We included participants with a body mass index between 18 and 30 kg/m 2, and to further reduce the likelihood of sleep apnea, we excluded those with a positive screening result on the Berlin Questionnaire. Participants were aged 18 to 65 years reported low nicotine, caffeine, and alcohol use no history of drug abuse or medications likely to affect sleep or alertness and no recent shift work or transmeridian travel (see supplemental material). All participants gave written informed consent. The study was approved by the Partners Human Research Committee, the Alfred Human Research Ethics Committee, and the University of Pennsylvania Institutional Review Board. Twenty individuals reporting healthy sleep (14 women) aged 34.75 ± 12.05 years were recruited from the general community in Boston, USA, and were age-matched (± 5 years) and gender-matched to 20 of the first 23 insomnia patients enrolled in the study. The final sample consisted of 76 individuals (44 women) aged 35.75 ± 12.40 years (mean ± SD) who met criteria for insomnia (see below). A large population-based study reported that insomnia patients with short sleep duration ( 30 kg/m 2). Given the difficulty in capturing neurobehavioral impairments using objective tests, relatively few studies have investigated the link between the sleep and neurobehavioral impairment. 19 Echoing previous concerns, 18 the authors acknowledged the heterogeneity of insomnia participants pooled across studies and the variability of diagnostic and screening methods utilized, and concluded that poor sensitivity of previous studies may mask consistent but small impairments on complex reaction time and selective attention tasks. 18 A more recent meta-analysis concluded that insomnia patients show small to moderate deficits on working memory, episodic memory, and problem-solving tasks. 17 One reason for these negative findings is that the deficits are likely subtle and limited to more complex cognitive processes. 15, 16Įarly studies reported that objective measures of sleepiness and neurobehavioral performance do not indicate deficits in individuals with insomnia. 5, 14 Treatment studies have shown improvements in self-reported daytime functioning following improved sleep quality. 13 This approach is supported by focus group and large population studies that have also linked self-reported poor sleep quality with complaints of reduced psychological well-being and self-reported cognitive difficulties. One approach places daytime complaints into the three categories of fatigue, physical health, and mental health symptoms. 9 Insomnia is also associated with workplace injuries 10, 11 and significant economic costs, through absenteeism and lost productivity, 12 which are a likely consequence of daytime impairments related to the disorder.ĭespite complaints of daytime functional impairment being a diagnostic criterion for insomnia, 1, 2 the specific nature of these impairments is not well understood. 7 A diagnosis of insomnia is unequivocally associated with decreased quality of life, 8 emphasizing the negative impact of the daytime symptoms. 1– 3 For many insomnia patients, the daytime complaints are the most salient consequence, 4– 6 with fatigue or psychological symptoms ultimately compelling them to seek treatment. Insomnia, fatigue, functional impairment, cognitive performance, sleep, sleepiness, depression IntroductionĬurrent diagnostic criteria for insomnia require the self-report of non-restorative sleep, and/or a difficulty initiating or maintaining sleep, along with a complaint of daytime impairment or distress.
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