title: Heritability and mortality risk of insomnia-related symptoms: a genetic epidemiologic study in a population-based twin cohort.
abstract: OBJECTIVE
  Our aim was to estimate heritability in phenotypic insomnia and the association between insomnia and mortality.
  
  
  METHODS
  Representative follow-up study.
  
  
  METHODS
  1990 survey of the Finnish Twin Cohort (N = 12502 adults; 1554 monozygotic and 2991 dizygotic twin pairs).
  
  
  METHODS
  Current insomnia-related symptoms (insomnia in general, difficulty in initiating sleep, sleep latency, nocturnal awakening, early morning awakening, and non-restorative sleep assessed in the morning and during the day) were asked. Latent class analysis was used to classify subjects into different sleep quality classes. Quantitative genetic modelling was used to estimate heritability. Mortality data was obtained from national registers until end of April 2009.
  
  
  RESULTS
  The heritability estimates of each symptom were similar in both genders varying from 34% (early morning awakening) to 45% (nocturnal awakening). The most parsimonious latent class analysis produced 3 classes: good sleepers (48%), average sleepers (up to weekly symptoms, 40%), and poor sleepers (symptoms daily or almost daily, 12%). The heritability estimate for the cluster was 46% (95% confidence interval 41% to 50%). In a model adjusted for smoking, BMI, and depressive symptoms, the all-cause mortality of poor sleepers was elevated (excess mortality 55% in men and 51% in women). Further adjustment for sleep length, use of sleep promoting medications, and sleep apnea-related symptoms did not change the results.
  
  
  CONCLUSIONS
  Insomnia-related symptoms were common in both genders. The symptoms and their clusters showed moderate heritability estimates. A significant association was found between poor sleep and risk of mortality, especially in those with somatic disease.
authors: Finnish Institute of Occupational Health, Helsinki, Finland. christer.hublin@ttl.fi
authors: Christer
authors: C
authors: Hublin
authors: Markku
authors: M
authors: Partinen
authors: Markku
authors: M
authors: Koskenvuo
authors: Jaakko
authors: J
authors: Kaprio
mesh_terms: D000368:Aged; D002423:Cause of Death; D002908:Chronic Disease / Q000453:epidemiology*; D015331:Cohort Studies; D016021:Epidemiologic Studies; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D040582:Inheritance Patterns; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D012306:Risk; D012737:Sex Factors; D007319:Sleep Initiation and Maintenance Disorders / Q000235:genetics* / Q000401:mortality*; D014429:Twins, Dizygotic; D014430:Twins, Monozygotic