• Julia A Shekleton, Erin E Flynn-Evans, Belinda Miller, Lawrence J Epstein, Douglas Kirsch, Lauren A Brogna, Liza M Burke, Erin Bremer, Jade M Murray, Philip Gehrman, Steven W Lockley, and Shantha M W Rajaratnam.
• Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA ; Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA ; School of Psychology and Psychiatry, Monash University, Melbourne, Australia.
• Sleep. 2014 Jan 1;37(1):107-16.

Study ObjectivesDespite the high prevalence of insomnia, daytime consequences of the disorder are poorly characterized. This study aimed to identify neurobehavioral impairments associated with insomnia, and to investigate relationships between these impairments and subjective ratings of sleep and daytime dysfunction.DesignCross-sectional, multicenter study.SettingThree sleep laboratories in the USA and Australia.PatientsSeventy-six individuals who met the Research Diagnostic Criteria (RDC) for Primary Insomnia, Psychophysiological Insomnia, Paradoxical Insomnia, and/or Idiopathic Childhood Insomnia (44F, 35.8 ± 12.0 years [mean ± SD]) and 20 healthy controls (14F, 34.8 ± 12.1 years).InterventionsN/A.Measurements And ResultsParticipants completed a 7-day sleep-wake diary, questionnaires assessing daytime dysfunction, and a neurobehavioral test battery every 60-180 minutes during an afternoon/evening sleep laboratory visit. Included were tasks assessing sustained and switching attention, working memory, subjective sleepiness, and effort. Switching attention and working memory were significantly worse in insomnia patients than controls, while no differences were found for simple or complex sustained attention tasks. Poorer sustained attention in the control, but not the insomnia group, was significantly associated with increased subjective sleepiness. In insomnia patients, poorer sustained attention performance was associated with reduced health-related quality of life and increased insomnia severity.ConclusionsWe found that insomnia patients exhibit deficits in higher level neurobehavioral functioning, but not in basic attention. The findings indicate that neurobehavioral deficits in insomnia are due to neurobiological alterations, rather than sleepiness resulting from chronic sleep deficiency.

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