title: Impact of middle-of-the-night awakenings on health status, activity impairment, and costs.
abstract: OBJECTIVE
  Middle-of-the-night (MOTN) awakenings with difficulty returning to sleep are among the most common symptoms of insomnia. Despite the epidemiological studies that have been conducted, there is a lack of data on the impact of MOTN awakenings on health status and socioeconomic indicators in comparison with other insomnia symptoms.
  
  
  METHODS
  Data were analyzed from the 2011 US National Health and Wellness Survey (adults ≥18 years old; N=60,783), which asked respondents whether they had experienced specific symptoms of insomnia (ie, MOTN awakenings, difficulty falling asleep, waking several times, waking up too early, or poor quality of sleep). Respondents who reported only one insomnia symptom were compared among insomnia subgroups and with no insomnia symptom controls with respect to demographics, health history, and health outcomes (Short Form-12v2, Work Productivity and Activity Impairment questionnaire, and costs). Additional analyses compared respondents with only MOTN awakenings and matched controls on health outcomes.
  
  
  RESULTS
  MOTN awakenings without other insomnia symptoms were reported by 3.5% of respondents. Poor quality of sleep was associated with the strongest effects on health status compared with other insomnia symptoms even after adjusting for demographic and health characteristics differences. Differences across insomnia symptoms with respect to cost-related outcomes were generally modest, though all were higher (if not significantly so) than respondents without insomnia. Respondents who experienced only waking several times and only MOTN awakenings had the highest direct costs, while respondents who experienced only poor quality of sleep and only difficulty falling asleep had the highest indirect costs. Respondents with only MOTN awakenings reported significantly worse mental and physical health status and worse health utilities relative to insomnia-free matched controls (all P<0.05). Annual per-employee indirect costs were also significantly higher ($4,328 vs $3,000; P<0.05). Among only MOTN awakenings respondents, 74.6% were considered only symptomatic (ie, they did not report having insomnia or having been diagnosed with insomnia).
  
  
  CONCLUSIONS
  These findings collectively highlight the prevalence and socioeconomic impact of specific types of insomnia symptoms, including MOTN awakenings, experienced by adults in the US.
authors.affiliation: Purdue Pharma, LP, Stamford, CT, USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Moline
authors.affiliation: Health Outcomes Practice, Kantar Health, New York, NY, USA.
authors.forename: Marco daCosta
authors.initials: Md
authors.lastname: DiBonaventura
authors.affiliation: Purdue Pharma, LP, Stamford, CT, USA.
authors.forename: Dhvani
authors.initials: D
authors.lastname: Shah
authors.affiliation: Purdue Pharma, LP, Stamford, CT, USA.
authors.forename: Rami
authors.initials: R
authors.lastname: Ben-Joseph
keywords: health outcomes; insomnia; nocturnal awakenings; sleep quality; sleep symptoms; work productivity
references.citation: Sleep Med Rev. 2002 Apr;6(2):97-111
references.pmid: 12531146
references.citation: Qual Life Res. 2009 May;18(4):415-22
references.pmid: 19288223
references.citation: Pharmacoeconomics. 2010;28(11):1015-23
references.pmid: 20936885
references.citation: J Occup Environ Med. 2011 Sep;53(9):1025-9
references.pmid: 21866052
references.citation: J Chronic Dis. 1987;40(5):373-83
references.pmid: 3558716
references.citation: Sleep. 2008 Apr;31(4):473-80
references.pmid: 18457234
references.citation: Neuropsychiatr Dis Treat. 2013;9:437-43
references.pmid: 23579788
references.citation: Pharmacoeconomics. 1993 Nov;4(5):353-65
references.pmid: 10146874
references.citation: Health Qual Life Outcomes. 2003 Apr 11;1:4
references.pmid: 12737635
references.citation: Pharmacoeconomics. 2004;22(3):165-84
references.pmid: 14871164
references.citation: J Med Econ. 2010;13(4):709-18
references.pmid: 21091098
references.citation: Ann Med. 2001 Jul;33(5):350-7
references.pmid: 11491194
references.citation: Health Qual Life Outcomes. 2012 Mar 15;10:30
references.pmid: 22420468
references.citation: J Psychiatr Res. 2008 Nov;43(1):48-54
references.pmid: 18374943
references.citation: J Psychiatr Res. 2009 Jul;43(10):934-40
references.pmid: 19261296
references.citation: Sleep Med Rev. 2010 Dec;14(6):379-89
references.pmid: 20359916
references.citation: Biol Psychiatry. 2006 Dec 15;60(12):1364-71
references.pmid: 16952333