Neurobehavioral performance impairment in insomnia: relationships with self-reported sleep and daytime functioning.
OBJECTIVE
Despite the high prevalence of insomnia, daytime consequences of the disorder are poorly characterized. This study aimed to identify neurobehavioral impairments associated with insomnia, and to investigate relationships between these impairments and subjective ratings of sleep and daytime dysfunction.


METHODS
Cross-sectional, multicenter study.


METHODS
Three sleep laboratories in the USA and Australia.


METHODS
Seventy-six individuals who met the Research Diagnostic Criteria (RDC) for Primary Insomnia, Psychophysiological Insomnia, Paradoxical Insomnia, and/or Idiopathic Childhood Insomnia (44F, 35.8 ± 12.0 years [mean ± SD]) and 20 healthy controls (14F, 34.8 ± 12.1 years).


METHODS
N/A.


RESULTS
Participants completed a 7-day sleep-wake diary, questionnaires assessing daytime dysfunction, and a neurobehavioral test battery every 60-180 minutes during an afternoon/evening sleep laboratory visit. Included were tasks assessing sustained and switching attention, working memory, subjective sleepiness, and effort. Switching attention and working memory were significantly worse in insomnia patients than controls, while no differences were found for simple or complex sustained attention tasks. Poorer sustained attention in the control, but not the insomnia group, was significantly associated with increased subjective sleepiness. In insomnia patients, poorer sustained attention performance was associated with reduced health-related quality of life and increased insomnia severity.


CONCLUSIONS
We found that insomnia patients exhibit deficits in higher level neurobehavioral functioning, but not in basic attention. The findings indicate that neurobehavioral deficits in insomnia are due to neurobiological alterations, rather than sleepiness resulting from chronic sleep deficiency.
Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA ; Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA ; School of Psychology and Psychiatry, Monash University, Melbourne, Australia.
Julia A
JA
Shekleton
Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA ; Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA.
Erin E
EE
Flynn-Evans
Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, Australia ; Central Clinical School, Monash University, Melbourne, Australia.
Belinda
B
Miller
Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA ; Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA ; Sleep HealthCenters, Brighton, MA.
Lawrence J
LJ
Epstein
Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA ; Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA ; Sleep HealthCenters, Brighton, MA.
Douglas
D
Kirsch
Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
Lauren A
LA
Brogna
Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
Liza M
LM
Burke
Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA.
Erin
E
Bremer
School of Psychology and Psychiatry, Monash University, Melbourne, Australia.
Jade M
JM
Murray
Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA.
Philip
P
Gehrman
Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA ; Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA ; School of Psychology and Psychiatry, Monash University, Melbourne, Australia.
Steven W
SW
Lockley
Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA ; Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA ; School of Psychology and Psychiatry, Monash University, Melbourne, Australia.
Shantha M W
SM
Rajaratnam
D000293:Adolescent; D000328:Adult; D000368:Aged; D001288:Attention / Q000502:physiology; D001315:Australia; D003071:Cognition / Q000502:physiology; D003430:Cross-Sectional Studies; D003863:Depression / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008570:Memory, Short-Term / Q000502:physiology; D008875:Middle Aged; D009483:Neuropsychological Tests; D057566:Self Report; D012890:Sleep / Q000502:physiology; D007319:Sleep Initiation and Maintenance Disorders / Q000503:physiopathology* / Q000523:psychology*; D012894:Sleep Stages / Q000502:physiology; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States; D014851:Wakefulness; D055815:Young Adult
Insomnia; cognitive performance; depression; fatigue; functional impairment; sleep; sleepiness