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Patients with insomnia, comorbid depression have more severe insomnia at baseline relative to patients with primary insomnia, other comorbidities

Wednesday, December 12 2007 | Comments
Evidence Grade 0 What's This?
Patients with insomnia and comorbid major depressive disorder appear to have the most severe nighttime and daytime symptoms at baseline as compared with patients who have primary insomnia (PI) or patients who have insomnia with comorbid generalized anxiety disorder, perimenopausal transition (PMT), or rheumatoid arthritis, new findings reveal.

Data were compiled from 5 randomized, double-blind trials (PI, n=828; MDD, n=543; GAD, n=593; PMT, n=407; RA, n=153). The patients were treated with eszopiclone or placebo in each of the studies.

Patient-reported sleep latency, wake after sleep onset (WASO), total sleep time (TST), sleep quality (measured using a scale of 0 to 10 with higher scores indicating better quality), and daytime functioning (measured on a similar scale, with higher scores again indicating better functioning) were used to evaluate the severity of insomnia at study entry.

Patients in all trials except the GAD study reported their data by phone, using an interactive voice response system. In the GAD trial, patients kept an electronic diary.

The results showed that patients with insomnia and MDD had the most severe baseline insomnia of the 5 populations evaluated. Median sleep latency for these patients was 126 min, whereas the other groups had a median sleep latency of 59 min to 67 min. In addition, median WASO for the patients with comorbid MDD was 75 min compared with a range of 39 min to 57 min for the other cohorts, while median TST for the patients with MDD was 246 min; the other groups had median TSTs of 310 min to 341 min. The mean sleep quality score for the patients with MDD was 4.1, whereas patients in the other cohorts had mean scores of 4.6 to 5.7.

Daytime functioning (alertness, ability to concentrate, physical well-being, and ability to function) also was impaired to a greater extent among patients with comorbid MDD relative to the other patient groups.

From these findings, the researchers concluded that assessing sleep quantity and quality, as well as daytime functioning, is important when managing patients with insomnia, "particularly when MDD has been diagnosed." (Roth T, et al. Poster #0725.)

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