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Epidemiology of insomnia disorder in older persons according to the Diagnostic and Statistical Manual of Mental Disorders: a systematic review and meta-analysis

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Key summary points

AbstractSection Aim

What are the prevalence and correlates of insomnia disorder in older persons according to the Diagnostic and Statistical Manual of Mental Disorders (DSM)?

AbstractSection Findings

The pooled prevalence of insomnia disorder in older persons according to the DSM was 19.6%, and varied according to the sample size, the age cutoff used, and the study quality (risk of bias). Insomnia in older persons is associated with the female gender, depression, anxiety, as well as cardiovascular, respiratory, and painful conditions.

AbstractSection Message

Further researches are needed with a focus on African populations, the widening of sample sizes, and the comparison according to the institutionalization status.

Abstract

Purpose

There is a scarcity of summarizing data on the epidemiology of insomnia in older persons, especially when diagnosed with international criteria. This study aimed to estimate the prevalence and correlates of insomnia disorder in older persons, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Methods

Through PubMed/MEDLINE, EMBASE, and Web of Science (WoS), we searched for relevant articles published before June 28, 2023. The risk of bias was weighed using the Joanna Briggs Institute’s (JBI’s) critical appraisal checklist for studies reporting prevalence data. For our analyses, we used a random-effect model, with subgroup analyses, meta-regression, and sensitivity analyses to explore potential sources of heterogeneity. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement.

Results

We included 18,270 participants across 16 studies. The male/female ratio was 0.89 (12 studies), and the mean age varied from 65.9 to 83.1 years (8 studies). The pooled prevalence of insomnia was 19.6% (95% CI = [12.3%; 28.3%]), with substantial heterogeneity. This prevalence fluctuated according to the sample size, the minimal age for inclusion, and the study quality, considering that the risk of bias was moderate for most of studies. There was a publication bias, with a very low level of certainty. Insomnia disorder was associated with the female gender, depression, anxiety, and somatic illnesses notably cardiovascular, respiratory, and painful ones.

Conclusion

Nearly one in every five old individuals was considered to have insomnia disorder, which was associated with the gender and the existence of mental health and/or somatic conditions.

Registration

We registered the protocol in the International Prospective Register of Systematic Reviews (PROSPERO) with registration number: CRD42022344675.

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Availability of data, code, and other materials

Data pertaining to search strategies, extraction tool, studies characteristics, risk of bias assessment, certainty appraisal, and meta-analyses are available in the article appendix.

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Authors and Affiliations

  1. Research department, Medical Mind Association, Yaoundé, Cameroon

    Francky Teddy Endomba

  2. Sleep Specialized Transversal Training, Psychiatry Internship Program, University of Burgundy, Dijon, France

    Francky Teddy Endomba

  3. Pôle Gériatrie, Centre Hospitalier Intercommunal de Haute-Comté, Pontarlier, France

    Patrick Yvan Tchebegna

  4. Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon

    Edmond Chiabi & Dominic Leandry Angong Wouna

  5. Centre d’Exploration du Sommeil, Centre Hospitaliser Spécialisé La Chartreuse, Dijon, France

    Clément Guillet

  6. Service de Psychiatrie Adultes, Centre Hospitalier Universitaire, Dijon, France

    Jean Christophe Chauvet-Gélinier

  7. INSERM LNC UMR1231, University of Burgundy, Dijon, France

    Jean Christophe Chauvet-Gélinier

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Contributions

Study conception: FTE, PYT, JCCG; protocol writing: FTE, PYT, EC, CG; article selection: FTE, PYT, EC, DLAW; data collection: FTE, PYT; risk of bias appraisal: FTE, PYT; statistical analyses: FTE, PYT; manuscript drafting: FTE, PYT, EC, DLAW, CG, JCCG; manuscript review and edition: all authors.

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Correspondence to Francky Teddy Endomba.

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Endomba, F.T., Tchebegna, P.Y., Chiabi, E. et al. Epidemiology of insomnia disorder in older persons according to the Diagnostic and Statistical Manual of Mental Disorders: a systematic review and meta-analysis. Eur Geriatr Med 14, 1261–1272 (2023). https://doi.org/10.1007/s41999-023-00862-2

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