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. 2024 May 1;20(5):681-687.
doi: 10.5664/jcsm.10964.

Association of preadmission insomnia symptoms with objective in-hospital sleep and clinical outcomes among hospitalized patients

Julie M Neborak  1 , Valerie G Press  2 , William F Parker  2 , Juan C Rojas  1 , Max Byron  2 , Swati Goyal  3 , David O Meltzer  2 , Babak Mokhlesi  1 , Vineet M Arora  2
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Association of preadmission insomnia symptoms with objective in-hospital sleep and clinical outcomes among hospitalized patients

Julie M Neborak et al. J Clin Sleep Med. .

Abstract

Study objectives: To determine the prevalence of preadmission insomnia symptoms among hospitalized patients and assess the association of insomnia symptoms with objective in-hospital sleep and clinical outcomes.

Methods: We conducted a prospective cohort study of medicine inpatients (age ≥ 50, no previously diagnosed sleep disorders). Participants answered the Insomnia Severity Index (ISI) questionnaire to assess for preadmission insomnia symptoms (scored 0-28; higher scores suggest more insomnia symptoms). Sleep duration and efficiency were measured with actigraphy. Participants self-reported 30-day postdischarge readmissions and emergency department and/or urgent care visits.

Results: Of 568 participants, 49% had ISI scores suggestive of possible undiagnosed insomnia (ISI ≥ 8). Higher ISI scores were associated with shorter sleep duration [β = -2.6, 95% confidence interval (CI) -4.1 to -1.1, P = .001] and lower sleep efficiency (β = -0.39, 95% CI -0.63 to -0.15, P = .001). When adjusted for age, sex, body mass index, and comorbidities, higher ISI scores were associated with longer length of stay (incidence rate ratio 1.01, 95% CI 1.00-1.02, P = .011), increased risk of 30-day readmission (odds ratio 1.04, 95% CI 1.01-1.07, P = .018), and increased risk of 30-day emergency department or urgent care visit (odds ratio 1.04, 95% CI 1.00-1.07, P = .043).

Conclusions: Among medicine inpatients, there was a high prevalence of preadmission insomnia symptoms suggestive of possible undiagnosed insomnia. Participants with higher ISI scores slept less with lower sleep efficiency during hospitalization. Higher ISI scores were associated with longer length of stay, increased risk of a 30-day postdischarge readmission, and increased risk of a 30-day postdischarge emergency department or urgent care visit.

Citation: Neborak JM, Press VG, Parker WF, et al. Association of preadmission insomnia symptoms with objective in-hospital sleep and clinical outcomes among hospitalized patients. J Clin Sleep Med. 2024;20(5):681-687.

Keywords: actigraphy; insomnia; outcomes.

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Conflict of interest statement

All authors have seen and approved of this manuscript. This study and the associated work were performed at the University of Chicago. Dr. Neborak is supported by an institutional research training grant (T32HL007605). Dr. Arora is supported by a mid-career mentoring award from the National Heart, Lung, and Blood Institute (K24HL136859) and by a career development award from the National Heart, Lung, and Blood Institute (R25HL116372). Dr. Press reports funding from the National Institutes of Health National Heart Lung and Blood Institute (R01HL146644), the Agency for Healthcare Research and Quality (R01HS027804), and the American Lung Association. Dr. Press discloses consultant fees from Vizient Inc. and Humana. Dr. Rojas is supported by the National Center for Advancing Translational Sciences of the National Institutes of Health through Grant Number 5KL2TR002387-05 that funds the Institute for Translational Medicine. Dr. Parker is supported by the National Institutes of Health (K08HL150291 and R01LM014263) and the Greenwall Foundation.

Figures

Figure 1
Figure 1. Prevalence and severity of preadmission insomnia symptoms.
Participants completed the ISI questionnaire at the time of enrollment (within 72 hours of admission) to assess for the prevalence and severity of insomnia symptoms that were present for the 2 weeks prior to admission. The ISI is a 7-item questionnaire and responses are on a 0 to 4 scale. Scores are then added to assess for the possible presence and severity of insomnia. A score of < 8 is suggestive of no insomnia, scores from 8 to 14 suggest subthreshold (or mild) insomnia, scores from 15 to 21 suggest moderate insomnia, and scores from 22 to 28 suggest severe insomnia. ISI = Insomnia Severity Index.
See this image and copyright information in PMC

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