title: Identifying At-Risk Individuals for Insomnia Using the Ford Insomnia Response to Stress Test.
abstract: OBJECTIVE
  A primary focus of the National Institute of Mental Health's current strategic plan is "predicting" who is at risk for disease. As such, the current investigation examined the utility of premorbid sleep reactivity in identifying a specific and manageable population at elevated risk for future insomnia.
  
  
  METHODS
  A community-based sample of adults (n = 2,892; 59.3% female; 47.9 ± 13.3 y old) with no lifetime history of insomnia or depression completed web-based surveys across three annual assessments. Participants reported parental history of insomnia, demographic characteristics, sleep reactivity on the Ford Insomnia in Response to Stress Test (FIRST), and insomnia symptoms. DSM-IV diagnostic criteria were used to determine insomnia classification.
  
  
  RESULTS
  Baseline FIRST scores were used to predict incident insomnia at 1-y follow-up. Two clinically meaningful FIRST cutoff values were identified: FIRST ≥ 16 (sensitivity 77%; specificity 50%; odds ratio [OR] = 2.88, P < 0.001); and FIRST ≥ 18 (sensitivity 62%; specificity 67%; OR = 3.32, P < 0.001). Notably, both FIRST cut-points outperformed known maternal (OR = 1.49-1.59, P < 0.01) and paternal history (P = NS) in predicting insomnia onset, even after controlling for stress exposure and demographic characteristics. Of the incident cases, insomniacs with highly reactive sleep systems reported longer sleep onset latencies (FIRST ≥ 16: 65 min; FIRST ≥ 18: 68 min) than participants with nonreactive insomnia (FIRST < 16: 37 min; FIRST < 18: 44 min); these groups did not differ on any other sleep parameters.
  
  
  CONCLUSIONS
  The current study established a cost- and time-effective strategy for identifying individuals at elevated risk for insomnia based on trait sleep reactivity. The FIRST accurately identifies a focused target population in which the psychobiological processes complicit in insomnia onset and progression can be better investigated, thus improving future preventive efforts.
authors.affiliation: Sleep and Circadian Research Laboratory, Departments of Psychiatry and Neurology, University of Michigan Medical School, Ann Arbor, MI.
authors.forename: David A
authors.initials: DA
authors.lastname: Kalmbach
authors.affiliation: Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, MI.
authors.forename: Vivek
authors.initials: V
authors.lastname: Pillai
authors.affiliation: Sleep and Circadian Research Laboratory, Departments of Psychiatry and Neurology, University of Michigan Medical School, Ann Arbor, MI.
authors.forename: J Todd
authors.initials: JT
authors.lastname: Arnedt
authors.affiliation: Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, MI.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Drake
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D039721:Diagnostic and Statistical Manual of Mental Disorders; D018450:Disease Progression; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018570:Risk Assessment; D012890:Sleep / Q000502:physiology; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology*; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult
keywords: FIRST; insomnia; sleep onset; sleep reactivity; vulnerability