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Status, alcohol use, body mass index, total days experienced insomnia in last 12 months, any psychological comorbidities (depression, post-traumatic stress disorder, all anxiety), all pain, CCI. Table 3. Adjusted results showing association between outcomes by ISI severity group. Covariates adjusted for: age, sex, marital status, education, employment status, smoking status, alcohol use, body mass index, total days experienced insomnia in last 12 months, any psychological comorbidities (depression, post-traumatic stress disorder, all anxiety), all pain, CCI. Severe InsomniaModerate Insomnia Mild (Subthreshold) InsomniaNo Clinically Significant Insomniap Value(n = 462)(n = 2049)(n = 4180)(n = 1865)MeanSE95% CI BMeanSE95% CI BMeanSE95% CI BMeanSE95% CI B SF-6D0.580.000.57–0.59−0.150.630.000.63–0.64−0.100.680.000.67–0.68−0.050.730.000.72–0.730.00EQ-5D0.650.010.64–0.66−0.180.740.000.74–0.75−0.090.790.000.79–0.80−0.040.830.000.82–0.840.00PCS45.680.3944.92–46.44−6.7148.410.1948.04–48.77−3.9850.630.1350.38–50.87−1.7652.390.2051.99–52.790.00MCS34.040.4733.13–34.96−13.438.940.2338.49–39.38−8.5043.300.1543.00–43.60−4.1447.440.2446.96–47.920.00 RR RR RR RR Absenteeism (%)16.063.2310.83–23.815.398.710.867.18–10.572.925.020.324.43–5.691.682.980.302.44–3.641.00Presenteeism (%)37.293.1731.56–44.063.2729.521.2327.21–32.042.5919.690.5218.69–20.731.7311.400.5010.47–12.421.00Total work productivity impairment (%)40.723.4434.51–48.043.2432.231.3329.73–34.942.5721.760.5720.68–22.911.7312.550.5411.54–13.651.00Activity impairment (%)44.812.3040.51–49.562.8535.420.8933.72–37.202.2524.990.4224.18–25.831.5915.710.4214.90–16.561.00Number of HCP visits in past 6 months4.670.274.16–5.241.343.890.113.67–4.121.113.550.073.41–3.691.023.490.113.27–3.721.00Number of ER visits in past 6 months0.480.060.37–0.614.190.260.020.23–0.302.310.200.010.18–0.221.730.110.010.09–0.141.00Number of hospitalizations in past 6 months0.260.040.20–0.354.260.130.010.11–0.162.110.080.010.07–0.101.340.060.010.05–0.081.00 Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( Share and Cite MDPI and ACS Style Chalet, F.-X.; Saskin, P.; Ahuja, A.; Thompson, J.; Olopoenia, A.; Modi, K.; Morin, C.M.; Wickwire, E.M. The Associations between Insomnia Severity and Health Outcomes in the United States. J. Clin. Med. 2023, 12, 2438. AMA Style Chalet F-X, Saskin P, Ahuja A, Thompson J, Olopoenia A, Modi K, Morin CM, Wickwire EM. The Associations between Insomnia Severity and Health Outcomes in the United States. Journal of Clinical Medicine. 2023; 12(6):2438. Chicago/Turabian Style Chalet, François-Xavier, Paul Saskin, Ajay Ahuja, Jeffrey Thompson, Abisola Olopoenia, Kushal Modi, Charles M. Morin, and Emerson M. Wickwire. 2023. "The Associations between Insomnia Severity and Health Outcomes in the United States" Journal of Clinical Medicine 12, no. 6: 2438. APA Style Chalet, F.-X., Saskin, P., Ahuja, A., Thompson, J., Olopoenia, A., Modi, K., Morin, C. M., & Wickwire, E. M. (2023). The Associations between Insomnia Severity and Health Outcomes in the United States. Journal of Clinical Medicine, 12(6), 2438. Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here. Article Metrics. Insomnia Core 8.4.4. Date released: (one month ago) Download. Insomnia Core 8.4.2. Date released: (2 months ago) Download. Insomnia Core 8.4.1. Date released: (2 months ago) Download. Insomnia Core 8.4.0. Date released: (2 months ago) Download. Insomnia Core 9.1.0. Date released: (one week ago) Download. Insomnia Core 9.0.0. Date released: (2 weeks ago) Download. Insomnia Core

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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 8.4.4. Date released: (one month ago) Download. Insomnia Core 8.4.2. Date released: (2 months ago) Download. Insomnia Core 8.4.1. Date released: (2 months ago) Download. Insomnia Core 8.4.0. Date released: (2 months ago) Download. Insomnia Core 9.1.0. Date released: (one week ago) Download. Insomnia Core 9.0.0. Date released: (2 weeks ago) Download. Insomnia Core