Effects of gastroesophageal reflux disease on sleep and outcomes.

BACKGROUND & AIMS: Nighttime symptoms of gastroesophageal reflux disease (GERD) are prevalent and have negative effects on sleep quality. We quantified the effects of GERD symptoms on sleep difficulties and their effects on outcomes. METHODS: Data were obtained from a patient-reported survey conducted in 2006 among the general US population. Respondents who had experienced GERD symptoms at least twice during the past month were categorized as GERD patients and were subclassified into groups on the basis of nighttime symptoms and sleep difficulties. Outcomes included health care resource use in past 6 months, work productivity and activity impairment (WPAI), and health-related quality of life (HRQOL) based on results of the Short-Form Health Survey (SF-8). Regression analysis was used to adjust for demographics and clinical characteristics. RESULTS: Of 11,685 survey respondents with GERD, 88.9% experienced nighttime symptoms, 68.3% sleep difficulties, 49.1% difficulty initiating asleep (induction symptoms), and 58.3% difficulty maintaining sleep (maintenance symptoms). Respondents with nighttime GERD symptoms were more likely to experience sleep difficulties (odds ratio, 1.53) and difficulties with induction (odds ratio, 1.43) and maintenance (odds ratio, 1.56) of sleep (P < .001 for all). Sleep difficulties were associated with 0.9 additional provider visits, a 5.5% increase in overall work impairment, a 10.9% increase in activity impairment, and reductions of 3.1 and 3.6 points in SF-8 physical and mental summary scores, respectively. CONCLUSIONS: Nighttime GERD symptoms are associated with interruption of sleep induction and maintenance and result in considerable economic burden and reduction in HRQOL.

The association between Alzheimer's disease symptom severity and caregiver outcomes: a cross-sectional study.

OBJECTIVE: To determine the association between Alzheimer's disease (AD) symptom severity and caregiver outcomes. METHOD: This was a database analysis of the Alzheimer's Disease Caregiver Study, a cross-sectional, caregiver-reported study conducted in 2007. Data were collected nationwide via the Internet and in 8 cities: Detroit, Michigan; Knoxville, Tennessee; Los Angeles, California; Miami, Florida; Philadelphia, Pennsylvania; Phoenix, Arizona; St Louis, Missouri; and Washington, DC. Participants were unpaid adult caregivers of AD patients (N = 1,077). Symptom severity was measured using the Revised Memory and Behavioral Problem Checklist (RMBPC). Caregiver outcomes included the Caregiver Burden Scale, diagnosis of anxiety and depression, use of the emergency room, hospitalization, number of physician visits, and missed workdays in the past 6 months. Linear and logistic regression models were developed to assess effects of AD symptom severity on outcomes. Covariates included caregiver and patient characteristics and interactions of AD symptom severity with covariates based on previous analyses. RESULTS: Of the 1,077 respondents, 1,034 had valid RMBPC overall symptom severity scores. AD symptom severity was a significant (P < .01) predictor of all caregiver outcomes except physician visits. Each unit increase in RMBPC severity score corresponded with an increase of 0.328 (95% CI, 0.101-0.554) units in caregiver burden. Each unit increase in severity resulted in increases in physician visits (b = 0.343; 95% CI, 0.052-0.635) and absenteeism (b = 1.722; 95% CI, 0.694-2.749). For each unit increase in RMBPC severity score, caregivers had greater likelihood of emergency room use (odds ratio = 1.506; 95% CI, 1.230-1.845), hospitalization (OR = 1.393; 95% CI, 1.091-1.777), anxiety (OR = 1.506; 95% CI, 1.257-1.805), and depression (OR = 1.811; 95% CI, 1.505-2.179). CONCLUSIONS: AD symptom severity is significantly associated with poorer caregiver outcomes. Therefore, treatments that slow AD symptom progression may be beneficial to caregiver outcomes.

Burden associated with chronic sleep maintenance insomnia characterized by nighttime awakenings among women with menopausal symptoms.

OBJECTIVE: The aim of this study was to quantify the burden associated with chronic sleep maintenance insomnia characterized by nighttime awakenings (CINA) among women with menopausal symptoms. METHODS: Data were obtained from the 2006 US National Health and Wellness Survey, an annual cross-sectional study of US adults 18 years or older. Analyses were limited to female respondents currently experiencing symptoms of menopause. The definition of CINA was experiencing nighttime awakenings at least twice per week for more than 1 month that have moderate to severe impact on daily life and not experiencing difficulty falling asleep. No insomnia was defined as not self-reporting insomnia, sleep difficulties, or sleep symptoms. Outcomes included resource utilization in the past 6 months, Work Productivity and Activity Impairment questionnaire, and Medical Outcomes Study Short-Form Health Survey (SF-8). Linear regression models were developed to assess the independent associations of CINA on outcomes, while adjusting for demographics and comorbidity. RESULTS: Among women with menopausal symptoms, 141 met the criteria for CINA and 1,305 met the criteria for no insomnia. Adjusting for demographics and comorbidity, those experiencing CINA had 0.1 (P = 0.041) more emergency department visits, 20.8% (P < 0.001) greater activity impairment, and SF-8 physical and mental summary scores that were 4.7 (P < 0.001) and 5.4 (P < 0.001) points, respectively, lower than those of women who are not experiencing insomnia. Among women with menopausal symptoms employed full-time, those experiencing CINA had greater impairment while working (presenteeism; 17.3%, P < 0.001) and overall (16.1%, P < 0.001) than did those who are not experiencing insomnia. CONCLUSIONS: Among women with menopausal symptoms, CINA in relative isolation was associated with a significant negative impact on healthcare utilization and its associated costs, health-related quality of life, and work productivity.

Burden of chronic sleep maintenance insomnia characterized by nighttime awakenings.

The objective of this study was to evaluate the economic and humanistic burden of chronic sleep maintenance insomnia characterized by nighttime awakenings (CINA). A database analysis of National Health and Wellness Survey, an annual cross-sectional study of health status and outcomes of US adults, was performed. CINA was defined as experiencing nighttime awakenings at least twice per week for more than 1 month that have moderate to severe impact on daily life and not experiencing difficulty falling asleep. No insomnia was defined as not self-reporting insomnia, sleep difficulties, or sleep symptoms. Outcomes included resource utilization in the past 6 months, the Work Productivity and Activity Impairment questionnaire, and the SF-8. Linear regression models were developed to assess the independent effects of CINA on outcomes while controlling for demographics and comorbidity. In all, 1523 respondents met the criteria for CINA and 24,106 met the criteria for no insomnia. Controlling for demographics and comorbidity, CINA sufferers had greater resource utilization (0.1 [P < 0.001] more emergency room visits, 0.2 [P = 0.001] more days hospitalized, and 2.5 [P < 0.001] more provider visits), 22.4% (P < 0.001) greater activity impairment, and SF-8 physical and mental summary scores that were 6.2 (P < 0.001) and 6.8 (P < 0.001) points lower than those with no insomnia, respectively. Among those employed full time, CINA sufferers had greater work productivity impairment (4.0% due to absenteeism, 17.6% due to presenteeism, and 15.6% greater overall productivity impairment) than those with no insomnia (P < 0.001 for all). CINA in relative isolation was associated with a significant negative impact on health care utilization and its associated costs, health-related quality 16 of life, and work productivity.

Burden of chronic sleep maintenance insomnia characterized by nighttime awakenings among anxiety and depression sufferers: results of a national survey.

OBJECTIVE: To identify and quantify the burden of chronic sleep maintenance insomnia characterized by nighttime awakenings (CINA) among depression and anxiety sufferers. METHOD: Data were obtained from the 2006 US National Health and Wellness Survey, an annual cross-sectional study of US adults. Analyses were limited to respondents diagnosed with depression or anxiety. The term CINA was defined as experiencing nighttime awakenings, without difficulty falling asleep, at least twice per week for more than 1 month that have moderate-severe impact on daily life. Outcomes included resource utilization in past 6 months, the Work Productivity and Activity Impairment questionnaire, and the Medical Outcomes Study 8-item Short-Form Health Survey (SF-8). Independent effects of CINA on outcomes adjusting for demographics and comorbidity were assessed using linear regression models. RESULTS: Among depression sufferers, 643 experienced CINA and 1,675 experienced no insomnia. Among anxiety sufferers, 476 experienced CINA and 1,356 experienced no insomnia. Adjusting for demographics and comorbidity, depression sufferers with CINA had 2.4 more provider visits, 13.2% greater work impairment (among full-time employed), 18.2% greater activity impairment, and SF-8 physical and mental summary scores that were 4.8 and 6.7 points lower than noninsomnia sufferers (P < .001 for all). Anxiety sufferers with CINA had 3.0 more provider visits, 15.8% greater work impairment (among full-time employed), 20.4% greater activity impairment, and SF-8 physical and mental summary scores that were 5.4 and 7.6 points lower than noninsomnia sufferers (P < .001 for all). CONCLUSIONS: Among depression and anxiety sufferers, CINA in relative isolation was associated with a significant negative impact on health care utilization and its associated costs, health-related quality of life, and work productivity.

Association of insomnia with quality of life, work productivity, and activity impairment.

PURPOSE: To assess the association of insomnia with health-related quality of life (HRQOL), work productivity, and activity impairment. METHODS: Data were obtained from the 2005 US National Health and Wellness Survey. Subjects were assigned to the insomnia group (diagnosed insomnia experienced at least a few times a month) or the noninsomnia group (no insomnia or sleep symptoms). HRQOL was assessed using the short form 8 (SF-8) (mental and physical scores). The work productivity and activity impairment questionnaire (WPAI) assessed absenteeism (work time missed), presenteeism (impairment at work), work productivity loss (overall work impairment), and activity impairment. Linear regression models were used to control for potential confounders. RESULTS: A total of 19,711 adults were evaluated (5,161 insomnia, 14,550 noninsomnia). Subjects in the insomnia group had significantly lower SF-8 physical (-5.40) and mental (-4.39) scores and greater activity impairment scores (+18.04) than subjects in the noninsomnia group (P < 0.01 for all). Employed subjects in the insomnia group had greater absenteeism (+6.27), presenteeism (+13.20), and work productivity loss (+10.33) scores than those in the noninsomnia group (P < 0.01 for all). CONCLUSIONS: Insomnia is significantly associated with poorer physical and mental quality of life and work productivity loss and activity impairment.

The association between asthma control and health care utilization, work productivity loss and health-related quality of life.

OBJECTIVE: To determine the association between asthma control and health outcomes. METHODS: Cross-sectional data on asthmatic patients were from the 2006 U.S. National Health and Wellness Survey. Asthma control was determined by the Asthma Control Test. Outcomes assessed included work productivity loss/activity impairment, health-related quality of life, and resource utilization. Effects of asthma control on outcomes were determined with linear and Poisson regression models. RESULTS: There were 2767 uncontrolled asthmatics and 2912 controlled asthmatics. Adjusting for confounders, controlled asthmatics reported (P < 0.001) higher physical and mental health-related quality of life scores (SF-8); fewer emergency room visits, hospitalization days, and medical provider visits; lower levels of overall work productivity loss and activity impairment. CONCLUSION: Results indicate that asthma control is associated with better health outcomes. Management with therapies optimizing asthma control may reduce direct and indirect costs of treatment.

Burden of illness associated with lower urinary tract symptoms including overactive bladder/urinary incontinence.

OBJECTIVES: To determine the effect of lower urinary tract symptoms, including overactive bladder/urinary incontinence, on health outcomes. METHODS: Data were obtained from the 2006 U.S. National Health and Wellness Survey. Cases (those who reported experiencing a sudden overwhelming urge to urinate, a frequent urge to urinate, or urinating >8 times/d) were matched 1:1 with controls (those not experiencing any symptoms) by age, race, sex, educational attainment, and comorbidity status. The outcome measures assessed included health resource use, work productivity loss/activity impairment, and health-related quality of life. RESULTS: Of the 62,833 respondents to the 2006 U.S. National Health and Wellness Survey, 13,957 case-control pairs were matched. The presence of lower urinary tract symptoms, including OAB/UI symptoms, was significantly associated with increased resource use (emergency room visits, odds ratio -1.57, 95% confidence interval -1.47-1.68; hospitalizations, odds ratio -1.56, 95% confidence interval 1.43-1.69; medical provider visits, odds ratio -1.52, 95% confidence interval 1.41-1.63), 8.03% greater overall work productivity loss (P < .001), 12.88% greater activity impairment (P < .001), and decreased health- related quality of life (mental scores, 4.07 points lower [P < .001]; physical scores, 4.14 points lower [P < .001]). CONCLUSIONS: The burden of illness associated with lower urinary tract conditions, including OAB/UI, extend beyond the diagnosed population. The appropriate diagnosis and treatment of symptoms could lead to better clinical, economic, and humanistic outcomes.

Economic and humanistic outcomes associated with comorbid type-2 diabetes, high cholesterol, and hypertension among individuals who are overweight or obese.

OBJECTIVE: To assess the association of diabetes, hypertension, and high cholesterol with economic and humanistic outcomes among overweight or obese individuals. METHODS: Data were from the 2006 National Health and Wellness Survey and were limited to overweight or obese adults (BMI > 27). Outcomes assessed include the SF-8, resource use, and the Work Productivity and Activity Impairment questionnaire. Independent effects of comorbid conditions were determined using linear regression models. RESULTS: Significant associations between comorbid conditions and outcomes were noted. Comorbid conditions had significant independent effects on outcomes. The presence of all three comorbid conditions was the strongest correlate of work productivity loss (B = 13.992) and activity impairment (B = 13.397) and had the strongest negative association with SF-8 physical (B = -8.239) and mental summary scores (B = -2.605). CONCLUSION: Among, overweight or obese individuals, comorbid conditions are associated with greater productivity loss, resource use, and poorer quality of life.