Insomnia disorder: clinical and research challenges for the 21st century

Luigi Ferini-Strambi^{1

2}, Reto Auer³, Bjørn Bjorvatn^{4

5}, Vincenza Castronovo², Oscar Franco⁶, Luca Gabutti⁷, Andrea Galbiati^{1

2}, Goeran Hajak⁸, Ramin Khatami⁹, Tsuyoshi Kitajima¹⁰, Doug McEvoy¹¹, Christoph Nissen¹², Michael Perlis¹³, Dirk A Pevernagie¹⁴, Winfried Randerath¹⁵, Dieter Riemann¹⁶, Giovanni Rizzo¹⁷, Eus Van Someren^{18

19}, Alexandros Vgontzas²⁰, Fabrizio Barazzoni²¹, Claudio Bassetti^{22

23}; European Sleep Foundation

Affiliations

¹ "Vita-Salute" San Raffaele University, Milan, Italy.
² Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.
³ Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
⁴ Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
⁵ Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway.
⁶ Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
⁷ Institute of Biomedicine, University of Southern Switzerland, Lugano, Switzerland.
⁸ Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Social Foundation Bamberg, Bamberg, Germany.
⁹ Center of Sleep Medicine, Sleep Research and Epilepsy, Klinik Barmelweid, Barmelweid Academy, Barmelweid, Switzerland.
¹⁰ Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan.
¹¹ Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia.
¹² University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
¹³ Department of Psychiatry, Behavioral Sleep Medicine Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
¹⁴ Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium.
¹⁵ Institute of Pneumology at the University of Cologne, Solingen, Germany.
¹⁶ Department of Psychiatry and Psychotherapy, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
¹⁷ IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
¹⁸ Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands.
¹⁹ Departments of Integrative Neurophysiology and Psychiatry, Center for Neurogenomics and Cognitive Research, Amsterdam UMC, Amsterdam Neuroscience, VU University, Amsterdam, The Netherlands.
²⁰ Sleep Research and Treatment Center, Department of Psychiatry, Penn State Hershey Medical Center, College of Medicine, Pennsylvania State University, Hershey, PA, USA.
²¹ Ente Ospedaliero Cantonale (EOC) Head Office, Bellinzona, Switzerland.
²² Department of Neurology, Inselspital University Hospital, University of Bern, Bern, Switzerland.
²³ Department of Neurology, Sechenov University, Moscow, Russia.

PMID: 33619858
DOI: 10.1111/ene.14784

Free article

Insomnia disorder: clinical and research challenges for the 21st century

Luigi Ferini-Strambi et al. Eur J Neurol. 2021 Jul.

Free article

. 2021 Jul;28(7):2156-2167.

doi: 10.1111/ene.14784. Epub 2021 Apr 9.

Authors

Affiliations

¹ "Vita-Salute" San Raffaele University, Milan, Italy.
² Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.
³ Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
⁴ Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
⁵ Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway.
⁶ Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
⁷ Institute of Biomedicine, University of Southern Switzerland, Lugano, Switzerland.
⁸ Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Social Foundation Bamberg, Bamberg, Germany.
⁹ Center of Sleep Medicine, Sleep Research and Epilepsy, Klinik Barmelweid, Barmelweid Academy, Barmelweid, Switzerland.
¹⁰ Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan.
¹¹ Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia.
¹² University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
¹³ Department of Psychiatry, Behavioral Sleep Medicine Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
¹⁴ Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium.
¹⁵ Institute of Pneumology at the University of Cologne, Solingen, Germany.
¹⁶ Department of Psychiatry and Psychotherapy, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
¹⁷ IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
¹⁸ Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands.
¹⁹ Departments of Integrative Neurophysiology and Psychiatry, Center for Neurogenomics and Cognitive Research, Amsterdam UMC, Amsterdam Neuroscience, VU University, Amsterdam, The Netherlands.
²⁰ Sleep Research and Treatment Center, Department of Psychiatry, Penn State Hershey Medical Center, College of Medicine, Pennsylvania State University, Hershey, PA, USA.
²¹ Ente Ospedaliero Cantonale (EOC) Head Office, Bellinzona, Switzerland.
²² Department of Neurology, Inselspital University Hospital, University of Bern, Bern, Switzerland.
²³ Department of Neurology, Sechenov University, Moscow, Russia.

PMID: 33619858
DOI: 10.1111/ene.14784

Abstract

Background and purpose: Insomnia is a common and debilitating disorder that is frequently associated with important consequences for physical health and well-being.

Methods: An international expert group considered the current state of knowledge based on the most relevant publications in the previous 5 years, discussed the current challenges in the field of insomnia and identified future priorities.

Results: The association of trajectories of insomnia with subsequent quality of life, health and mortality should be investigated in large populations. Prospective health economics studies by separating the costs driven specifically by insomnia and costs attributable to its long-term effects are needed. Ignoring the heterogeneity of insomnia patients leads to inadequate diagnosis and inefficient treatment. Individualized interventions should be promoted. More data are needed on both the impact of sleep on overnight effects, such as emotion regulation, and the potential compensatory effort to counteract diurnal impairments. Another gap is the definition of neurocognitive deficits in insomnia patients compared to normal subjects after chronic sleep loss. There are also a number of key gaps related to insomnia treatment. Expert guidelines indicate cognitive-behavioural therapy for insomnia as first-line treatment. They neglect, however, the reality of major healthcare providers. The role of combined therapy, cognitive-behavioural therapy for insomnia plus pharmacological treatment, should be evaluated more extensively.

Conclusion: Whilst insomnia disorder might affect large proportions of the population, there are a number of significant gaps in the epidemiological/clinical/research studies carried out to date. In particular, the identification of different insomnia phenotypes could allow more cost-effective and efficient therapies.

Keywords: cognitive-behavioral therapy for insomnia; insomnia; insomnia treatment; phenotypes; sleep.

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References

REFERENCES

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Insomnia disorder: clinical and research challenges for the 21st century

Affiliations

Insomnia disorder: clinical and research challenges for the 21st century

Authors

Affiliations

Abstract

References

REFERENCES

MeSH terms

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Miscellaneous