Prévalence et facteurs sociodémographiques associés à l’insomnie et au temps de sommeil en France (15–85 ans)Insomnia and total sleep time in France: Prevalence and associated socio-demographic factors in a general population survey☆
La qualité du sommeil a un impact fort sur la santé. L’objet de cette étude est de quantifier le temps de sommeil et la prévalence de l’insomnie chronique dans la population des 15 à 85 ans et d’explorer les facteurs associés à cette pathologie.
Méthode
Dans le cadre du Baromètre santé 2010, enquête en population générale, 27 653 individus de 15 à 85 ans ont été interrogés.
Résultat
Le temps de sommeil moyen des 15 à 85 ans est de 7 heures 13, plus élevé pour les femmes que pour les hommes (7 heures 18 vs 7 heures 07 ; p < 0,001), tandis que 15,8 % des 15 à 85 ans présentent une insomnie chronique. La part d’insomnie chronique est stable avec l’âge parmi les femmes, tandis qu’elle augmente chez les hommes jusqu’à 45 à 54 ans, avant de diminuer au-delà. Elle est liée au fait d’être une femme, à des situations de précarité, à certains événements de vie difficiles tels que les violences subies ou encore à l’alcoolisation à risque chronique. Les troubles du sommeil déclarés sur les 8 derniers jours apparaissent en hausse par rapport à 1995, avec une stabilisation depuis 2000 à un niveau élevé.
Conclusions
Ces résultats justifient la mise en œuvre d’actions de prévention et d’éducation à la santé visant à aider la population à préserver un sommeil de qualité.
Abstract
Introduction
Sleep is considered as a major protective factor for good health and quality of life. The epidemiology of chronic insomnia and other sleep disorders has recently been developed in France. The aim of this study was to evaluate total sleep time and the prevalence of chronic insomnia in the general population aged 15 to 85 years. It was also to investigate factors associated with sleep disorders.
Methods
Within the framework of the Health Barometer 2010, a French general population survey, 27,653 15 to 85-year-old individuals were questioned about their health behaviors and attitudes, in particular about their sleeping time and habits.
Results
The average sleeping time of the 15 to 85-year-old was 7 hours 13 minutes. It was higher for women than for men (7 hours 18 minutes vs 7 hours 07 minutes; P < 0.001), whereas 15.8 % of the population presented criteria for chronic insomnia, 19.3 % of women and 11.9 % of men (P < 0.001). The prevalence of chronic insomnia was stable with age among women, around 19 %, whereas it increased for men from 3 % in the 15–19-year age range to 18 % in the 45–54-year age range, before decreasing to 8 % beyond 65 years. Chronic insomnia was also found to be related to precarious situations and to several difficult events of life such as violence or chronic alcohol abuse, whereas the relationship observed with tobacco smoking was no longer found after logistic regression adjustment for socio-demographic characteristics. Since the beginning of 1990s, a single-question inquiry on “sleeping problems present during the last 8 days” has been asked in the Health Barometer. The rate of subjects concerned increased from 1995, with a prevalence stabilized at a high level since 2000.
Conclusions
Based on these data, we think that the surveillance of sleep disorders is an important public health issue and that prevention and health educational initiatives should be launched in the general population to promote a better quality of sleep.
Introduction
De nombreux travaux ont montré le rôle fondamental du sommeil sur la santé, le bien-être et l’équilibre physique et psychologique des individus à tous les âges de la vie (Giordanella, 2006). Il constitue un important facteur de protection de l’état de santé. À l’inverse, les troubles du sommeil ont des conséquences sur le fonctionnement de l’organisme et du psychisme, et de ce fait sur la vie sociale et professionnelle, telles que l’absentéisme ou les accidents de la route et du travail liés à la somnolence (Léger et al., 2002, Godet-Cayre et al., 2006, Léger et al., 2006). Si une majorité des Français dort environ sept heures par jour (Léger et al., 2011), cette durée ne peut toutefois pas être considérée comme une norme prophylactique, dans la mesure où certains individus ont besoin de neuf heures de sommeil quotidien, lorsque d’autres, plus rarement, peuvent se contenter de cinq heures sans retentissement particulier sur la journée suivante. Cependant, ces durées extrêmes sont rares et la plupart des adultes trouvent leur compte de sommeil en dormant entre sept et huit heures la veille des jours de travail et huit à neuf heures la veille des jours de repos.
Le sommeil est essentiel à la préservation des capacités cognitives et motrices, à l’ajustement de nombreuses sécrétions hormonales ainsi qu’à la restauration du système immunitaire ou encore au repos du système cardiovasculaire. Un manque ponctuel de sommeil se rattrape aisément, mais un manque chronique est susceptible de favoriser, entre autres pathologies, l’hypertension artérielle, l’obésité, le diabète, les maladies cardiovasculaires, ainsi que des troubles de l’humeur ou du comportement (NIH, 2005). Des études récentes ont d’ailleurs établi un lien entre durée de sommeil et espérance de vie (Gallicchio et Kalesan, 2009). Il apparaît ainsi particulièrement important d’assurer une surveillance épidémiologique des comportements de la population en matière de sommeil. Si les enquêtes françaises en population générale comportant une ou des questions sur les troubles du sommeil sont nombreuses (Chan-Chee et al., 2011), permettant parfois de suivre des évolutions (Beck et al., 2009), les enquêtes représentatives s’appuyant sur des outils permettant de mesurer de façon fiable l’insomnie selon les critères définis par l’American Academy of Sleep Medicine sont plus rares (Léger et al., 2000).
La connaissance épidémiologique du sommeil et de ses troubles repose depuis quelques années sur des outils standardisés, mais n’en demeure pas moins complexe, notamment parce que le temps moyen de sommeil nécessaire par nuit peut varier nettement d’un individu à l’autre, ce qui rend difficile la fixation d’un seuil de référence. Dans ce souci, un module complet sur le sommeil construit en collaboration avec l’Institut national du sommeil et de la vigilance (INSV) a été incorporé au questionnaire du Baromètre santé 2010 de l’Inpes, enquête en population générale. L’objectif de cet article est, d’une part, de quantifier le temps de sommeil et la prévalence de l’insomnie dans la population des 15 à 85 ans et d’explorer les facteurs associés à cette pathologie, en termes de facteurs sociodémographiques, d’événements de vie, de violences subies, d’état de santé et de conduites addictives. D’autre part, dans la mesure où le module sur le sommeil a été posé pour la première fois en 2010, il s’agira de suivre les évolutions de prévalence des troubles du sommeil dans les 8 derniers jours, par rapport aux Baromètres santé antérieurs, évalués à partir de questions sur le sommeil issues d’une échelle de qualité de vie posée depuis 1995 (Parkerson et al., 1990).
Section snippets
Méthode
Depuis le début des années 1990, l’Institut national de prévention et d’éducation pour la santé (Inpes) mène, en partenariat avec de nombreux acteurs de santé, une série d’enquêtes appelées Baromètres santé, qui abordent les différents comportements et attitudes de santé des Français (Guilbert et al., 2001, Beck et al., 2007). Ces enquêtes sont des sondages aléatoires à deux degrés (ménage puis individu) réalisés à l’aide du système de collecte assistée par téléphone et informatique (CATI). Le
Temps de sommeil selon l’âge et le sexe
En 2010, le temps de sommeil moyen des 15 à 85 ans est 7 heures 13, plus élevé pour les femmes que pour les hommes (7 heures 18 vs 7 heures 07 ; p < 0,001), et le temps médian est de 7 heures 20 (7 h 30 pour les femmes et 7 heures 15 pour les hommes). Un quart de la population dort moins de 6 heures 29 par jour (22,9 % des femmes, 28,1 % des hommes) tandis qu’à l’opposé, un quart dort plus de 8 heures 00 par jour (27,8 % des femmes, 22,9 % des hommes).
Selon l’âge, la courbe du temps de sommeil suit une
Discussion
Le temps de sommeil moyen observé dans le Baromètre santé apparaît assez court, mais comparable à celui observé en population adulte lors des études annuelles de l’Institut national du sommeil et de la vigilance (INSV, 2012). L’étude confirme cependant un décalage parfois important entre le temps de sommeil dont les individus estiment avoir besoin et leur temps de sommeil réel. Ce résultat n’est en revanche pas comparable à celui de l’enquête emploi du temps de l’Insee qui observe une durée
Conclusion
Au-delà du temps de sommeil et de l’insomnie chronique, d’autres indicateurs, tels que la satisfaction de son propre sommeil ou encore la dette de sommeil, fournissent un regard complémentaire sur le sommeil de la population. La qualité et la quantité du sommeil s’avèrent très dépendantes de la bonne synchronisation de l’horloge biologique avec les horaires de coucher et de lever. Cette synchronisation se trouve fréquemment perturbée chez les jeunes adultes (qui ont tendance à retarder leurs
Déclaration d’intérêts
Les auteurs déclarent ne pas avoir de conflits d’intérêts en relation avec cet article.
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Derivation of research diagnostic criteria for insomnia: report of an American Academy of Sleep Medicine Work Group
Studies on the prevalence of chronic insomnia disorder often show disparate results. Although a consensus now exists among the three main classification systems for diagnostic criteria, most prevalence studies are only based on clinical criteria defining insomnia syndrome (night and daytime symptoms) with time criteria (weekly frequency and duration). The aim of this descriptive study was to thoroughly assess the inclusion and exclusion criteria, notes and differential diagnosis for chronic insomnia disorder according to the International Classification of Sleep Disorders, 3rd edition (ICSD-3), and ascertain its current prevalence in the Spanish general adult population. The prevalence of insomnia symptoms was 43.4%, chronic insomnia syndrome was 13.7%, and chronic insomnia disorder was 14.0% (women 14.6%, men 13.4%; 18-34 y.o. 11.1%, 35-54 y.o. 11.5%, 55+ y.o. 17.9%). The latter two definitions showed close prevalence results because figures from inclusion and exclusion criteria and notes practically matched and cancelled each other out. A thorough assessment of the prevalence of chronic insomnia disorder would require that, in addition to clinical and time criteria, inclusion and exclusion criteria and modifiers be considered. These elements differ according to sex and age, and strongly influence the results. They included opportunity for sleep, associated sleep disorders, physical problems such as chronic pain, and, notably, asymptomatic patients dependent on prescription drugs for sleep. Current data suggest that the prevalence of chronic insomnia disorder in Spain has more than doubled in 20 years, with an increase of almost 47%.
One of the first epidemiological study on the French population aged between 18 and 65 years has indicated that 46.2% reported sleep complaints in the last 8 days, and 12.5% were severe complaints, using sleep items extracted from two questionnaires related to heath profile and quality of life [9]. The same researcher group identified thereafter that the average sleeping time of the 15 to 85-year-old among a French general population was 7 h 13 min, and that 15.8% of the population presented criteria for chronic insomnia [35]. Our results on a French working population aged 18–60 years thus broadly confirm these studies, with the exception of a lower prevalence of insomnia compared to Beck et al. [35], probably related to our population whose age limit is 60 years (vs. 85 years in Ref. [35]).
Pro-inflammatory cytokines are involved in sleep-wake regulation and are associated with caffeine consumption. This is a cross-sectional study in 1023 active French workers investigating associations between self-reported sleep complaints (>3months) and total sleep time (TST) with nine single-nucleotide-polymorphisms (SNPs) including pro-inflammatory cytokines, according to caffeine consumption. Participants were characterized as low, moderate and high (0–50, 51–300, and >300 mg/day) caffeine consumers. After adjusting the odd ratios (OR) for age, gender, and smoking, the risk of sleep complaints was higher in subjects with genetic mutations in tumor necrosis factor alpha (TNF-α, rs 1800629) (ORa [95%CI] = 1.43 [1.07–1.92] for both G/A and A/A aggregate genotypes) or interleukin-1 beta (IL-1β, rs1143627) (ORa = 1.61 [1.08–2.44] for homozygous A/A genotype), and the risk was higher when subjects carry the mutations in TNF-α plus IL-1β regardless of caffeine consumption. When stratified with caffeine consumption, the risk of sleep complaints was higher in TNF-α A allele carriers in high caffeine consumers, and in homozygous A/A genotype of IL-1β in moderate and high consumers. None of the nine SNPs influence TST, with the exception of the mutation on CYP1A2 and only when stratified with caffeine consumption. Our results also indicated more caffeine side-effects when carrying mutation on IL1β. This study showed that polymorphisms in TNF-α and/or IL-1β influenced sleep complaints but did not influence total sleep time. This suggests that management of sleep complaints, which can be addressed by clinical interventions, should consider the influence of the genetic profile of pro-inflammatory cytokines.
The association was not significant in Europe. Consistent with our result, several prior studies25,42 showed that there was no significant association between smoking and insomnia in Europe. Differences in living habits, social atmosphere, and genes might contribute to different results between areas.
This study investigated the impact of smoking on the incidence of insomnia.
Systematic review and meta-analysis of cohort studies.
PubMed, EMBASE, Web of Science, Cochrane Library, and OVID were searched through March 2020. Cohort studies reporting the effect of smoking on the incidence of insomnia were included. We quantitatively analyzed the basic framework and study characteristics and then pooled estimate effects with 95% confidence intervals (CIs) of outcomes of each included study using fixed-effects meta-analyses.
This systematic review included six cohort studies involving 12,445 participants. Quantitatively summarized results suggested that smoking could significantly increase the incidence of insomnia (odds ratio [OR]: 1.07, 95% CI: 1.02, 1.13). Regular smoking was significantly associated with the incidence of insomnia (OR = 1.07, 95% CI: 1.01, 1.13). As for occasional smokers and ex-smokers, the pooled analysis did not indicate a significant association (occasional smoker: OR = 2.09, 95% CI: 0.44, 9.95; ex-smoker; OR = 1.02, 95% CI: 0.67, 1.54). Subgroup analysis by age, gender ratio, and region showed a statistically significant relationship between smoking and the incidence of insomnia in specific groups.
Integrated longitudinal observational evidence identified smoking as a significant risk factor of insomnia. Considering the limited amount of available studies, more high-quality and prospective cohort studies of large sample sizes are needed to explore details of this association.
One consequence of presenteeism is a decrease in quality of life (Lopes et al., 2018; Tsuji et al., 2018). The quality of sleep also affects quality of life (Beck et al., 2013). In most workers, insomnia and presenteeism affect workplace costs (Kessler et al., 2011; Swanson et al., 2011).
Sleep disturbance, cognitive disturbances, and presenteeism have been identified to contribute to functional disability in workers. However, the role of perceived cognitive disturbances in these relationships is yet to be well understood. Therefore, we examined the mediating effects of perceived cognitive disturbances in Japanese adult workers.
We administered to 458 Japanese adult workers the Pittsburgh Sleep Quality Index, Cognitive Complaints in Bipolar Disorder Rating Assessment, Work Limitations Questionnaire 8, and Sheehan Disability Scale in order to assess reported sleep disturbance, perceived cognitive disturbances, presenteeism, and functional disability, respectively. We performed structural equation modeling to evaluate the relations among the variables.
The results of the structural equation modeling showed that perceived cognitive disturbances significantly mediated the effects of reported sleep disturbance on presenteeism and functional disability; furthermore, presenteeism significantly mediated the effects of reported sleep disturbance and perceived cognitive disturbances on functional disability.
This study was a cross-sectional design, which could have prevented us from evaluating the causal relationships among the parameters. Furthermore, all the participants were adults; hence, our results cannot be generalized to children or adolescents.
Our results showed the mediating effects of perceived cognitive disturbances in the relations between reported sleep disturbance, presenteeism, and functional disability. To reduce the functional disability and presenteeism associated with reported sleep disturbance, the mediating effects of perceived cognitive disturbances in adult workers should be evaluated. In the future, development of interventions targeting perceived cognitive disturbances associated with reported sleep disturbance may be needed.
Insomnia is a public health problem with many repercussions. It affects a significant proportion of the general population worldwide, but the estimated prevalences in different countries are difficult to compare due to the use of heterogeneous methodologies. The objectives of the study were to compare the prevalence of insomnia in the general population in different sites around the world and to identify sociodemographic and mental health associated factors, using the same tool and within a single study.
This multicenter cross-sectional study is based on the Mental Health in the General Population survey (MHPG). It included several sites in France and 12 countries around the world with a representative sampling of the general population. The prevalence of short-term insomnia disorder was estimated by the occurrence within one month of at least one symptom, at a minimum frequency of three per week, with repercussions on everyday life.
Out of the 57,298 participants, 11.3% had a diagnosis of short-term insomnia disorder, with significant differences in prevalence between sites, ranging from 2.3% to 25.5%. Insomnia was significantly related to having mood disorders, anxiety disorders, substance use disorders and psychotic disorders. Insomnia was also more common among women, older adults, working participants and those who practice a religion.
The prevalence of insomnia was highly variable between sites, but the predictors appeared to be the same everywhere. Insomnia seemed to be more related to the presence of mood and anxiety disorders than a site-specific effect and thus may be a good indicator of mental health.
Insomnia and affective temperaments influence depressive symptoms in the general population. However, the ways in which the interaction between insomnia and affective temperaments affects depressive symptoms remains unknown. We studied the moderating effects of affective temperaments on the relationship between insomnia and depressive symptoms in adult community volunteers.
The participants were recruited from a community in Japan (n = 525). The Athens Insomnia Scale; Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Auto-questionnaire version; and Patient Health Questionnaire-9 were used to evaluate insomnia, affective temperaments, and depressive symptoms, respectively. A hierarchical multiple regression analysis were conducted to evaluate the interactions.
Insomnia significantly and positively interacted with cyclothymic, depressive, and anxious temperaments with regard to depressive symptoms, while insomnia significantly and negatively interacted with hyperthymic temperament on depressive symptoms. No significant interaction between insomnia and irritable temperament with regard to depressive symptoms were observed.
Since the participants were adult community volunteers in Japan, the results may not be generalizable to other communities.
This study suggests that the influence of insomnia on depressive symptoms is moderated positively by cyclothymic, depressive, and anxious temperament and negatively by hyperthymic temperament. In adult community volunteers, affective temperaments may moderate the influence that insomnia has on depressive symptoms. Therefore, it may be useful to consider affective temperaments while dealing with depressive symptoms associated with insomnia.
