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Association of insomnia with quality of life, work productivity, and activity impairment

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To assess the association of insomnia with health-related quality of life (HRQOL), work productivity, and activity impairment.


Data were obtained from the 2005 US National Health and Wellness Survey. Subjects were assigned to the insomnia group (diagnosed insomnia experienced at least a few times a month) or the noninsomnia group (no insomnia or sleep symptoms). HRQOL was assessed using the short form 8 (SF-8) (mental and physical scores). The work productivity and activity impairment questionnaire (WPAI) assessed absenteeism (work time missed), presenteeism (impairment at work), work productivity loss (overall work impairment), and activity impairment. Linear regression models were used to control for potential confounders.


A total of 19,711 adults were evaluated (5,161 insomnia, 14,550 noninsomnia). Subjects in the insomnia group had significantly lower SF-8 physical (−5.40) and mental (−4.39) scores and greater activity impairment scores (+18.04) than subjects in the noninsomnia group (P < 0.01 for all). Employed subjects in the insomnia group had greater absenteeism (+6.27), presenteeism (+13.20), and work productivity loss (+10.33) scores than those in the noninsomnia group (P < 0.01 for all).


Insomnia is significantly associated with poorer physical and mental quality of life and work productivity loss and activity impairment.

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  1. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric association.

    Google Scholar 

  2. National Institutes of Health. (2005). National Institutes of Health State of the science conference statement on manifestations and management of chronic insomnia in adults, June 13–15, 2005. Sleep, 28(9), 1049–1057.

    Google Scholar 

  3. Roth, T. (2005). Prevalence, associated risks, and treatment patterns of insomnia. The Journal of Clinical Psychiatry, 66(Suppl 9), 10–13.

    PubMed  Google Scholar 

  4. Chilcott, L. A., & Shapiro, C. M. (1996). The socioeconomic impact of insomnia. An overview. PharmacoEconomics, 10(Suppl 1), 1–14. doi:10.2165/00019053-199610010-00001.

    Article  PubMed  Google Scholar 

  5. Ohayon, M. M. (2002). Epidemiology of insomnia: What we know and what we still need to learn. Sleep Medicine Reviews, 6(2), 97–111. doi:10.1053/smrv.2002.0186.

    Article  PubMed  Google Scholar 

  6. Silber, M. H. (2005). Clinical practice. Chronic insomnia. The New England Journal of Medicine, 353(8), 803–810. doi:10.1056/NEJMcp043762.

  7. Leger, D., Scheuermaier, K., Philip, P., Paillard, M., & Guilleminault, C. (2001). SF-36: Evaluation of quality of life in severe and mild insomniacs compared with good sleepers. Psychosomatic Medicine, 63(1), 49–55.

    PubMed  CAS  Google Scholar 

  8. Hatoum, H. T., Kong, S. X., Kania, C. M., Wong, J. M., & Mendelson, W. B. (1998). Insomnia, health-related quality of life and healthcare resource consumption. A study of managed-care organisation enrollees. PharmacoEconomics, 14(6), 629–637. doi:10.2165/00019053-199814060-00004.

    Article  PubMed  CAS  Google Scholar 

  9. Hohagen, F., Rink, K., Kappler, C., Schramm, E., Riemann, D., Weyerer, S., et al. (1993). Prevalence and treatment of insomnia in general practice. A longitudinal study. European Archives of Psychiatry and Clinical Neuroscience, 242(6), 329–336. doi:10.1007/BF02190245.

    Article  PubMed  CAS  Google Scholar 

  10. Fullerton, D. S. (2006). The economic impact of insomnia in managed care: A clearer picture emerges. The American Journal of Managed Care, 12(8, Suppl), S246–S252.

    PubMed  Google Scholar 

  11. Linton, S. J., & Bryngelsson, I. L. (2000). Insomnia and its relationship to work and health in a working-age population. Journal of Occupational Rehabilitation, 10(2), 169–183. doi:10.1023/A:1009408204694.

    Article  Google Scholar 

  12. Ware, J. E., Kosinski, M., Dewey, J. E., & Gandek, B. (2001). A manual for users of the SF-8 health survey. Lincoln: Quality Metric Incorporated.

    Google Scholar 

  13. Ware, J. E., Kosinski, M., & Keller, S. D. (1994). SF-36 physical and mental health summary scales: A user’s manual. Boston, MA: The Health Institute.

    Google Scholar 

  14. Reilly, M. C., Zbrozek, A. S., & Dukes, E. M. (1993). The validity and reproducibility of a work productivity and activity impairment instrument. PharmacoEconomics, 4(5), 353–365. doi:10.2165/00019053-199304050-00006.

    Article  PubMed  CAS  Google Scholar 

  15. Prasad, M., Wahlqvist, P., Shikiar, R., & Shih, Y. C. (2004). A review of self-report instruments measuring health-related work productivity: A patient-reported outcomes perspective. PharmacoEconomics, 22(4), 225–244. doi:10.2165/00019053-200422040-00002.

    Article  PubMed  Google Scholar 

  16. Samsa, G., Edelman, D., Rothman, M. L., Williams, G. R., Lipscomb, J., & Matchar, D. (1999). Determining clinically important differences in health status measures: A general approach with illustration to the Health Utilities Index Mark II. PharmacoEconomics, 15(2), 141–155. doi:10.2165/00019053-199915020-00003.

    Article  PubMed  CAS  Google Scholar 

  17. Norman, G. R., Sloan, J. A., & Wyrwich, K. W. (2003). Interpretation of changes in health-related quality of life: The remarkable universality of half a standard deviation. Medical Care, 41(5), 582–592. doi:10.1097/00005650-200305000-00004.

    Article  PubMed  Google Scholar 

  18. Best, S. J., Krueger, B., Hubbard, C., & Smith, A. (2001). An assessment of the generalizability of internet surveys. Social Science Computer Review, 19(2), 131–145.

    Article  Google Scholar 

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The National Health and Wellness Survey (NHWS) is conducted and wholly owned by Consumer Health Sciences, Princeton, NJ. Takeda Pharmaceutical Company, Ltd., Deerfield, IL licensed access to NHWS and funded the analysis for and preparation of this paper. Assistance with manuscript preparation was provided by Sara Sarkey, PhD, an employee of Takeda Pharmaceuticals North America.

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Correspondence to Susan C. Bolge.

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Bolge, S.C., Doan, J.F., Kannan, H. et al. Association of insomnia with quality of life, work productivity, and activity impairment. Qual Life Res 18, 415–422 (2009).

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