Insomnia disorders are associated with increased cardiometabolic disturbances and death risks from cardiovascular diseases in psychiatric patients treated with weight-gain-inducing psychotropic drugs: results from a Swiss cohort.

STUDY OBJECTIVES: Insomnia disorders as well as cardiometabolic disorders are highly prevalent in the psychiatric population compared to the general population. We aimed to investigate their association and evolution over time in a Swiss psychiatric cohort. METHODS: Data for 2861 patients (8954 observations) were obtained from two prospective cohorts (PsyMetab and PsyClin) with metabolic parameters monitored routinely during psychotropic treatment. Insomnia disorders were based on the presence of ICD-10 "F51.0" diagnosis (non-organic insomnia), the prescription of sedatives before bedtime or the discharge letter. Metabolic syndrome was defined using the International Diabetes Federation definition, while the 10-year risk of cardiovascular event or death was assessed using the Framingham Risk Score and the Systematic Coronary Risk Estimation, respectively. RESULTS: Insomnia disorders were observed in 30% of the cohort, who were older, predominantly female, used more psychotropic drugs carrying risk of high weight gain (olanzapine, clozapine, valproate) and were more prone to suffer from schizoaffective or bipolar disorders. Multivariate analyses showed that patients with high body mass index (OR = 2.02, 95%CI [1.51-2.72] for each ten-kg/m2 increase), central obesity (OR = 2.20, [1.63-2.96]), hypertension (OR = 1.86, [1.23-2.81]), hyperglycemia (OR = 3.70, [2.16-6.33]), high density lipoprotein hypocholesterolemia in women (OR = 1.51, [1.17-1.95]), metabolic syndrome (OR = 1.84, [1.16-2.92]) and higher 10-year risk of death from cardiovascular diseases (OR = 1.34, [1.17-1.53]) were more likely to have insomnia disorders. Time and insomnia disorders were associated with a deterioration of cardiometabolic parameters. CONCLUSIONS: Insomnia disorders are significantly associated with metabolic worsening and risk of death from cardiovascular diseases in psychiatric patients.

Cost-effectiveness of neuroimaging technologies in management of psychiatric and insomnia disorders: A meta-analysis and prospective cost analysis.

BACKGROUND: The optimal diagnostic strategy for patients with psychiatric and insomnia disorders has not been established yet. PURPOSE: The purpose of this study was to perform cost-effectiveness analysis of six neuroimaging technologies in diagnosis of patients with psychiatric and insomnia disorders. METHODS: An economic evaluation study was conducted in three parts, including a systematic review for determining diagnostic accuracy, a descriptive cross-sectional study with Activity-Based Costing (ABC) technique for tracing resource consumption, and a cost-effectiveness analysis using a short-term decision-analytic model. RESULTS: In the first phase, 93 diagnostic accuracy studies were included in the systematic review. The accumulated results (meta-analysis) showed that the highest diagnostic accuracy for psychiatric and insomnia disorders was attributed to PET (sensitivity of 90% and specificity of 80%) and MRI (sensitivity of 76% and specificity of 78%) respectively. In the second phase of the study, we calculated the cost of each technology. The results showed that MRI has the lowest cost. Based on the results in the model of cost-effectiveness sMRI ($ 50.08 per accurate diagnosis) and MRI ($ 58.54 per accurate diagnosis) were more cost-effective neuroimaging technologies. CONCLUSION: In psychiatric disorders, no single strategy was characterized by both low cost and high accuracy. However, MRI and PET scan had lower cost and higher accuracy for psychiatric disorders, respectively. MRI was the least costly with the highest diagnostic accuracy in insomnia disorders. Based on our model, sMRI in psychiatric disorders and MRI in insomnia disorders were the most cost-effective technologies.

A combination of Eschscholtzia californica Cham. and Valeriana officinalis L. extracts for adjustment insomnia: A prospective observational study.

Eschscholtzia californica Cham. and Valeriana officinalis L. have long been used for the management of sleep disorders and anxiety. Use of a fixed combination of these two plant extracts (Phytostandard® d'Eschscholtzia et de Valériane, PiLeJe Laboratoire, France) was investigated in an observational study. Adults with adjustment insomnia according to the criteria of the International Classification of Sleep Disorders and with an insomnia severity index (ISI) score >7 enrolled by GPs took a maximum of four tablets of the eschscholtzia and valerian combination every night for four weeks. Within one month, ISI score decreased by approximately 30% (from 16.09 ±â€¯3.67 at inclusion (V1) to 11.32 ±â€¯4.78 at 4 weeks (V2); p < 0.0001). Night sleep duration significantly increased between the first and the fourth week of supplement intake, sleep efficiency increasing from 78.4% ±â€¯12.5 to 84.6% ±â€¯10.2 (p = 0.002). There was no improvement in sleep latency. The number of awakenings decreased by approximately 25% and their total duration by approximately 25 min. Anxiety score significantly decreased by 50% from 13.9 ±â€¯7.3 at V1 to 6.7 ±â€¯6.3 at V2 (p < 0.0001). The supplement was well tolerated. These results suggest that the tested combination of eschscholtzia and valerian extracts could be beneficial for the management of insomnia in adults and deserves further investigation.

Prevalence and associated factors of insomnia syndrome in the elderly residing in kahrizak nursing home, tehran, iran.

BACKGROUND: As insomnia is common, especially among the elderly in the nursing homes, we aimed to estimate insomnia prevalence among the elderly residing in nursing homes as well as to determine factors associated with insomnia in the elderly. METHODS: This cross-sectional study was carried out in 2009 on 772 elderly residents at Kahrizak Nursing Home, Tehran Iran. The information was gathered through 5-part questionnaires by interviewing either the individuals or the nurses in charge and also reviewing the subjects' medical files. Eventually, the necessary data were analyzed using oneway ANOVA and Chi-square tests. RESULTS: The mean age of the participants was 76.8 ± 8.05 years (range, 65 to 107 years). Based on the results, 303 (39.2%) of the elderly, including 86 (34.7%) men and 217 (41.1%) women, had insomnia syndrome. 433 (56.1%) participants complained of difficulty initiating sleep, 357 (46.2%) of disrupted sleep, 362 (46.9%) of early morning awakening, and 313 (40.5%) of non-restorative sleep. Our findings also showed that age (P = .004), number of diseases (P = .019), motility status (P = .017), sleep environment satisfaction (P < .001), cognitive status (P = .023), and functional autonomy (P = .003) were significantly associated with insomnia. CONCLUSION: Insomnia is a prevalent disorder amongst the nursing home elderly population, especially elderly women, and several pharmaceutical and nonpharmaceutical factors may trigger its occurrence. However, to prevent this problem, further studies are required in Iran and Middle Eastern region to establish a reliable understanding about insomnia patterns, causes, and cures.

Insomnia and its symptoms in adolescents: comparing DSM-IV and ICSD-II diagnostic criteria.

STUDY OBJECTIVES: Many studies of adolescent insomnia use experience of insomnia-like symptoms to categorize "caseness." This is likely to lead to inflated prevalence and may have important ramifications for the research using individual symptoms to operationalize insomnia. The aim of the present study was to contrast the occurrence of insomnia symptoms with cases of insomnia diagnosed using criteria from the fourth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) and the second edition of the International Classification of Sleep Disorders (ICSD-II) in a sample of Australian adolescents. METHODS: Data were collected from 384 representative Australian adolescents aged 13-18 years old (59% male). During school hours, adolescents completed a comprehensive questionnaire battery targeting insomnia criteria and then completed a sleep diary for 7 days. RESULTS: Insomnia symptoms were frequently reported by adolescents (e.g., 34.6% for frequent sleep-related daytime consequences). The proportion of adolescents meeting the diagnositc criteria for insomnia was much smaller: 10.9% of adolescents were classified as having General Insomnia using ICSD-II criteria, and 7.8% were classified as having Primary Insomnia according to DSM-IV criteria. ICSD-II Psychophysiological Insomnia was observed in 3.4% of adolescents. Insomnia diagnoses did not vary according to age, gender, school grade, or socioeconomic status. Using the ICSD-II criteria for General Insomnia resulted in a significantly higher number of insomnia diagnoses than did DSM-IV criteria for Primary Insomnia (p < 0.001) and ICSD-II Psychophysiological Insomnia (p < 0.001). CONCLUSIONS: These results reveal that approximately 3 adolescents in the average classroom of 30 are likely to meet the diagnostic criteria for insomnia, while many more will have insomnia symptoms. There were significant differences in prevalence rates, depending on how insomnia was operationalized.