Understanding the unmet needs in insomnia treatment: a systematic literature review of real-world evidence

Figures & data

Table 1. Summarized results from common direct costs outcomes reported in studies by Bolge et al. [52,64,65].^a

Population	Sample size (n)	Emergency room visits, mean (SD)	Days hospitalized, mean (SD)	Traditional medical provider visits, mean (SD)
General population split into CINA sufferers and non-insomnia sufferers	25,629	CINA: 0.4 (0.9) No insomnia: 0.1 (0.7) -p < 0.001	CINA: 0.8 (4.2) No insomnia: 0.3 (2.4) -p < 0.001	CINA: 8.0 (11.9) No insomnia: 3.3 (4.6) -p < 0.001
Patients diagnosed with depression or anxiety split into CINA suffers and those without insomnia	4,510	Depression with CINA: 0.5 (1.1) Depression without CINA: 0.3 (1.1) -p < 0.001 Anxiety with CINA: 0.5 (1.2) Anxiety without CINA: 0.3 (1.0) -p < 0.001	Depression with CINA: 0.8 (3.8) Depression without CINA: 0.6 (4.8) -p = 0.410 Anxiety with CINA: 1.0 (3.4) Anxiety without CINA: 0.5 (3.6) -p = 0.025	Depression with CINA: 9.7 (10.6) Depression without insomnia: 6.0 (7.1) -p < 0.001 Anxiety with CINA: 10.6 (11.4) Anxiety without insomnia: 6.4 (7.2) -p < 0.001
Females experiencing symptoms of menopause split into CINA suffers and those without insomnia	1,446	Experiencing CINA: 0.3 (0.6) No insomnia: 0.1 (0.5) -p < 0.001	Experiencing CINA: 0.6 (2.7) No insomnia: 0.2 (1.1) -p = 0.001	Experiencing CINA: 5.5 (5.6) No insomnia: 3.8 (4.8) -p < 0.001

CINA: chronic sleep maintenance insomnia characterized by night-time awakenings; SD: standard deviation.

^aUnadjusted results are reported in the table. Results adjusted by linear regression models are also reported in the original publications.

Table 2. Summarized results from common indirect cost outcomes reported in studies by Bolge et al. [52,64,65].^a

Population	Sample size (n)	Absenteeism, mean (SD)	Presenteeism, mean (SD)	Overall work productivity, mean (SD)	Activity impairment, mean (SD)
General population split into CINA sufferers and non-insomnia sufferers	25,629	CINA: 8.5 (21.2) No insomnia: 2.8 (12.3) -p < 0.001	CINA: 34.4 (25.4) No insomnia: 10.4 (19.2) -p < 0.001	CINA: 30 (30.8) No insomnia: 9.0 (20.3) -p < 0.001	CINA: 52.0 (29.1) No insomnia: 16.8 (24.9) -p < 0.001
Patients diagnosed with depression or anxiety split into CINA suffers and those without insomnia	4,510	Depression with CINA: 10.4 (22.0) Depression without CINA: 4.2 (14.0) -p < 0.001 Anxiety with CINA: 12.2 (25.2) Anxiety without CINA: 5.3 (16.4) -p < 0.001	Depression with CINA: 40.9 (24.0) Depression without CINA: 20.5 (23.7) -p < 0.001 Anxiety with CINA: 42.7 (23.8) Anxiety without CINA: 20.0 (24.2) -p < 0.001	Depression with CINA: 33.6 (31.4) Depression without CINA: 17.0 (25.1) -p < 0.001 Anxiety with CINA: 37.4 (32.5) Anxiety without CINA: 17.4 (26.6) -p < 0.001	Depression with CINA: 59.6 (26.3) Depression without CINA: 35.5 (30.3) -p < 0.001 Anxiety with CINA: 61.5 (26.1) Anxiety without CINA: 32.5 (30.5) -p < 0.001
Females experiencing symptoms of menopause split into CINA suffers and those without insomnia	1,446	CINA: 4.3 (13.2) No insomnia: 1.7 (9.1) -p = 0.089	CINA: 31.7 (26.1) No insomnia: 9.2 (17.5) -p < 0.001	CINA: 29.0 (23.3) No insomnia: 8.6 (16.2) -p < 0.001	CINA: 47.8 (29.4) No insomnia: 16.9 (24.9) -p < 0.001

CINA: chronic sleep maintenance insomnia characterized by night-time awakenings; n: number; SD: standard deviation.

^aUnadjusted results are reported in the table. Results adjusted by linear regression models are also reported in the original publications.

Figure 1. PRISMA diagram of the systematic literature review.

Figure 2. QoL (mean MCS and PCS scores) of patients with insomnia compared to good sleepers and the impact of using sleep medication.

Figure 3. QoL of patients with comorbid insomnia and type 2 diabetes mellitus compared to those without insomnia.

Figure 4. Geographic distribution of publications reporting data on off-label treatment of insomnia stratified by drug-class and region.

Figure 5. Duration of benzodiazepine use for patients with insomnia across six regions in Italy.

Bolge SC, Balkrishnan R, Kannan H, et al. Burden associated with chronic sleep maintenance insomnia characterized by nighttime awakenings among women with menopausal symptoms. Menopause. 2010;17(1):80–86.

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Bolge SC, Joish VN, Balkrishnan R, et al. Burden of chronic sleep maintenance insomnia characterized by nighttime awakenings among anxiety and depression sufferers: results of a national survey. Prim Care Comp J Clin Psychiatry. 2010;12(2):PCC.09m00824.

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Bolge SC, Joish VN, Balkrishnan R, et al. Burden of chronic sleep maintenance insomnia characterized by nighttime awakenings. Popul Health Manage. 2010;13(1):15–20.

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Data availability statement

No new data were generated or analyzed in support of this research.