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Table 2 Studies of patients: measures and outcomes relating to insomnia

From: Clinician and patient barriers to the recognition of insomnia in family practice: a narrative summary of reported literature analysed using the theoretical domains framework

Authors (Year) Country (town and community) Study population Measures Main findings TDF Domain(s)
Kushida et al. (2000) [18] United States (Idaho, rural cohort) Primary care patients seen at the clinic over a 1 year period (1997–1998) n = 1249, all 18+. (participation rate 60.1% 1254/2087) Questionnaires (focused on sleep disordered symptoms for insomnia, RLS, OSA), ESS, SF-36 – daytime functioning (face-to-face or mail-out/ Interviews 32.3% had insomnia (29.7% of men and 34.5% of women). Knowledge, Skills
14.1% experienced insomnia on a nightly basis.
State that patients have limited access to sleep specialists and a lack of training for physicians
Aikens & Rouse (2005) [36] United States (Urban population) N = 700 consecutive attendees at primary care, screened for insomnia. 326 mailed a follow-up survey to which n = 180 responded Questionnaires assessing insomnia, sleep quality, and daytime consequences of sleepiness and fatigue (ISI, PSQI, ESS, DBAS, MFIS) Of the 180 responders, 72% had probable insomnia. Those who had discussed it with their physician (52% of those with probable insomnia) reported poorer overall health Those who were more educated, had >co-morbid symptoms, lower TST or > daytime dysfunction more likely to discuss Knowledge, Behavioural regulation, Beliefs about consequences.
Morin et al. (2006) [4] Canada, Quebec Province. 2001 French speaking adults aged 18+. Mean age 44.7 Telephone survey with insomnia defined as per the DSM-IV and the ICD-10 29.9% reported insomnia symptoms. Behavioural regulation, Beliefs about consequences.
13% had consulted a healthcare professional about their insomnia.
15% had used a herbal product, 11% a prescribed sleep medication, 3.84% an OTC drug and 4.1% alcohol to manage insomnia.
Daytime fatigue, psychological distress and physical discomfort were symptoms prompting individuals to seek treatment.
Bartlett et al. (2008) [6] Australia, New South Wales, (mixed urban-rural) Postal survey of 10,000 people randomly selected from the electoral roll (5000 aged 18–24 and 5000 aged 25–64). 3300 responded. Direct contact with a random subset of non-responders (n = 100) was undertaken (response rate of 49%) by telephone. Postal survey and direct contact. Survey included AIS and ESS. Population weighted prevalence of insomnia = 33% and in 74.7% of these the complaint has been present for > 12 months. Behavioural regulation, Beliefs about consequences.
Population weighted prevalence of a visit to a doctor for insomnia = 11.1%
Risk factors for insomnia were: older age, daytime sleepiness, short sleep duration (< 6.5 h), reduced enthusiasm.
Self-medication for insomnia was common but often satisfaction with treatment was poor. For prescription drugs 39% of users were satisfied compared with 16% for OTC drugs and 25% for herbal products.
Bailes et al. (2009) [27] Canada (Montreal, city cohort) N = 191 older patients (aged 50+) in primary care. n = 138 from 2 hospital-based sleep clinics (new referrals aged 18+). Sleep Symptom Checklist- 21 items (insomnia, sleep disorders, daytime symptoms and psychological distress) they had discussed with their physician in the past year. Primary care patients often have sleep symptoms they do not discuss, or discuss non-specifically. Knowledge
Subsequent PSG with primary care participants
Those referred to the sleep clinic were more likely to have discussed sleep problems (also younger and more males)
Those who completed PSG more likely to report sleep symptoms compared with those who completed questionnaire only.
Dyas et al. (2010) [9] UK (Lincolnshire, rural cohort Patients (who had sought help for insomnia in the previous 6 months) Focus groups/ semi-structured interviews separate for patients (n = 30, 11 M, 19 F, aged 25–70) Patients felt a need to convince professionals of their health problems. Beliefs about capabilities, Environmental Context and Resources
Patients often suffered for long periods before seeking help, and had tried self-help methods
Patients recognised sleep problems were linked to detrimental outcomes.
Clinicians noted multiple causes of sleep problems
Clinicians often focused on underlying causes rather than addressing treatment or consequences of non-treatment.
Omvik et al. (2010) [46] Norway Epidemiological postal survey (n = 5000). Mean age 48.1. Sleep medication prevalence and reasons for use questions Prevalence of sleep medication use: Lifetime = 18.8%, Current = 7.9% and Chronic = 4.2%. Social influences
Bergen Insomnia Scale, Global Sleep Assessment Questionnaire, Structured Clinical Interview for DSM., WHOqoL, SDS Sleep medication use associated with low SES, older age, female gender, frequent sleep and/or mood disturbance.
  Among those who had ever used a sleep medication, 80.3% would prefer a non-drug treatment.
Senthilvel et al. (2011) [19] United States (Cleveland Ohio, urban population) New adult patients aged 18–65 (n = 101) 52% female, mean age = 38 years CSHQ, Berlin, ESS, STOP, review of GP records of the consultation 30% of cases = possible insomnia, but limited screening and sleep history obtained during the consult Environmental Context and resources
Bjorvatn et al. (2017) [15] Norway Patients visiting their GP (n = 1346), 35.9% Male BIS, Self-reported sleep problems (1-item), insomnia (DSM-IV criteria), hypnotic use BIS insomnia rate = 53.6%, sleep problems (single item) = 55.8%. Knowledge, Skills
Hypnotics used by 16.2% (daily use was 5.5%).
  1. RLS = Restless Legs Syndrome, OSA = Obstructive Sleep Apnoea, ESS = Epworth Sleepiness Scale, PSG = polysomnography, ISI = Insomnia Severity Index, Pittsburgh Sleep Quality Index, DBAS = Dysfunctional Beliefs About Sleep Scale, MFIS = Modified Fatigue Impact Scale, TST = Total Sleep Time, CSHQ = Cleveland Sleep Habits questionnaire, STOP = Rapid Screening Tool for OSA, AIS = Athens Insomnia Scale, WHOQoL = World Health Organization’s quality of life assessment. SDS = Severity of Dependence Scale., DSM- Diagnostic and Statistical Manual, ICD-10 = International Classification of Diseases, 10th edition. DSKQ = Dartmouth Sleep Knowledge Questionnaire, BIS=Bergen Insomnia Scale, GP = General Practitioner (equivalent to family practitioner in USA)