title: Clinical and polysomnographic predictors of the natural history of poor sleep in the general population.
abstract: OBJECTIVE
  Approximately 8-10% of the general population suffers from chronic insomnia, whereas another 20-30% of the population has insomnia symptoms at any given time (i.e., poor sleep). However, few longitudinal studies have examined risk factors of the natural history of poor sleep, and none have examined the role of polysomnographic (PSG) variables.
  
  
  METHODS
  Representative longitudinal study.
  
  
  METHODS
  Sleep laboratory.
  
  
  METHODS
  From a random, general population sample of 1,741 individuals of the adult Penn State Cohort, 1,395 were followed up after 7.5 yr.
  
  
  METHODS
  Full medical evaluation and 1-night PSG at baseline and telephone interview at follow-up.
  
  
  RESULTS
  The rate of incident poor sleep was 18.4%. Physical (e.g., obesity, sleep apnea, and ulcer) and mental (e.g., depression) health conditions and behavioral factors (e.g., smoking and alcohol consumption) increased the odds of incident poor sleep as compared to normal sleep. The rates of persistent, remitted, and poor sleepers who developed chronic insomnia were 39%, 44%, and 17%, respectively. Risk factors for persistent poor sleep were physical health conditions combined with psychologic distress. Shorter objective sleep duration and a family history of sleep problems were risk factors for poor sleep evolving into chronic insomnia.
  
  
  CONCLUSIONS
  Poor sleep appears to be primarily a symptom of physical and mental health conditions, whereas the persistence of poor sleep is associated with psychologic distress. Importantly, sleep apnea appears to be associated with incident poor sleep but not with chronic insomnia. Finally, this study suggests that objective short sleep duration in poor sleepers is a biologic marker of genetic predisposition to chronic insomnia.
authors.affiliation: Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA, USA.
authors.forename: Julio
authors.initials: J
authors.lastname: Fernandez-Mendoza
authors.forename: Alexandros N
authors.initials: AN
authors.lastname: Vgontzas
authors.forename: Edward O
authors.initials: EO
authors.lastname: Bixler
authors.forename: Ravi
authors.initials: R
authors.lastname: Singareddy
authors.forename: Michele L
authors.initials: ML
authors.lastname: Shaffer
authors.forename: Susan L
authors.initials: SL
authors.lastname: Calhoun
authors.forename: Maria
authors.initials: M
authors.lastname: Karataraki
authors.forename: Antonio
authors.initials: A
authors.lastname: Vela-Bueno
authors.forename: Duanping
authors.initials: D
authors.lastname: Liao
mesh_terms: D000328:Adult; D005260:Female; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D017286:Polysomnography; D012890:Sleep / Q000502:physiology; D007319:Sleep Initiation and Maintenance Disorders / Q000209:etiology* / Q000503:physiopathology; D055815:Young Adult