Original articleStudio Morfeo: insomnia in primary care, a survey conducted on the Italian population1☆
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:
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Bonanni E, Iudice A (Department of Neurosciences, Section of Neurology, University of Pisa)
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Bruni O, Ottaviano S (Pediatric Sleep Center, Department of Developmental Neurology and Psychiatry, University of Rome ‘La Sapienza’)
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Dolso P (Sleep Disorders Center, Department of Neurosciences, S. Maria della Misericordia, Udine)
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Ferri R, Cosentino F (Sleep Research Center, Department of
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Part of the results were presented in Abstract form at the 2001 APSS congress.
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See Acknowledgments.