enfermedad Crónica , Terapia Combinada , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Electrofisiología/instrumentación , Diseño de Equipo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Piperazinas/uso terapéutico , Estudios Prospectivos , Trastornos del Inicio y del Mantenimiento del Sueño/diagnóstico , Trastornos del Inicio y del Mantenimiento del Sueño/tratamiento farmacológicoRESUMEN
STUDY OBJECTIVES: The present study examined the sleep microstructure in relation to insomnia and chronic use of benzodiazepines in older adults. PARTICIPANTS: The participants were 46 older adults, aged 55 or older (mean age = 62.9), who were divided into three groups: insomnia sufferers using BZ chronically (n = 15), drug-free insomnia sufferers (n = 15), and self-defined good sleepers (n = 16). DESIGN: Participants completed 3 consecutive nights of polysomnography in the laboratory. Spectral analyses were carried on the second night of sleep recordings. Stages 2, 3, and 4 of the first 4 cycles of the second night were retained for the analysis. RESULTS: Results showed no significant differences between drug-free insomnia sufferers and good sleepers. However, benzodiazepine users exhibited significantly less delta and theta activity over the night than did good sleepers. When compared to drug-free insomnia sufferers, benzodiazepine users had less delta and theta activity within cycle 2 only. Regarding high-frequency bands, benzodiazepine users had more beta 1 activity within cycle 3 than did good sleepers and more than both drug-free insomnia sufferers and good sleepers within cycle 4. CONCLUSIONS: The findings show that spectral analysis is an efficient tool to detect and quantify the effects of benzodiazepine use on sleep structure, particularly with older adults, a group for whom macrostructure sleep alterations due to physiologic aging are hard to distinguish from sleep changes induced by insomnia and the use of hypnotic drugs. In addition, these results raise important questions about the effects and indications of prolonged use of benzodiazepine medications in older adults with insomnia complaints.
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Benzodiazepinas/efectos adversos , Electroencefalografía , Trastornos del Inicio y del Mantenimiento del Sueño/inducido químicamente , Envejecimiento/fisiología , Ritmo Delta/efectos de los fármacos , Esquema de Medicación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Polisomnografía , Índice de Severidad de la Enfermedad , Trastornos del Inicio y del Mantenimiento del Sueño/diagnóstico , Encuestas y Cuestionarios , Ritmo Teta/efectos de los fármacosRESUMEN
OBJECTIVE: The objective of the present study was to evaluate the relationship between objective and subjective sleep quality and objective and subjective evaluation of cognitive performance in older adults suffering of chronic insomnia (using or not benzodiazepines, BZs) or self-reported good sleepers. METHODS: Three groups of participants 55 years and older were evaluated: 20 insomnia sufferers using BZs chronically, 20 drug-free insomnia sufferers and 20 good sleepers. Objective sleep (PSG) and subjective sleep (sleep diaries, SD) were measured. Objective measures of cognitive performance (attention/concentration, verbal/visual memory, executive function and psychomotor speed) and subjective perception of daily performance were evaluated. RESULTS: Correlational analysis revealed that objective and subjective measures of daytime performance are differentially related to sleep quality for the three groups. An objective good night of sleep is associated with better cognitive performance in good sleepers and drug-free individuals. On the other hand, the impression of having slept well is related to better cognitive performance in good sleepers and chronic insomnia sufferers using BZs. CONCLUSION: Daytime performance and sleep quality are related, but differently so for a good sleeper, an insomnia sufferer without treatment, or one using BZs to alleviate sleep difficulties.