Objective prevalence of insomnia in the São Paulo, Brazil epidemiologic sleep study

Authors

  • Laura S. Castro MSc,

    Corresponding author
    1. Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
    • Address requests for single reprints to Dr Castro, Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo/UNIFESP, rua Napoleão de Barros, 925, Vila Clementino, São Paulo, SP 04024-002, Brazil. E-mail: laura.psisono@gmail.comAddress correspondence to Dr Leger, Université Paris Descartes, Paris Cité Sorbonne APHP Hôtel Dieu, Centre du Sommeil et de la Vigilance/1 Place du Parvis Notre Dame, 75181 Paris Cedex 04, France. E-mail: damien.leger@htd.aphp.fr

    Search for more papers by this author
  • Dalva Poyares MD, PhD,

    1. Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
    Search for more papers by this author
  • Damien Leger MD, PhD,

    Corresponding author
    1. Center of Sleep and Alertness, Paris Descartes University, Sorbonne Paris Cité, Hotel Dieu, Public Assistance Hospitals of Paris, Paris, France
    • Address requests for single reprints to Dr Castro, Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo/UNIFESP, rua Napoleão de Barros, 925, Vila Clementino, São Paulo, SP 04024-002, Brazil. E-mail: laura.psisono@gmail.comAddress correspondence to Dr Leger, Université Paris Descartes, Paris Cité Sorbonne APHP Hôtel Dieu, Centre du Sommeil et de la Vigilance/1 Place du Parvis Notre Dame, 75181 Paris Cedex 04, France. E-mail: damien.leger@htd.aphp.fr

    Search for more papers by this author
  • Lia Bittencourt MD, PhD,

    1. Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
    Search for more papers by this author
  • Sergio Tufik MD, PhD

    1. Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
    Search for more papers by this author

  • The study protocol, statistical code, and data set are available from Dr Castro (laura.psisono@gmail.com) for approved individuals.

Abstract

Objective

Using polysomnography, the gold standard for sleep assessment, this study aimed to describe the objective prevalence of insomnia in the São Paulo, Brazil, Epidemiologic Sleep Study cohort of 1,101 adults (20–80 years old).

Methods

Objective insomnia was defined by meeting 1 of the following criteria: sleep onset latency >30 minutes (sleep initiating insomnia), wake after sleep onset lasting >30 minutes (sleep maintenance insomnia), total sleep time <360 minutes and a terminal wakefulness >30 minutes (insomnia with too short duration of sleep or early morning awakening), or a combination of the previous quantitative criteria (mixed disorder). Using validated questionnaires based on Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria, subjective insomnia was categorized into 3 groups: good sleepers, insomnia symptoms, and DSM-IV insomnia.

Results

A total of 1,042 subjects participated in the study (95% response rate). The prevalence of objective insomnia was 32%. The subjective prevalence of insomnia symptoms was 45%, and the subjective prevalence of DSM-IV insomnia was 15%. Sociodemographic factors were similar in both the objective insomnia and the DSM-IV insomnia groups. Age, but not psychiatric symptoms, was predictive of objective insomnia. The subjective criteria were not adequately sensitive (36%) to identify objective insomnia, but were adequately specific (77%) to rule out polysomnography noninsomnia.

Interpretation

The prevalence of objective insomnia assessed by polysomnography was higher than the prevalence of subjective insomnia according to DSM-IV–validated questionnaires. Clinical trials.gov ID: NCT00596713. Ann Neurol 2013;74:537–546

Ancillary