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Impairment Associated With Sleep Problems in the Community: Relationship to Physical and Mental Health Comorbidity

From the Departments of Psychiatry and Family and Preventive Medicine (M.B.S.), University of California, San Diego, San Diego, California; Departments of Psychiatry and Community Health Sciences (S.-L.B., J.S.), University of Manitoba, Winnipeg, Manitoba, Canada; and Institute of Clinical Psychology and Psychotherapy Unit: Epidemiology and Service Research (F.J.), Technical University of Dresden, Dresden, Germany.

Address correspondence and reprint requests to Murray B. Stein, Departments of Psychiatry and Family and Preventive Medicine, University of California, San Diego, 9500 Gilman Drive (0855), La Jolla, CA 92093-0855. E-mail: mstein{at}ucsd.edu

Objective: To explore the extent to which associations between sleep problems and functional impairment are attributable to comorbid mental and physical health problems. Sleep problems are being increasingly recognized as a source of morbidity and role impairment. Little is known, however, about the extent to which associations between sleep problems and functional impairment are attributable to comorbid mental and physical health problems.

Methods: We utilized data from the German Health Survey (n = 4181; response rate: 87.6%; ages 18–65 years) to examine the relationships between sleep problems (assessed by the Pittsburgh Sleep Quality Inventory (PSQI)), mental and physical health comorbidity, and disability and health-related quality of life (assessed by the Medical Outcomes Scale Short Form-36 (SF-36)).

Results: A total of 1595 (35.2%) respondents reported current sleep problems (PSQI score of >5). After adjusting for sociodemographic factors, we found the presence of sleep problems was associated with having one or more physical health problems (adjusted odds ratio (AOR) = 1.21, 95% Confidence Interval (CI) = 1.01–1.45) and one or more mental disorders (AOR = 3.58, 95% CI = 2.95–4.35). Among persons with one or more physical health problems, the co-occurrence of a sleep problem was associated with poorer physical component scores on the SF-36 (45.7 versus 48.6, p <.001) and increased odds of 1 disability days in the past 30 days due to physical problems (AOR = 1.55, 95% CI = 1.20–1.98), even after adjusting for sociodemographic factors and comorbidity with other mental and physical health conditions.

Conclusions: More than one third of adults in the community report sleep problems. These often co-occur with other physical and mental health problems, and when they do they are generally associated with an increased burden of role disability and functional impairment.

Key Words: sleep • insomnia • anxiety • depression • physical illness • quality of life

Abbreviations: AOR = adjusted odds ratio; CCI = Charlson Comorbidity Index; GHS = German Health Survey; MCS = Mental Component Score; NCS-R = National Comorbidity Survey Replication; OR = odds ratio; PCS = Physical Component Score; PSQI = Pittsburgh Sleep Quality Index; SF-36 = Short Form-36.