Elsevier

Sleep Medicine

Volume 5, Issue 1, January 2004, Pages 67-75
Sleep Medicine

Original article
Studio Morfeo: insomnia in primary care, a survey conducted on the Italian population1

https://doi.org/10.1016/j.sleep.2003.09.006Get rights and content

Abstract

Background and purpose

To carry out an observational epidemiological survey (Studio Morfeo), to determine: (1) the frequency of insomnia in a large Italian population presenting directly to the general physician (GP); (2) the impact of insomnia on the quality of life, on the use of health-care resources and on co-morbidity.

Patients and methods

The study was accomplished by GPs, trained by sleep specialists accredited by the Italian Association of Sleep Medicine. Only patients spontaneously presenting to their GP for medical problems were surveyed. Each GP was asked to enroll at least five patients across a routine week of medical activity including both morning and afternoon clinics. The first patient of each weekday was recruited after obtaining written consent. According to the responses to the sleep-related questions, patients were classified into three categories: (1) no insomnia, (2) level 1 insomnia with absence of day-time dysfunction and (3) level 2 insomnia with presence of day-time dysfunction.

Results

A total of 3284 patients were enrolled by 738 GPs in this Italian survey. Insomnia was reported by 64% of all interviewed patients, with 20% classified as level 1 and 44% as level 2. Logistic analysis indicated that depression (odds ratio, 2.70), involvement of >1 organ systems (odds ratio, 1.24), female gender (odds ratio, 1.19), unemployment (odds ratio, 1.18), low education (odds ratio, 1.18) and increasing age (odds ratio, 1.02) were the major risk factors for insomnia.

Conclusions

Our findings indicate that insomnia is a frequent disturbance in the Italian primary care population, is associated with high risk of co-morbid conditions, and results in increased use of health-care resources.

Introduction

Sleep disorders have a relevant impact on the overall health status of the general population, with approximately one-third complaining of poor or insufficient sleep and experiencing insomnia symptoms, e.g. difficulty in initiating sleep, disrupted sleep, and early morning awakenings [1]. The presence of insomnia is also frequent in the Italian population. Lugaresi and co-workers carried out the first Italian epidemiological study of insomnia in 1983 in the restricted territory of the Republic of San Marino [2], involving approximately 6000 subjects out of 20,000 inhabitants. Investigation extended to all ages and social classes and revealed that 13.4% of the total population complained of habitually poor sleep. In 1991, an epidemiological survey was carried out on a representative sample of the Italian adult population [3]. Fifty-one percent of the approximately 2000 subjects interviewed reported having experienced insomnia symptoms at least once in the previous year. Transient (one to a few nights) and short-term (1–3 weeks) insomnia had occurred in 15.5% of the population, while 13.2% complained of chronic insomnia. A computer-assisted interview, conducted in seven European countries on about 26,000 subjects aged between 15 and 100 years, revealed that insomnia symptoms were very frequent in the general population (36.8%) with prevalence in Italy around 28% [1]. Although treatment is available for virtually all people, and despite the wide diffusion of the problem, patients who complain of insomnia do not very often bring the disturbance to the attention of their physicians [4], [5], [6], considering insomnia to be simply an inconvenient condition lacking any life-threatening consequences. In recent years, however, a number of surveys have ascertained the magnitude of insomnia, not only in terms of reduced productivity and impaired quality of life, but also as a cause of increased absenteeism, accidents, hospitalization, alcohol consumption, depression, morbidity and even mortality [7], [8], [9]. Moreover, due to the lack of training in sleep medicine, general practitioners (GPs) do not diagnose insomnia in the numbers that would be predicted by the surveys carried out in the general population.

Description of each national situation can be useful in examining the local status of clinical care and the public awareness of insomnia [10], [11]. Studio Morfeo was carried out to better define these issues in our country, and is part of a long-term project sponsored by the Italian Association of Sleep Medicine (AIMS) aimed at improving the understanding among health professionals and the general public of treatment of sleep disorders. The objective of Studio Morfeo was to determine the frequency of insomnia in a representative population presenting to the GP for health problems other than sleep disorder, and to determine the impact of insomnia on the quality of life, health-care resource use and co-morbidity.

Section snippets

Procedures

Sixteen Sleep Disorders Centers accredited by AIMS and distributed throughout Italy invited a number of GPs practicing in local territories to carry out observational surveys on sleep-related disorders. The GPs attended an intensive course on the diagnosis, clinical relevance and treatment strategies of insomnia and were trained on the survey protocol. However, selection of patients was not biased by the training course; only the first patient of each weekday who met the enrollment criteria was

Demographics and sleep evaluation

A total of 3284 patients were enrolled by 738 GPs in this survey covering the Italian territory (Fig. 1). Insomnia was reported by 64% (95% CI, 62–65%) of all interviewed patients, with 20% classified as level 1 insomnia and 44% as level 2 insomnia. Table 1 shows the demographic characteristics of the population. Level 2 insomnia more frequently affected women (67.1%). Patients with level 1 insomnia were older (59.2±15.7 years) than patients with level 2 insomnia (53.7±15.3 years) and

Discussion

Studio Morfeo is the first Italian observational investigation on the distribution of insomnia in primary care. Insomnia is an extremely common disturbance. In particular, the primary care population showed a high prevalence of insomnia (64%), and most insomniacs (44%) complained of diurnal disturbances as a consequence of their nocturnal disorder. The risk of insomnia was higher among the female population, increasing with advancing age, and it was more frequent among unemployed people, those

Acknowledgments

Studio Morfeo Committee members who participated in the survey and collaborated in the writing out of the manuscript:

  • Bonanni E, Iudice A (Department of Neurosciences, Section of Neurology, University of Pisa)

  • Bruni O, Ottaviano S (Pediatric Sleep Center, Department of Developmental Neurology and Psychiatry, University of Rome ‘La Sapienza’)

  • Dolso P (Sleep Disorders Center, Department of Neurosciences, S. Maria della Misericordia, Udine)

  • Ferri R, Cosentino F (Sleep Research Center, Department of

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