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de Lange MA, Richmond RC, Eastwood SV, Davies NM. Insomnia symptom prevalence in England: a comparison of cross-sectional self-reported data and primary care records in the UK Biobank. BMJ Open 2024; 14:e080479. [PMID: 38719300 PMCID: PMC11086527 DOI: 10.1136/bmjopen-2023-080479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 03/27/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES We aimed to use a large dataset to compare self-reported and primary care measures of insomnia symptom prevalence in England and establish whether they identify participants with similar characteristics. DESIGN Cross-sectional study with linked electronic health records (EHRs). SETTING Primary care in England. PARTICIPANTS 163 748 UK Biobank participants in England (aged 38-71 at baseline) with linked primary care EHRs. OUTCOME MEASURES We compared the percentage of those self-reporting 'usually' having insomnia symptoms at UK Biobank baseline assessment (2006-2010) to those with a Read code for insomnia symptoms in their primary care records prior to baseline. We stratified prevalence in both groups by sociodemographic, lifestyle, sleep and health characteristics. RESULTS We found that 29% of the sample self-reported having insomnia symptoms, while only 6% had a Read code for insomnia symptoms in their primary care records. Only 10% of self-reported cases had an insomnia symptom Read code, while 49% of primary care cases self-reported having insomnia symptoms. In both primary care and self-reported data, prevalence of insomnia symptom cases was highest in females, older participants and those with the lowest household incomes. However, while snorers and risk takers were more likely to be a primary care case, they were less likely to self-report insomnia symptoms than non-snorers and non-risk takers. CONCLUSIONS Only a small proportion of individuals experiencing insomnia symptoms have an insomnia symptom Read code in their primary care record. However, primary care data do provide a clinically meaningful measure of insomnia prevalence. In addition, the sociodemographic characteristics of people attending primary care with insomnia were consistent with those with self-reported insomnia, thus primary care records are a valuable data source for studying risk factors for insomnia. Further studies should replicate our findings in other populations and examine ways to increase discussions about sleep health in primary care.
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Affiliation(s)
- Melanie A de Lange
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rebecca C Richmond
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- NIHR Oxford Health Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Sophie V Eastwood
- Institute of Cardiovascular Science, University College London, London, UK
| | - Neil M Davies
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Division of Psychiatry & Department of Statistical Sciences, University College London, London, UK
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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D'Souza EW, MacGregor AJ, Markwald RR, Elkins TA, Zouris JM. Investigating insomnia in United States deployed military forces: A topic modeling approach. Sleep Health 2024; 10:75-82. [PMID: 38071173 DOI: 10.1016/j.sleh.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 09/12/2023] [Accepted: 09/29/2023] [Indexed: 03/01/2024]
Abstract
STUDY OBJECTIVES This retrospective study analyzed free-text clinical notes from medical encounters for insomnia among a sample of deployed US military personnel. Topic modeling, a natural language processing technique, was used to identify thematic patterns in the clinical notes that were potentially related to insomnia diagnosis. METHODS Clinical notes of patient clinical encounters coded for insomnia from the US Department of Defense Military Health System Theater Medical Data Store were analyzed. Following preprocessing of the free text in the clinical notes, topic modeling was employed to identify relevant underlying topics or themes in 32,864 unique patients. The machine-learned topics were validated using human-coded potential insomnia etiological issues. RESULTS A 12-topic model was selected based on quantitative metrics, interpretability, and coherence of terms comprising topics. The topics were assigned the following labels: personal/family history, stimulants, stress, family/relationships, other sleep disorders, depression, schedule/environment, anxiety, other medication, headache/concussion, pain, and medication refill. Validation of these topics (excluding the two medication topics) against their corresponding human-coded potential etiological issues showed strong agreement for the assessed topics. CONCLUSIONS Analysis of free-text clinical notes using topic modeling resulted in the identification of thematic patterns that largely mirrored known correlates of insomnia. These findings reveal multiple potential etiologies for deployment-related insomnia. The identified topics may augment electronic health record diagnostic codes and provide valuable information for sleep researchers and providers. As both civilian and military healthcare systems implement electronic health records, topic modeling may be a valuable tool for analyzing free-text data to investigate health outcomes.
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Affiliation(s)
- Edwin W D'Souza
- Leidos, Inc., San Diego, California, USA; Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
| | - Andrew J MacGregor
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA.
| | - Rachel R Markwald
- Warfighter Performance Department, Naval Health Research Center, San Diego, California, USA
| | - Trevor A Elkins
- Leidos, Inc., San Diego, California, USA; Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
| | - James M Zouris
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
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3
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Bachrach RL, Tighe CA, Beyer N, Hruska K, Phares A, Atchison K, Baniak L, Haas G, Bramoweth AD. Sleep and Alcohol Use Among Veterans Living With Long COVID. J Prim Care Community Health 2024; 15:21501319241246992. [PMID: 38628054 PMCID: PMC11025314 DOI: 10.1177/21501319241246992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/22/2024] [Accepted: 03/26/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVES Study objectives were to: (1) better understand sleep experiences and unhealthy alcohol use among Veterans with long COVID and (2) explore providers' perceptions of barriers and facilitators to delivering evidence-based care for sleep problems and unhealthy alcohol use in patients with long COVID. METHODS VA electronic health records were used to conduct chart reviews (n = 57) of patients evaluated in a VA COVID-19 Recovery Clinic during 1 calendar year; semi-structured interviews were completed with Veterans (n = 5) and clinicians (n = 7) recruited from the clinic. Veteran participants also completed quantitative, self-report measures assessing sleep- and alcohol-related experiences and behaviors. RESULTS Data from chart reviews and interviews suggested that Veterans with long COVID often had pre-existing sleep problems that were exacerbated during long COVID. Patients and providers agreed that sleep interventions would be beneficial and acceptable in the COVID-19 Recovery clinic. Conversely, few Veterans with long COVID had a pre-existing alcohol use disorder (AUD) diagnosis; alcohol use occurred less frequently and was less often discussed between patients and providers. Providers had mixed viewpoints on delivering alcohol-related care in the clinic; some were highly amenable, others were unsure whether patients would be receptive. CONCLUSIONS This study is among the first to take a mixed-method approach to understanding experiences of sleep-wake behaviors and unhealthy alcohol use in Veterans with long COVID. Characterizing sleep and alcohol-related experiences, examining associations with functioning, and exploring perspectives on treatment approaches is critical to support efforts to refine, personalize, and optimize evidence-based sleep and alcohol care for Veterans living with long COVID.
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Affiliation(s)
- Rachel L. Bachrach
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- University of Michigan, Ann Arbor, MI, USA
| | - Caitlan A. Tighe
- Providence College, Providence, RI, USA
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Nicole Beyer
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | | | - Angela Phares
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | | | - Lynn Baniak
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- University of Pittsburgh, Pittsburgh, PA, USA
| | - Gretchen Haas
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- University of Pittsburgh, Pittsburgh, PA, USA
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Manber R, Simpson N, Gumport NB. Perspectives on increasing the impact and reach of CBT-I. Sleep 2023; 46:zsad168. [PMID: 37903637 PMCID: PMC10710991 DOI: 10.1093/sleep/zsad168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/06/2023] [Indexed: 11/01/2023] Open
Abstract
Cognitive behavioral therapy for insomnia is now recognized as the front-line treatment for chronic insomnia, yet many challenges remain in improving its impact and reach. This manuscript describes our perspective on some of these challenges. Based on the literature that maladaptive cognitions predict low adherence and that high levels of cognitive-emotional hyperarousal may be associated with poor outcomes, we propose added focus on cognitive therapy strategies in CBT-I. Specifically, we propose broadening the range of traditional cognitive therapy strategies, utilizing acceptance-based strategies, and fuller integration of the broadened range of cognitive strategies into CBT-I throughout the course of treatment. We also highlight a few other promising emerging approaches to enhance the impact of CBT-I. These include involving partners to promote adherence with CBT-I treatment recommendations, using culturally relevant treatment adaptations to increase retention of patients in treatment, and using strategies for timely identification of barriers to engagement. We propose broadening the public health impact of CBT-I by integrating support for reduction in long-term use of hypnotic sleep medications, which is in line with current medical guidelines. We advocate for a case conceptualization-based approach for implementing CBT-I in a patient-centered manner, flexibly, yet with fidelity, to enhance its impact by addressing the factors above. For increasing the reach of CBT-I, we discuss the need to train more clinicians and ways to combine therapist and digital deliveries of CBT-I, highlighting stepped care strategies.
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Affiliation(s)
- Rachel Manber
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA. 94305USA
| | - Norah Simpson
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA. 94305USA
| | - Nicole B Gumport
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA. 94305USA
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5
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Pfeiffer PN, Ganoczy D, Zivin K, Gerlach L, Damschroder L, Ulmer CS. Guideline-concordant use of cognitive behavioral therapy for insomnia in the Veterans Health Administration. Sleep Health 2023; 9:893-896. [PMID: 37704561 DOI: 10.1016/j.sleh.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 07/03/2023] [Accepted: 07/08/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE To characterize guideline-concordant use of cognitive behavioral therapy for insomnia vs. sleep medications among Veterans Health Administration patients. METHODS Cognitive behavioral therapy for insomnia was identified from the text of psychotherapy notes within the Veterans Health Administration's electronic medical record. Patients that received first-line cognitive behavioral therapy for insomnia (ie, no prior insomnia treatment) were compared to those who first received a sleep medication in fiscal year 2021. RESULTS Among 5,519,016 patients, first-line cognitive behavioral therapy for insomnia was received by 9313 (0.2%) whereas 225,618 (4.1%) were newly prescribed a sleep medication without prior cognitive behavioral therapy for insomnia. Patients over 60 years old and those with substance use disorders were less likely to receive first-line cognitive behavioral therapy for insomnia compared to other patients. CONCLUSIONS Adherence to practice guidelines to provide cognitive behavioral therapy for insomnia as first-line treatment for insomnia disorder remains a challenge, highlighting the need to better integrate effective implementation strategies within therapist training programs. Targeted strategies may be needed for older patients or those with substance use disorders.
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Affiliation(s)
- Paul N Pfeiffer
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA; Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.
| | - Dara Ganoczy
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Kara Zivin
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA; Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Lauren Gerlach
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA; Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Laura Damschroder
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Christi S Ulmer
- Durham VA Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham, North Carolina, USA; Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
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6
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El-Solh AA, Lawson Y, Wilding GE. Association Between Hypnotic Use and All-Cause Mortality in Patients with Chronic Obstructive Pulmonary Disease and Insomnia. Int J Chron Obstruct Pulmon Dis 2023; 18:2393-2404. [PMID: 37942297 PMCID: PMC10629458 DOI: 10.2147/copd.s430609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/27/2023] [Indexed: 11/10/2023] Open
Abstract
Purpose Hypnotics are commonly prescribed in patients with COPD to manage insomnia. Given the considerable risks associated with these drugs, the aim of the study was to evaluate the risk of all-cause mortality associated with hypnotics in a cohort of veterans with COPD presenting with insomnia. Methods We conducted a retrospective cohort study that used Veterans Health Administration Corporate Data Warehouse with data supplemented by linkage to Medicare, Medicaid, and National Death Index data from 2010 through 2019. The primary outcome was all-cause mortality. Analyses were conducted using propensity score 1:1 matching to balance baseline characteristics. Results Of the 5759 veterans with COPD (mean [SD] age, 71.7 [11.2]; 92% men), 3585 newly initiated hypnotic agents during the study period. During a mean follow-up of 7.4 (SD, 2.7) years, a total of 2301 deaths occurred, with 65.2 and 48.7 total deaths per 1000 person-years among hypnotic users and nonusers, respectively. After propensity matching, hypnotic use was associated with a 22% increased risk of mortality compared with hypnotic nonusers (hazard ratio [HR] 1.22; 95% confidence interval [CI],1.11-1.35). The benzodiazepine receptor agonists (BZRAs) group experienced a higher incidence rate of all-cause mortality compared to hypnotic nonusers (Incidence rate ratio [IRR] 1.27; 95% CI, 1.14-1.43). Conversely, the mortality rate of non-BZRA hypnotics decreased after the first 2 years and was not significantly different for hypnotic nonusers (IRR 1.04; 95% CI, 0.82-1.11). Conclusion Among patients with COPD and insomnia, treatment with hypnotics was associated with a higher risk of all-cause mortality. The association was observed in patients prescribed BZRAs. The risk of mortality for non-BZRAs moderated after the first 2 years, indicating a class effect.
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Affiliation(s)
- Ali A El-Solh
- Research Department, VA Western New York Healthcare System, Buffalo, NY, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine; Jacobs School of Medicine, Buffalo, NY, USA
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions; University at Buffalo, Buffalo, NY, USA
| | - Yolanda Lawson
- Research Department, VA Western New York Healthcare System, Buffalo, NY, USA
| | - Gregory E Wilding
- Department of Biostatistics, School of Public Health and Health Professions; University at Buffalo, Buffalo, NY, USA
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7
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Tighe CA, Berlin GS, Boland EM, Miller KE, Bramoweth AD. Identifying predictors of the amount of veteran participation in cognitive behavioral therapy for insomnia in the Veterans Affairs health care system. Psychol Serv 2023:2024-22275-001. [PMID: 37917476 PMCID: PMC11063118 DOI: 10.1037/ser0000818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Insomnia is a prevalent and negatively impactful disorder among veterans. The Department of Veterans Affairs (VA) has committed significant resources to the development and dissemination of training related to cognitive behavioral therapy for insomnia (CBT-I), the recommended first-line intervention for chronic insomnia disorder. It has been established that VA clinicians can be effectively trained to deliver high fidelity CBT-I and that treatment results in significant improvements in insomnia. However, there is a paucity of research examining rates and predictors of veterans' participation in CBT-I in routine VA clinical care. In this study, we conducted a secondary analysis of data from VA electronic health records (EHR) to determine individual predisposing, enabling, and need factors associated with CBT-I participation. The sample included veterans who had at least one CBT-I templated note from the VA mid-Atlantic region of the United States (VISN4) between 2015 and 2019 in their chart (N = 2,801). CBT-I participation was defined by number of CBT-I templated notes occurring within a 6-month period from the initial note. Findings indicated that veterans most often completed only one session of CBT-I and, on average, completed approximately three sessions. Results from multinomial logistic regression identified significant associations of race, the presence of comorbid mental health disorders, rurality, presence of insomnia diagnosis, and insomnia medication with CBT-I participation; associations varied depending on how CBT-I participation was defined. More work is needed to better understand factors contributing to participation and reasons for completion and noncompletion of CBT-I. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Caitlan A Tighe
- Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System
| | | | | | - Katherine E Miller
- Mental Illness Research, Education and Clinical Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center
| | - Adam D Bramoweth
- Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System
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Germain A, Wolfson M, Brock MS, O'Reilly B, Hearn H, Knowles S, Mysliwiec V, Wallace ML. Digital CBTI hubs as a treatment augmentation strategy in military clinics: study protocol for a pragmatic randomized clinical trial. Trials 2023; 24:648. [PMID: 37803393 PMCID: PMC10557157 DOI: 10.1186/s13063-023-07686-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/28/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Chronic insomnia is the most prevalent sleep disorder among military service members, and it compromises readiness, performance, and physical and mental health. Cognitive behavioral treatment for insomnia (CBTI) is the standard of care for the treatment of insomnia recommended by the VA/DoD Clinical Practice Guideline, the American Academy of Sleep Medicine, and the American College of Physicians. CBTI is highly effective but has limited scalability. It is often unavailable in clinical settings where service members receive sleep care. Digital technologies offer unique opportunities to scale and broaden the geographic reach of CBTI services and support increased patient access and engagement in behavioral sleep care. This study aims to evaluate the impact and acceptability of digital CBTI hubs to augment military treatment facilities' capabilities in behavioral sleep medicine. METHODS This is a multi-site, non-inferiority randomized clinical trial designed to compare the effects of in-person (face-to-face or virtual) insomnia care as usual at three military sleep clinics versus CBTI delivered remotely and asynchronously through digital CBTI hubs. Digital CBTI hubs are led by licensed, certified clinicians who use NOCTEM's® evidence-based clinical decision support platform COAST™ (Clinician Operated Assistive Sleep Technology). Changes in insomnia severity and daytime symptoms of depression and anxiety will be compared at baseline, at 6-8 weeks, and at 3-month follow-up. Patient satisfaction with insomnia care as usual versus digital CBTI hubs will also be examined. We hypothesize that digital CBTI hubs will be non-inferior to insomnia care as usual for improvements in insomnia and daytime symptoms as well as patient satisfaction with insomnia care. DISCUSSION Digital technology has a high potential to scale CBTI accessibility and delivery options required to meet the insomnia care needs of military service members. Digital CBTI hubs using COAST offer a novel approach to broaden service members' access to CBTI and to serve as an augmentation strategy for existing sleep services at military treatment facilities. The pragmatic approach leveraging technology in this trial has the potential to rapidly inform clinical practice within the Defense Health Agency as well as other healthcare systems. TRIAL REGISTRATION ClinicalTrials.gov NCT05490550. Registered on 14 July 2023.
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Affiliation(s)
- Anne Germain
- NOCTEM, LLC, 218 Oakland Avenue, Pittsburgh, PA, 15213, USA.
| | - Megan Wolfson
- NOCTEM, LLC, 218 Oakland Avenue, Pittsburgh, PA, 15213, USA
| | - Matthew S Brock
- Department of Sleep Medicine, Wilford Hall Ambulatory Surgical Center, 1100 Wilford Hall Loop, Lackland AFB, San Antonio, TX, 78236, USA
| | - Brian O'Reilly
- Madigan Army Medical Center, Joint Base Lewis-McChord, WA, 9040 Jackson Ave., Joint Base Lewis-McChord, WA, 98431, USA
| | - Hunter Hearn
- Carl R. Darnall Army Medical Center, Sleep Disorder Center, 36065 Santa Fe Ave., Fort Hood, Fort Cavazos, TX, 76544, USA
| | - Shelley Knowles
- Carl R. Darnall Army Medical Center, Sleep Disorder Center, 36065 Santa Fe Ave., Fort Hood, Fort Cavazos, TX, 76544, USA
| | - Vincent Mysliwiec
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, 78229, USA
| | - Meredith L Wallace
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, USA
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Bonfils KA, Longenecker JM, Soreca I, Hammer LA, Tighe CA, Haas GL, Bramoweth AD. Sleep disorders in veterans with serious mental illnesses: prevalence in Veterans Affairs health record data. J Clin Sleep Med 2023; 19:1651-1660. [PMID: 37141001 PMCID: PMC10476039 DOI: 10.5664/jcsm.10630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/21/2023] [Accepted: 04/21/2023] [Indexed: 05/05/2023]
Abstract
STUDY OBJECTIVES This study aimed to estimate the 12-month prevalence of diagnosed sleep disorders among veterans with and without serious mental illnesses (SMI) in Veterans Affairs health record data in 2019. We also examined diagnosed sleep disorders across a 9-year period and explored associations with demographic and health factors. METHODS This study used health record data from VISN 4 of the Veterans Health Administration from 2011 to 2019. SMI diagnoses included schizophrenia and bipolar spectrum diagnoses as well as major depression with psychosis. Sleep diagnoses included insomnias, hypersomnias, sleep-related breathing disorders, circadian rhythm sleep-wake disorders, and sleep-related movement disorders. Demographic and health-related factors were also collected from the record. RESULTS In 2019, 21.8% of veterans with SMI were diagnosed with a sleep disorder. This is a significantly higher proportion than for veterans without SMI, 15.1% of whom were diagnosed with a sleep disorder. Sleep disorder rates were highest in veterans with a chart diagnosis of major depression with psychosis. From 2011 to 2019, the overall prevalence of sleep disorders in veterans with SMI more than doubled (10.2%-21.8%), suggesting improvements in the detection and diagnosis of sleep concerns for this group. CONCLUSIONS Our findings suggest that identification and diagnosis of sleep disorders for veterans with SMI has improved over the past decade, though diagnoses still likely underrepresent actual prevalence of clinically relevant sleep concerns. Sleep concerns may be at particularly high risk of going untreated in veterans with schizophrenia-spectrum disorders. CITATION Bonfils KA, Longenecker JM, Soreca I, et al. Sleep disorders in veterans with serious mental illnesses: prevalence in Veterans Affairs health record data. J Clin Sleep Med. 2023;19(9):1651-1660.
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Affiliation(s)
- Kelsey A. Bonfils
- School of Psychology, The University of Southern Mississippi, Hattiesburg, Mississippi
| | - Julia M. Longenecker
- VISN 4 Mental Illness Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Isabella Soreca
- VISN 4 Mental Illness Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Lillian A. Hammer
- School of Psychology, The University of Southern Mississippi, Hattiesburg, Mississippi
| | - Caitlan A. Tighe
- VISN 4 Mental Illness Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Gretchen L. Haas
- VISN 4 Mental Illness Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania and Department of Psychology, Dietrich School of Arts and Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Adam D. Bramoweth
- VISN 4 Mental Illness Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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10
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Luyster FS, Boudreaux-Kelly MY, Bon JM. Insomnia in chronic obstructive pulmonary disease and associations with healthcare utilization and costs. Respir Res 2023; 24:93. [PMID: 36964552 PMCID: PMC10039604 DOI: 10.1186/s12931-023-02401-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/16/2023] [Indexed: 03/26/2023] Open
Abstract
Insomnia has been linked to adverse chronic obstructive pulmonary disease (COPD) outcomes including exacerbations, yet its impact on COPD-related healthcare utilization and costs is unknown. In this study, we investigated the associations between insomnia and healthcare utilization and costs in patients with COPD. A retrospective cohort of veterans with COPD were identified from national Veterans Affairs administration data for fiscal years 2012-2017. Insomnia was operationalized as having an insomnia diagnosis based on International Classification of Disease codes or having a prescription of > 30 doses of a sedative-hypnotic medication in a given fiscal year. The index date for insomnia was the first date when dual criteria for COPD and insomnia was met. The index date for those without insomnia was set as the COPD index date. Our primary outcomes were 1-year healthcare utilization and costs related to outpatient visits and hospitalizations after index date. COPD-related healthcare utilization variables included number of prescription fills of corticosteroids and/or antibiotics and outpatient visits and hospitalizations with a primary diagnosis of COPD. Out of 1,011,646 patients (96% men, mean age 68.4 years) diagnosed with COPD, 407,363 (38.8%) had insomnia. After adjustment for confounders, insomnia was associated with higher rates of outpatient visits, hospitalizations, and fills for corticosteroids and/or antibiotics, longer hospital length of stay, and $10,344 higher hospitalization costs in the 12 months after index date. These findings highlight the importance of insomnia as a potentially modifiable target for reducing the burden of COPD on patients and healthcare systems.
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Affiliation(s)
- Faith S Luyster
- School of Nursing, University of Pittsburgh, 3500 Victoria St, 415 Victoria Building, Pittsburgh, PA, 15241, USA.
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
| | | | - Jessica M Bon
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
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11
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Wickwire EM, Amari DT, Juday TR, Frech FH, Gor D, Malhotra M. Cardiac events and economic burden among patients with hypertension and treated insomnia in the USA. Future Cardiol 2022; 18:731-741. [PMID: 35787013 DOI: 10.2217/fca-2022-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Cardiovascular (CV) event risk, healthcare resource utilization (HCRU) and costs have not been elucidated among hypertension patients with treated insomnia (H + TI). Materials & methods: Adult patients with H + TI were identified in IBM MarketScan databases. H + TI patients were matched 1:1 on age and sex to controls with hypertension but without sleep disorders. Multivariable models were used to estimate associations between treated insomnia and CV event risk, HCRU and costs. Results: In total, 81,502 H + TI patients (mean age = 62 years, 53% female) were matched. Relative to controls, H + TI patients were 2.4 times as likely to have CV events. H + TI patients incurred higher costs per patient per month (US$2343 vs US$1013). Conclusion: Treated insomnia was associated with higher costs and HRCU in hypertension patients.
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Affiliation(s)
- Emerson M Wickwire
- Department of Psychiatry, University of Maryland, Baltimore, MD 21201, USA.,Sleep Disorders Center, Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Maryland, Baltimore, MD 21201, USA
| | | | | | | | - Deval Gor
- Genesis Research, Hoboken, NJ 07030, USA
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