title: Burden associated with chronic sleep maintenance insomnia characterized by nighttime awakenings among women with menopausal symptoms.
abstract: 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.
authors.affiliation: Consumer Health Sciences, Princeton, NJ, USA. sbolge@its.jnj.com
authors.forename: Susan C
authors.initials: SC
authors.lastname: Bolge
authors.forename: Rajesh
authors.initials: R
authors.lastname: Balkrishnan
authors.forename: Hema
authors.initials: H
authors.lastname: Kannan
authors.forename: Brian
authors.initials: B
authors.lastname: Seal
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Drake
mesh_terms: D000041:Absenteeism; D000328:Adult; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D008593:Menopause / Q000523:psychology*; D008875:Middle Aged; D015995:Prevalence; D011788:Quality of Life; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications* / Q000453:epidemiology* / Q000523:psychology; D014481:United States / Q000453:epidemiology