title: Metacognitive beliefs relate specifically to sleep quality in primary insomnia: a pilot study.
abstract: OBJECTIVE
  To identify whether metacognitive aspects are a specific mental pattern of primary insomnia (PI) or an aspecific correlate of sleep alterations.
  
  
  METHODS
  Sleep quality (Pittsburgh Sleep Quality Index: PSQI), anxiety (Self-rating Anxiety State: SAS), depression (Beck Depression Inventory: BDI) and metacognition (Metacognitions Questionnaire - Insomnia: MCQ-I) were evaluated in 24 PI patients, 13 snorers and 17 healthy controls. Rank-transformed PSQI, BDI, SAS and MCQ-I scores were submitted to one-way analysis of variance with group as a between-factor. PSQI was submitted to three-way analysis of covariance (ANCOVA) with MCQ-I, BDI or SAS as covariate and group as a between-factor. Post-hoc analyses were conducted using pairwise comparisons with Sidak correction.
  
  
  RESULTS
  As expected, PSQI scores significantly differentiated the three groups, one from another: PI had highest scores followed by snorers and healthy controls. PI subjects had MCQ-I scores significantly higher than those of snorers and healthy controls; no difference between the latter groups was found. The ANCOVA on PSQI with MCQ-I as a covariate abolished the difference in sleep quality between PI and snorers, whereas covarying for BDI or SAS left the differences in sleep quality between the groups unchanged.
  
  
  CONCLUSIONS
  These preliminary results lead to two main conclusions: (i) metacognitive aspects are more prominent in PI when compared to snorers and healthy controls; (ii) MCQI shows higher sensitivity in defining PI patients, with respect to PSQI. If these findings are confirmed and expanded by further studies, the development of a specific metacognitive model of primary insomnia may be warranted.
authors.affiliation: Department of Clinical and Experimental Medicine, Psychiatric Unit, University of Pisa, Italy. Electronic address: l.palagini@ao-pisa.toscana.it.
authors.forename: Laura
authors.initials: L
authors.lastname: Palagini
authors.affiliation: PERCRO Lab, Scuola Superiore Sant'Anna, Pisa, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Piarulli
authors.affiliation: Institute of Clinical Physiology, National Research Council (CNR), Pisa, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Menicucci
authors.affiliation: Department of Surgery, Medical, Molecular & Critical Area Pathology, University of Pisa, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Cheli
authors.affiliation: Department of Surgery, Medical, Molecular & Critical Area Pathology, University of Pisa, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Lai
authors.affiliation: PERCRO Lab, Scuola Superiore Sant'Anna, Pisa, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Bergamasco
authors.affiliation: Department of Clinical and Experimental Medicine, Psychiatric Unit, University of Pisa, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Mauri
authors.affiliation: School of Psychological Sciences, University of Manchester, UK.
authors.forename: S D
authors.initials: SD
authors.lastname: Kyle
authors.affiliation: Nuffield Department of Clinical Neurosciences/Sleep & Circadian Neuroscience Institute, University of Oxford, Oxford, UK.
authors.forename: C A
authors.initials: CA
authors.lastname: Espie
authors.affiliation: Institute of Clinical Physiology, National Research Council (CNR), Pisa, Italy; Department of Surgery, Medical, Molecular & Critical Area Pathology, University of Pisa, Italy; Extreme Centre, Scuola Superiore Sant'Anna, Pisa, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Gemignani
mesh_terms: D016022:Case-Control Studies; D003071:Cognition; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D011581:Psychological Tests; D012890:Sleep; D007319:Sleep Initiation and Maintenance Disorders / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Cognitive behavioral therapy; Insomnia; Intrusive negative thoughts; Metacognitive beliefs; Model of primary insomnia; Poor sleep quality