Diagnostic manuals describe insomnia disorder (ID) characterised by fatigue and sleepiness as diurnal consequences of nocturnal symptoms. However, patients with ID do not frequently report sleepiness in the clinical setting. The present study aimed to investigate subjective sleepiness in ID measured through the Epworth Sleepiness Scale (ESS) and its independence towards daytime functioning and fatigue, and to evaluate cognitive behavioural therapy for insomnia (CBT-I) improvement in daytime consequences and their relationship to sleepiness and fatigue. We retrospectively collected the ESS evaluation in a large sample of 105 healthy controls (HCs), 671 patients with ID, and 602 patients with sleep disorders characterised by excessive daytime sleepiness (EDS). Moreover, we conducted a pre–post evaluation of the ESS in a sub-sample of patients with ID who underwent CBT-I. Component 2 of the Insomnia Severity Index and Profile of Mood States–Fatigue Inertia Scale was used to evaluate daytime functioning and fatigue. Patients with ID reported ESS levels comparable to that observed in HCs and significantly lower than the EDS group. No significant correlation arose between ESS and the diurnal impact of the disorder, suggesting the independence between daytime functioning and sleepiness in ID. Contrarily, insomnia severity and diurnal impact significantly correlated with fatigue. Data showed a statistically significant increase in sleepiness after CBT-I, despite significantly improving daytime consequences and fatigue. Although diagnostic manuals report sleepiness and fatigue as daytime consequences of sleep symptoms in patients with ID, these retrospective data indicate a dissociation between these entities. This evidence aligns with the core feature of ID: the hyperarousal status that pervades patients also during wakefulness.

Challenging subjective excessive daytime sleepiness as an insomnia symptom: a retrospective study / Fasiello, Elisabetta; Mombelli, Samantha; Sforza, Marco; Zucconi, Marco; Casoni, Francesca; Chadia, Konstantina; Castronovo, Vincenza; Steiropoulos, Paschalis; De Gennaro, Luigi; Ferini‐strambi, Luigi; Galbiati, Andrea. - In: JOURNAL OF SLEEP RESEARCH. - ISSN 0962-1105. - (2023). [10.1111/jsr.14118]

Challenging subjective excessive daytime sleepiness as an insomnia symptom: a retrospective study

Fasiello, Elisabetta;De Gennaro, Luigi;
2023

Abstract

Diagnostic manuals describe insomnia disorder (ID) characterised by fatigue and sleepiness as diurnal consequences of nocturnal symptoms. However, patients with ID do not frequently report sleepiness in the clinical setting. The present study aimed to investigate subjective sleepiness in ID measured through the Epworth Sleepiness Scale (ESS) and its independence towards daytime functioning and fatigue, and to evaluate cognitive behavioural therapy for insomnia (CBT-I) improvement in daytime consequences and their relationship to sleepiness and fatigue. We retrospectively collected the ESS evaluation in a large sample of 105 healthy controls (HCs), 671 patients with ID, and 602 patients with sleep disorders characterised by excessive daytime sleepiness (EDS). Moreover, we conducted a pre–post evaluation of the ESS in a sub-sample of patients with ID who underwent CBT-I. Component 2 of the Insomnia Severity Index and Profile of Mood States–Fatigue Inertia Scale was used to evaluate daytime functioning and fatigue. Patients with ID reported ESS levels comparable to that observed in HCs and significantly lower than the EDS group. No significant correlation arose between ESS and the diurnal impact of the disorder, suggesting the independence between daytime functioning and sleepiness in ID. Contrarily, insomnia severity and diurnal impact significantly correlated with fatigue. Data showed a statistically significant increase in sleepiness after CBT-I, despite significantly improving daytime consequences and fatigue. Although diagnostic manuals report sleepiness and fatigue as daytime consequences of sleep symptoms in patients with ID, these retrospective data indicate a dissociation between these entities. This evidence aligns with the core feature of ID: the hyperarousal status that pervades patients also during wakefulness.
2023
cognitive behavioural therapy, diurnal functioning, fatigue, hyperarousal, insomnia disorder, sleepiness
01 Pubblicazione su rivista::01a Articolo in rivista
Challenging subjective excessive daytime sleepiness as an insomnia symptom: a retrospective study / Fasiello, Elisabetta; Mombelli, Samantha; Sforza, Marco; Zucconi, Marco; Casoni, Francesca; Chadia, Konstantina; Castronovo, Vincenza; Steiropoulos, Paschalis; De Gennaro, Luigi; Ferini‐strambi, Luigi; Galbiati, Andrea. - In: JOURNAL OF SLEEP RESEARCH. - ISSN 0962-1105. - (2023). [10.1111/jsr.14118]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1694044
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