title: The associations of insomnia with costly workplace accidents and errors: results from the America Insomnia Survey.
abstract: BACKGROUND
  Insomnia is a common and seriously impairing condition that often goes unrecognized.
  
  
  OBJECTIVE
  To examine associations of broadly defined insomnia (ie, meeting inclusion criteria for a diagnosis from International Statistical Classification of Diseases, 10th Revision, DSM-IV, or Research Diagnostic Criteria/International Classification of Sleep Disorders, Second Edition) with costly workplace accidents and errors after excluding other chronic conditions among workers in the America Insomnia Survey (AIS).
  
  
  METHODS
  A national cross-sectional telephone survey (65.0% cooperation rate) of commercially insured health plan members selected from the more than 34 million in the HealthCore Integrated Research Database.
  
  
  METHODS
  Four thousand nine hundred ninety-one employed AIS respondents.
  
  
  METHODS
  Costly workplace accidents or errors in the 12 months before the AIS interview were assessed with one question about workplace accidents "that either caused damage or work disruption with a value of $500 or more" and another about other mistakes "that cost your company $500 or more."
  
  
  RESULTS
  Current insomnia with duration of at least 12 months was assessed with the Brief Insomnia Questionnaire, a validated (area under the receiver operating characteristic curve, 0.86 compared with diagnoses based on blinded clinical reappraisal interviews), fully structured diagnostic interview. Eighteen other chronic conditions were assessed with medical/pharmacy claims records and validated self-report scales. Insomnia had a significant odds ratio with workplace accidents and/or errors controlled for other chronic conditions (1.4). The odds ratio did not vary significantly with respondent age, sex, educational level, or comorbidity. The average costs of insomnia-related accidents and errors ($32 062) were significantly higher than those of other accidents and errors ($21 914). Simulations estimated that insomnia was associated with 7.2% of all costly workplace accidents and errors and 23.7% of all the costs of these incidents. These proportions are higher than for any other chronic condition, with annualized US population projections of 274 000 costly insomnia-related workplace accidents and errors having a combined value of US $31.1 billion.
  
  
  CONCLUSIONS
  Effectiveness trials are needed to determine whether expanded screening, outreach, and treatment of workers with insomnia would yield a positive return on investment for employers.
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Victoria
authors.initials: V
authors.lastname: Shahly
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Berglund
authors.forename: Catherine
authors.initials: C
authors.lastname: Coulouvrat
authors.forename: Timothy
authors.initials: T
authors.lastname: Fitzgerald
authors.forename: Goeran
authors.initials: G
authors.lastname: Hajak
authors.forename: Thomas
authors.initials: T
authors.lastname: Roth
authors.forename: Alicia C
authors.initials: AC
authors.lastname: Shillington
authors.forename: Judith J
authors.initials: JJ
authors.lastname: Stephenson
authors.forename: James K
authors.initials: JK
authors.lastname: Walsh
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Kessler
mesh_terms: D000062:Accidents, Occupational / Q000191:economics* / Q000523:psychology; D000328:Adult; D000368:Aged; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004651:Employment / Q000191:economics / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D007319:Sleep Initiation and Maintenance Disorders / Q000191:economics* / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D013689:Telephone; D014481:United States / Q000453:epidemiology; D055815:Young Adult