Oleg Zaslavsky1, Andrea Z LaCroix2, Lauren Hale3, Hilary Tindle4, Tamar Shochat5. 1. Faculty of Health Science and Social Welfare, University of Haifa, Israel. Electronic address: oleg.zaslavsky@fulbrightmail.org. 2. Division of Epidemiology, School of Medicine, University of California San Diego, CA, United States; Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, United States. 3. Department of Preventive Medicine, Program in Public Health, School of Medicine, Stony Brook University, NY, United States. 4. Division of General Internal Medicine, University of Pittsburgh, PA, United States. 5. Faculty of Health Science and Social Welfare, University of Haifa, Israel.
Abstract
OBJECTIVES/ BACKGROUND: We assessed prevalence and correlates of insomnia; associations between changes in insomnia with incidence of physical, emotional, and mixed impairments (PI, EI, and MI, respectively); and age as a moderator in these relationships. PARTICIPANTS/ METHODS: The Women's Health Initiative (WHI) clinical trial (CT) and observational study (OS) cohorts with 1- and 3-year follow-ups, respectively, were studied. Participants included 39,864 CT and 53,668 OS postmenopausal women free of PI or EI at baseline. Insomnia Rating Scale (IRS), with a cutoff score of ≥9 indicated insomnia. Normal-Normal, Abnormal-Abnormal, Normal-Abnormal, and Abnormal-Normal categories indicated change in insomnia over time. PI, EI, and MI were constructed using Short Form-36 (SF-36) Physical and Emotional subscales (cutoff ≤60) and the modified Center for Epidemiological Studies Depression scale (cutoff ≤0.06). RESULTS: Among 93,532 women, 24.5% had insomnia at baseline. The highest odds ratios (ORs) for impairments were found in the Normal-Abnormal and Abnormal-Abnormal categories. In the CT cohort, Normal-Abnormal category, ORs were 1.86 (95% CI = 1.57-2.20) for PI, 4.11 (95% CI = 3.59-4.72) for EI, and 6.37 (95% CI = 4.65-8.74) for MI. Respective ORs for the OS cohort were 1.70 (95% CI = 1.51-1.89), 3.80 (95% CI = 3.39-4.25), and 4.41 (95% CI = 3.56-5.46). Interactions between changes in insomnia and age showed distinct albeit nonsignificant patterns. CONCLUSIONS: The results suggest that exposure to insomnia increases vulnerability to impairment. Future studies are needed to understand the directionality of these relationships.
RCT Entities:
OBJECTIVES/ BACKGROUND: We assessed prevalence and correlates of insomnia; associations between changes in insomnia with incidence of physical, emotional, and mixed impairments (PI, EI, and MI, respectively); and age as a moderator in these relationships. PARTICIPANTS/ METHODS: The Women's Health Initiative (WHI) clinical trial (CT) and observational study (OS) cohorts with 1- and 3-year follow-ups, respectively, were studied. Participants included 39,864 CT and 53,668 OS postmenopausal women free of PI or EI at baseline. Insomnia Rating Scale (IRS), with a cutoff score of ≥9 indicated insomnia. Normal-Normal, Abnormal-Abnormal, Normal-Abnormal, and Abnormal-Normal categories indicated change in insomnia over time. PI, EI, and MI were constructed using Short Form-36 (SF-36) Physical and Emotional subscales (cutoff ≤60) and the modified Center for Epidemiological Studies Depression scale (cutoff ≤0.06). RESULTS: Among 93,532 women, 24.5% had insomnia at baseline. The highest odds ratios (ORs) for impairments were found in the Normal-Abnormal and Abnormal-Abnormal categories. In the CT cohort, Normal-Abnormal category, ORs were 1.86 (95% CI = 1.57-2.20) for PI, 4.11 (95% CI = 3.59-4.72) for EI, and 6.37 (95% CI = 4.65-8.74) for MI. Respective ORs for the OS cohort were 1.70 (95% CI = 1.51-1.89), 3.80 (95% CI = 3.39-4.25), and 4.41 (95% CI = 3.56-5.46). Interactions between changes in insomnia and age showed distinct albeit nonsignificant patterns. CONCLUSIONS: The results suggest that exposure to insomnia increases vulnerability to impairment. Future studies are needed to understand the directionality of these relationships.
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