Insomnia with Objective Short Sleep Duration: the Most Biologically Severe Phenotype of the Disorder

By A. Vgontzas, J. Fernandez‐Mendoza, Duanping Liao, E. Bixler. Sleep Medicine Reviews, 2013

706 citations recorded by the source corpus.

Summary Until recently, the association of chronic insomnia with significant medical morbidity was not established and its diagnosis was based solely on subjective complaints. We present evidence that insomnia with objective short sleep duration is the most biologically severe phenotype of the disorder, as it is associated with cognitive-emotional and cortical arousal, activation of both limbs of the stress system, and a higher risk for hypertension, impaired heart rate variability, diabetes, neurocognitive impairment, and mortality. Also, it appears that objective short sleep duration is a biological marker of genetic predisposition to chronic insomnia. In contrast, insomnia with objective normal sleep duration is associated with cognitive-emotional and cortical arousal and sleep misperception but not with signs of activation of both limbs of the stress system or medical complications. Furthermore, the first phenotype is associated with unremitting course, whereas the latter is more likely to remit. We propose that short sleep duration in insomnia is a reliable marker of the biological severity and medical impact of the disorder. Objective measures of sleep obtained in the home environment of the patient would become part of the routine assessment of insomnia patients in a clinician’s office setting. We speculate that insomnia with objective short sleep duration has primarily biological roots and may respond better to biological treatments, whereas insomnia with objective normal sleep duration has primarily psychological roots and may respond better to psychological interventions alone.

Subfields: Cognitive Neuroscience, Endocrine and Autonomic Systems, Experimental and Cognitive Psychology

View Paper: https://www.semanticscholar.org/paper/c7e310746ecf6574694ea9609a15cb58e1b82e23

How researchers see this paper

The researchers whose trusted networks rank it highest, strongest advocate first. Every researcher gets a different order.

In Cognitive Neuroscience

1. Christoph Nissen
2. Kai Spiegelhalder
3. C. Baglioni
4. Michael R. Irwin
5. Dieter Riemann
6. C. Espie

In Endocrine and Autonomic Systems

1. Christoph Nissen
2. Kai Spiegelhalder
3. C. Baglioni
4. Michael R. Irwin
5. Dieter Riemann
6. C. Espie

In Experimental and Cognitive Psychology

1. Christoph Nissen
2. Kai Spiegelhalder
3. C. Baglioni
4. Michael R. Irwin
5. Dieter Riemann
6. C. Espie

Citations in the corpus

• European guideline for the diagnosis and treatment of insomnia (2017, positive): “Another recent discovery concerns differences between insomnia with, and without, an objective short sleep duration (Fernandez-Mendoza, 2017; Vgontzas et al., 2013).”
• Why Sleep Is Important for Health: A Psychoneuroimmunology Perspective (2014, background): “…insomnia with short sleep duration are more likely to show increases in urinary catecholamines and levels of their metabolites than are insomniacs without objective sleep disturbance, similar to the greater activation of inflammatory biomarkers in this more severe phenotype (Vgontzas et al. 2013).”