Sara Olavarrieta-Bernardino

Cognitive-emotional hyperarousal as a premorbid characteristic of individuals vulnerable to insomnia.

Objective: To examine whether cognitive-emotional hyperarousal is a premorbid characteristic of middle-aged and young good sleepers vulnerable to stress-related insomnia. Methods: Self-reported information was collected from two samples of 305 middle-aged and 196 young adults. From those adults, 149 middle-aged (50.34 ± 4.47 years) and 85 young (20.19 ± 1.31 years) good sleepers were selected for the present study. The Ford Insomnia Response to Stress Test (FIRST) was used to measure vulnerability to stress-related insomnia. Trait measures of personality, arousability, rumination, presleep arousal, and coping skills were entered as predictors in the linear regression models, at the same time controlling for gender, depression, and anxiety. Results: The regression models showed that arousability (&bgr; = 0.546), neuroticism (&bgr; = 0.413), perceived stress (&bgr; = 0.375), and rumination (&bgr; = 0.214) were associated with FIRST scores in middle-aged adults. Among young adults, the regression models revealed that presleep cognitive arousal (&bgr; = 0.448), arousability (&bgr; = 0.426), neuroticism (&bgr; = 0.320), presleep somatic arousal (&bgr; = 0.290), emotion-oriented coping (&bgr; = 0.220), and rumination (&bgr; = 0.212) were associated with FIRST scores. Finally, individuals with high FIRST scores did not show lower scores in measures of cognitive-emotional hyperarousal compared with chronic insomniacs. Conclusions: These data suggest that cognitive-emotional hyperarousal may be a premorbid characteristic of subjects vulnerable to insomnia. It seems that maladaptive coping stress strategies and cognitive-emotional hyperarousal predispose to the development of insomnia and that interventions targeting these characteristics may be important in the prevention and treatment of chronic insomnia. BMI = body mass index; DSM-IV-TR = Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, Text Revised; FIRST = Ford Insomnia Response to Stress Test; ISI = Insomnia Severity Index; PSQI = Pittsburgh Sleep Quality Index.

Insomnia and sleep quality among primary care physicians with low and high burnout levels

OBJECTIVE The aim of this study was to assess insomnia and sleep quality in primary care physicians with low and high burnout scores. METHODS A representative sample of 240 physicians was drawn from 70 medical centers in Madrid, Spain. Based on quartile splits of the overall index of the Shirom-Melamed Burnout Questionnaire, 55 participants were allocated to a low-burnout group, and 58 were included in a high-burnout group. The questionnaire also included sociodemographic data, insomnia symptomatology, and the Pittsburgh Sleep Quality Index. RESULTS Of the total sample, 18.8% met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for insomnia diagnoses. More individuals with high burnout scores (21.1%) than individuals with low burnout scores (6.9%) fulfilled these criteria. Results of multivariate logistic regression analyses showed that burnout was the only variable related to insomnia diagnoses (odds ratio=7.56; 95% confidence interval=2.38-14.02). Furthermore, the results of multivariate analysis of covariance, after adjustments for sociodemographic variables, indicated that subjects from the high-burnout group scored significantly higher than subjects from the low-burnout group on the global sleep quality index and its components, indicating significantly greater disturbed sleep for the former. CONCLUSION The results of the present study provide support for a clear relationship between burnout and disturbed sleep, as shown by the high prevalence of insomnia and poor sleep quality among physicians with high levels of burnout.

Nighttime sleep and daytime functioning correlates of the insomnia complaint in young adults.

The nighttime and daytime correlates of the insomnia complaint (IC) were assessed in an in-class survey on a sample of 1238 first year university students (18.85+/-1.45 years) at the Universidad Autónoma of Madrid, Spain. Evidence was found that the likelihood of complaining of insomnia was increased by perceiving difficulties with initiating and maintaining sleep, reporting low quality of nocturnal sleep, having a long sleep onset latency and having an evening circadian preference. The most strongly related daytime variables to IC being perceived difficulties in concentrating, feelings of irritability and fatigue, and symptoms of anxiety and depression. The data, in addition to confirm those of clinical studies on subjects complaining of insomnia, suggest that having an evening chronotype increases the vulnerability of adolescents and young adults to complain of insomnia.

Cognitive–emotional hyperarousal in the offspring of parents vulnerable to insomnia: a nuclear family study

Cognitive–emotional hyperarousal is believed to be a predisposing factor for insomnia; however, there is limited information on the association of familial vulnerability to insomnia and cognitive–emotional hyperarousal. The aim of this study was to estimate the heritability of stress‐related insomnia and examine whether parental vulnerability to stress‐related insomnia is associated with cognitive–emotional hyperarousal in their offspring. We studied a volunteer sample of 135 nuclear families comprised of 270 middle‐aged (51.5 ± 5.4 years) fathers and mothers and one of their biological offspring (n = 135, 20.2 ± 1.1 years). We measured vulnerability to stress‐related insomnia (i.e. Ford Insomnia Response to Stress Test: FIRST), perceived stress, depression and anxiety in all participants, and arousability, presleep cognitive and somatic arousal, coping and personality in the offspring. We found a heritability estimate of 29% for FIRST scores. High FIRST parents had three to seven times the odds of having offspring highly vulnerable to stress‐related insomnia. Offspring of high FIRST parents showed higher arousability, presleep cognitive arousal and emotion‐oriented coping. Furthermore, high FIRST mothers contributed to offsprings higher anxiety and lower task‐oriented coping, while high FIRST fathers contributed to offsprings higher presleep somatic arousal and conscientiousness. Vulnerability to stress‐related insomnia is significantly heritable. Parents vulnerable to stress‐related insomnia have offspring with cognitive–emotional hyperarousal who rely upon emotion‐oriented coping. These data give support to the notion that arousability and maladaptive coping are key factors in the aetiology of insomnia.

The Spanish version of the Insomnia Severity Index: A confirmatory factor analysis

OBJECTIVE To examine the psychometric properties of the Spanish version of the Insomnia Severity Index (ISI) and to determine its factor structure with confirmatory factor analysis (CFA). METHODS Self-reported information was collected from a sample of 500 adults (mean age 39.13 [standard deviation 15.85]years) drawn from a population of medical students and their social networks. Together with the ISI, a measure of the subjective severity of insomnia, subjects completed the Pittsburg Sleep Quality Index, the Epworth Sleepiness Scale, and the Profile of Mood States to study concurrent validity of the ISI. CFA was used to test alternative models to ascertain the factorial structure of the ISI. RESULTS The Spanish version of the ISI showed adequate indices of internal consistency (Cronbachs α=0.82). CFA showed that a three-factor structure provided a better fit to the data than one-factor and two-factor structures. The ISI was significantly correlated with poor sleep quality, fatigue, anxiety, and depression, and discriminated between good and poor sleepers. CONCLUSIONS The ISI is a reliable and valid instrument to assess the subjective severity of insomnia in Spanish-speaking populations. Its three-factor structure (i.e., night-time sleep difficulties, sleep dissatisfaction and daytime impact of insomnia) makes it a psychometrically robust and clinically useful measure.

Sleep and Behavioral Correlates of Napping Among Young Adults: A Survey of First-Year University Students in Madrid, Spain

Objective: Between November 2002 and March 2003, the authors assessed the prevalence and correlates of napping among Spanish university students. Participants: The sample comprised 1,276 first-year university students; the mean age was 18.74 ± 1.24 years, and 35.45% were men. Methods: The study was cross-sectional, and the students completed self-report, anonymous questionnaires provided during an in-class survey. Results: Almost half (44%) of the sample reported napping (90% did so after lunch for longer than 1 hour). Multiple logistic regression analysis showed that experiencing an irregular sleep-wakefulness pattern, having a morning school schedule, and being male were significant predictor variables of napping. Further significant outcome variables related to napping were having excessive daytime sleepiness, missing classes because of tiredness, better ability to concentrate later in the afternoon, and a perception of deeper nighttime sleep. Conclusions: Habitual napping is common among Spanish university students and associated with an irregular sleep-wakefulness pattern. Taking long postlunch naps seems to be used by students to cope with insufficient sleep and daytime sleepiness.