title: Insomnia, hypnotic use, and health-related quality of life in a nationally representative sample.
abstract: OBJECTIVE
  To assess health-related quality of life (HRQoL) associated with insomnia and prescription hypnotic use.
  
  
  METHODS
  Primary outcomes were mental component summary (MCS) and physical component summary (PCS) scores from the 12-item Short-Form Health Survey. Using multiple regression, subjects in the 2005 through 2009 Medical Expenditure Panel Survey with diagnosed insomnia were compared against those without that diagnosis. Among subjects with diagnosed insomnia, users of prescription hypnotics were compared against nonusers.
  
  
  RESULTS
  Of 104,274 adults, 1.3 % (n = 1,401) had an insomnia diagnosis. Of those, 45.6 % (n = 639) used prescription hypnotics. For subjects with insomnia, mean PCS and MCS scores were 9.2 and 7.0 points lower (p < 0.001), respectively. After controlling for demographic and clinical covariates, differences remained significant (PCS:5.1;
  6.2; p < 0.001). Among subjects with insomnia, HRQoL scores were not different between prescription hypnotic users (n = 639) and nonusers (n = 762). Analysis by drug class revealed lower PCS scores (difference: 7.5, p < 0.001) with benzodiazepine use (n = 129) versus benzodiazepine receptor agonist use (n = 493), but the adjusted difference was not significant (difference: 3.8, p = .018).
  
  
  CONCLUSIONS
  Diagnosed insomnia was associated with consistent decreases in both physical and mental HRQoL scores, regardless of whether prescription hypnotics were used. Benzodiazepine use may be associated with a further decrease in physical HRQoL scores. Although limited by its retrospective design, this study provides a first look at real-world hypnotic use outcomes at a national level. Important next steps include studies with patients serving as their own controls, and further evaluation of the sensitivity of HRQoL instruments to the effects of insomnia treatments.
authors.affiliation: College of Pharmacy, The University of Texas at Austin, 2409 University Avenue A1930, Austin, TX, 78712, USA, julieta.scalo@austin.utexas.edu.
authors.forename: Julieta
authors.initials: J
authors.lastname: Scalo
authors.forename: Pooja
authors.initials: P
authors.lastname: Desai
authors.forename: Karen
authors.initials: K
authors.lastname: Rascati
mesh_terms: D000328:Adult; D000368:Aged; D001569:Benzodiazepines / Q000627:therapeutic use; D011307:Drug Prescriptions; D005260:Female; D058785:GABA-A Receptor Agonists / Q000627:therapeutic use; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D012890:Sleep / Q000187:drug effects* / Q000502:physiology; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy* / Q000523:psychology*; D012923:Social Class
chemical_list: D058785:GABA-A Receptor Agonists; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines