Population health management
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The objective of this study was to evaluate the economic and humanistic burden of chronic sleep maintenance insomnia characterized by nighttime awakenings (CINA). A database analysis of National Health and Wellness Survey, an annual cross-sectional study of health status and outcomes of US adults, was performed. CINA was defined as experiencing nighttime awakenings at least twice per week for more than 1 month that have moderate to severe impact on daily life and not experiencing difficulty falling asleep. ⋯ Controlling for demographics and comorbidity, CINA sufferers had greater resource utilization (0.1 [P < 0.001] more emergency room visits, 0.2 [P = 0.001] more days hospitalized, and 2.5 [P < 0.001] more provider visits), 22.4% (P < 0.001) greater activity impairment, and SF-8 physical and mental summary scores that were 6.2 (P < 0.001) and 6.8 (P < 0.001) points lower than those with no insomnia, respectively. Among those employed full time, CINA sufferers had greater work productivity impairment (4.0% due to absenteeism, 17.6% due to presenteeism, and 15.6% greater overall productivity impairment) than those with no insomnia (P < 0.001 for all). CINA in relative isolation was associated with a significant negative impact on health care utilization and its associated costs, health-related quality 16 of life, and work productivity.