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Morin 4 and Emerson M. Wickwire 5,6 1 Idorsia Pharmaceuticals Ltd., Hegenheimermattweg 91, 4123 Allschwil, Switzerland 2 Idorsia Pharmaceuticals US Inc., One Radnor Corporate Center, Suite 101, 100 Matsonford Rd, Radnor, PA 19087, USA 3 Cerner Enviza, 51 Valley Stream Pkwy, Malvern, PA 19355, USA 4 Department of Psychology, Cervo Brain Research Centre, Laval University, Québec City, QC G1V 0A6, Canada 5 Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA 6 Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA * Author to whom correspondence should be addressed. Submission received: 15 February 2023 / Revised: 15 March 2023 / Accepted: 20 March 2023 / Published: 22 March 2023 Abstract: Little is known about the associations between insomnia severity, insomnia symptoms, and key health outcomes. Using 2020 United States National Health and Wellness Survey (NHWS) data, we conducted a retrospective, cross-sectional analysis to determine the associations between insomnia severity and a number of health outcomes germane to patients (health-related quality of life (HRQoL), employers and government (workplace productivity), and healthcare payers (healthcare resource utilization (HCRU)). The Insomnia Severity Index (ISI) questionnaire was used to evaluate overall insomnia severity. HRQoL was assessed using the physical and mental component summary scores of the Short Form-36v2 (SF-36v2) questionnaire, and health utility status was measured using the Short Form-6D (SF-6D) and EuroQoL-5D (EQ-5D) questionnaires. Workplace productivity was measured using the Work Productivity and Activity Impairment (WPAI) questionnaire. After adjusting for confounders, greater insomnia severity was significantly associated with worsened quality of life, decreased productivity, and increased HCRU in an apparent linear fashion. These findings have important implications for future research, including the need for specific assessment of insomnia symptoms and their impact on key health outcomes. 1. IntroductionInsomnia, defined as difficulty initiating and/or maintaining sleep with associated daytime consequence, is the most common sleep disorder among adults. In the United States (US), 10–15% of the population experiences chronic insomnia disorder, defined as frequency of difficulty sleeping of three or more nights per week, and duration for three or more months, with associated daytime insomnia symptoms [1,2,3]. Chronic insomnia is associated with a broad range of adverse consequences, including increased rates of poorer mental health outcomes (e.g., depression, anxiety, chronic pain, substance abuse, suicide), poorer physical health outcomes (e.g., cardiovascular disease, diabetes, stroke) and worsened health-related quality of life (HRQoL) [4]. In addition to those consequences for patients and their families, insomnia is also associated with a substantial economic burden that is borne by payers, by employers, and by society. For example, untreated insomnia is associated with increased healthcare resource utilization (HCRU) and other related costs (borne by payers), as well as increased absenteeism and diminished workplace productivity costs (i.e., presenteeism; borne

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Or had been diagnosed, with narcolepsy, sleep apnea, or other non-insomnia related sleep difficulties in the past 12 months; (2) experienced symptoms or self-reported a diagnosis of another serious medical condition (any type of cancer, chronic liver disease, cirrhosis, epilepsy, multiple sclerosis, muscular dystrophy, or Parkinson’s disease); or (3) were pregnant at the time of survey completion. 2.3. Insomnia Cohort IdentificationParticipants were identified based on responses to two standard assessment items within the NHWS: ‘Which of the following conditions have you experienced in the last 12 months?’ and ‘Which of your conditions have been diagnosed by a physician?’. Participants who reported experiencing insomnia in the previous 12 months, with or without receipt of a physician-assigned diagnosis of insomnia, completed the Insomnia Severity Index (ISI; see below). Insomnia severity was then determined based on responses to the validated ISI. 2.4. Insomnia SeverityInsomnia severity was assessed using the ISI, a well-established measure of insomnia symptoms that occur during both nighttime and daytime, albeit in broad categories [16]. The ISI is a 7-item self-report questionnaire assessing the nature, severity, and impact of insomnia [16,17,18,19]. Seven items are scored from 0 (indicating little/no insomnia) to 4 (indicating problems with insomnia), and total scores range from 0 to 28. Based on this summary score, insomnia severity is categorized as follows: severe insomnia (22–28), moderate insomnia (15–21), ‘subthreshold’ (mild) insomnia (8–14), and ‘no clinically significant’ insomnia (0–7) [16]. 2.5. Outcomes 2.5.1. Health-Related Quality of LifeTo provide insight into the burden of insomnia from the patient perspective, HRQoL was assessed using the Medical Outcomes Study 36-Item Version 2 Short Form Survey Instrument (SF-36v2) (RAND, Santa Monica, CA, USA) [20]. SF-36v2 is a measure of general HRQoL that comprises 36 items that map onto 8 health domains: physical functioning, physical role limitations, bodily pain, general health, vitality, social functioning, emotional role limitations, and mental health. These individual domains are summarized in two component summary scores, the physical component summary (PCS) and mental component summary (MCS). PCS and MCS scores range from 0 to 100, each based on a population norm with a midpoint of 50, with higher scores indicating better HRQoL. Differences greater than 3.0 on the norm-based scoring algorithm were considered to be minimal clinically important differences (MCID) for scores on both scales [21]. 2.5.2. Health Utility StatusHealth utilities were assessed using two established measures: the Short Form-6 Dimensions (SF-6D) and the EuroQoL-5 Dimensions (EQ-5D-5L). SF-6D health utility index scores were derived from responses on the SF-36v2 [22]. EuroQol-5D (EQ-5D) health utility index scores were derived from the EQ-5D-5L, a self-report measure of health for clinical and economic appraisal that is comprised of five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression [20]. Both SF-6D and EQ-5D health utility index scores range from 0.00 (a health state equivalent to death) to 1.00 (a health state equivalent to perfect health), with higher scores indicating better health status. Consistent with previous studies, differences greater than 0.04 and 0.07 were considered to be MCID for SF-6D and EQ-5D, respectively [22,23].. Insomnia Core 9.0.0. Date released: (one month ago) Download. Insomnia Core 8.6.1. Date released: (5 months ago) Download. Insomnia Core Insomnia Core 9.0.0. Date released: (one month ago) Download. Insomnia Core 8.6.1. Date released: (4 months ago) Download. Insomnia Core 8.6.0. Date released: (5 months ago) Download. Insomnia Core 8.5.1. Date released: (5 months ago) Download.

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