Chronic insomnia: night timing and comorbidity

Objectives To evaluate insomnia distribution according to type and psychiatric/organic comorbidity among subjects reporting chronic insomnia to a tertiary sleep center Materials and Methods All adult subjects reporting chronic insomnia over the last 3 years have been retrospectively evaluated: demographic data, insomnia duration, type (initial (II), central (CI), terminal insomnia (TI)), comorbidity with sleep or organic/psychiatric disorders, personals scores on Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI), Hamilton Anxiety rating Scale (HAM A), Pittsburgh Sleep Questionnaire Index (PSQI), SF-36 2v (MCS and PCS). Obstructive Sleep Apnea Syndrome (OSAS) patients were excluded. Results 106 patients (39 M, 67 F, mean age 52.7 years ) have been assessed: insomnia mean duration 8.7 years; 67 patients (II) of which 31 included repeated nocturnal awakenings; 31 (CI) and 17 (TI); 9 mixed type (II-TI). 23 older patients (mean age 61.7 years) were hypertensive: 14 with II. 82 (mean age 50.8 years, mean BDI and HAM A scores 19 and 20.7, respectively) presented psychiatric symptoms of which 35 presented II, 11 CI and 4 IT. Other comorbidities included: thyroid disorders (20), GERD (40), headache (7), diabetes (6), cardiopaty (6), fibromyalgia (3), epilepsy (1). Comorbid sleep disorders included: RLS (10), bruxism (4) and snoring (3). None of the patients showed EDS (mean ESS 4.9); mean PSQI was 9.2 (poor sleepers) without any significant statistical difference between hypertensive, normotensive, depressive and non depressive patients. Life quality was severely reduced in all (SF-36 2v mean MCS and PCS 53.6% and 56.4%, respectively). Conclusions Our sample had a M:F ratio of 1:1.7 and a prevalence (>50%) of II. Comorbid psychiatric disorders were almost the rule. Hypertension, significantly age related, accounted for 23 % of the population. All patients independently from insomnia type and hypertension and/or depression were poor sleepers and had a severely altered quality of life.