Validating Insomnia Severity Index (ISI) in a Bangladeshi Population: Using Classical Test Theory and Rasch Analysis

The COVID-19 outbreak is associated with sleep problems and mental health issues among individuals. Therefore, there is a need to assess sleep efficiency during this tough period. Unfortunately, the commonly used instrument on insomnia severity—the Insomnia Severity Index (ISI)—has never been translated and validated among Bangladeshis. Additionally, the ISI has never been validated during a major protracted disaster (such as the COVID-19 outbreak) when individuals encounter mental health problems. The present study aimed to translate the ISI into Bangla language (ISI-Bangla) and validate its psychometric properties. First, the linguistic validity of the ISI-Bangla was established. Then, 9790 Bangladeshis (mean age = 26.7 years; SD = 8.5; 5489 [56.1%] males) completed the Bangla versions of the following questionnaires: ISI, Fear of COVID-19 Scale (FCV-19S), and Patient Health Questionnaire-9 (PHQ-9). All the participants also answered an item on suicidal ideation. Classical test theory and Rasch analyses were conducted to evaluate the psychometric properties of the ISI-Bangla. Both classical test theory and Rasch analyses support a one-factor structure for the ISI-Bangla. Moreover, no substantial differential item functioning was observed across different subgroups (gender, depression status (determined using PHQ-9), and suicidal ideation). Additionally, concurrent validity of the ISI-Bangla was supported by significant and moderate correlations with FCV-19S and PHQ-9; known-group validity was established by the significant difference of the ISI-Bangla scores between participants who experienced suicidal ideation and those without. The present psychometric validation conducted during the COVID-19 outbreak suggests that the ISI-Bangla is a promising and operationally adequate instrument to assess insomnia in Bangladeshis.

Association between Insomnia and Irritable Bowel Syndrome among Adolescents in South Korea: A Quantitative Cross-Sectional Study

Insomnia refers to having difficulty sleeping even when given the opportunity and environment to sleep. Irritable bowel syndrome is a functional bowel disease that is accompanied by abdominal pain and irregular defecation but not organic lesions. Although insomnia and irritable bowel syndrome are pathophysiologically related, studies on their relationship among adolescents are lacking. This study aimed to determine the prevalence of insomnia and irritable bowel syndrome among adolescents and the association between them. In May 2021, a survey was conducted among high school adolescents from Daegu Metropolitan City, South Korea, using the Korean version of the Insomnia Severity Index and the Rome IV diagnostic criteria for irritable bowel syndrome. Data were analyzed using chi-square and Mann–Whitney tests and logistic regression analyses. The incidence of insomnia (Insomnia Severity Index score ≥ 10) was 18.4% (n = 74) while that of irritable bowel syndrome was 10.7% (n = 43). Irritable bowel syndrome was strongly associated with an increased incidence of insomnia (odds ratio = 3.30, 95% confidence interval: 1.66–6.53). Therefore, the association between insomnia and irritable bowel syndrome has relevance in the treatment of insomnia in adolescents.

Sleep in post-COVID-19 recovery period and its impact on different domains of quality of life

Background COVID-19 pandemic became a global health problem affecting the life of millions of people all over the world. The effects of this pandemic were not only on the physical and medical aspects but also on the psychological issues including anxiety disorders, depressive manifestations, sleep problems and others. Sleep disorders were very commonly reported during the novel Coronavirus-19 pandemic either in the acute phase of COVID-19 infection or after recovery. These sleep problems might have a drastic burden on the recovered patients’ life. This study aimed to investigate the sleep in the post-Coronavirus-19 period and if has an impact on the different items of patients’ quality of life. This cross-sectional observational study investigated the sleep problems in 500 patients in the post recovery period using Insomnia Severity Index and Pittsburgh sleep quality index (PSQI), their relation to this critical period and their impact on different domains of Quality of Life which was assessed by the SF36 Health Survey. Results Socio-demographic characteristics of 500 post-Coronavirus-19 patients were collected; the insomnia severity index and Pittsburgh sleep quality index evaluated the sleep pattern. The quality of life was investigated using Short Form 36 scale. The study revealed high scores of insomnia severity index (13.01 ± 4.9), Pittsburgh sleep quality index (15.37 ± 4.43), also high scores of different items of scale of quality of life in the studied group. Conclusion Post-COVID-19 sleep disturbances were commonly reported in the recovery period, also these sleep deficits had an impact on the physical and mental aspects of quality of life, so these sleep problems must be managed properly especially in this critical pandemic era.

EXTENT OF ANXIETY AND STRESS IN DIFFERENT GROUPS OF HEALTH CARE WORKERS OF SIKKIM BASED ON THEIR EXTENT OF INSOMNIA

The aim of the present study is to measure the extent of anxiety and stress among different groups of the health care workers (HCW) of Sikkim, based on the level of insomnia they were suffering from. The sample of the present study consisted of 153 HCWs. Depression anxiety and Stress Scale (DASS-21) and Insomnia Severity Index were administered. Different groups of health care workers, based on different levels of Insomnia were found to have different extent of anxiety and stress.

Childhood Trauma and Insomnia Increase Suicidal Ideation in Schizophrenia Patients: A Cross-Sectional Study

Objectives: This study aimed to investigate the effect of childhood trauma, especially its specific dimensions, and clinical risk factors for suicidal ideation in patients with schizophrenia.Methods: A total of 83 inpatients with schizophrenia were enrolled and divided into two groups: with suicidal ideation (n = 33) and without suicidal ideation (n = 50). All participants were administered the Childhood Trauma Questionnaire-Short Form, the Insomnia Severity Index, the Beck Scale for Suicide Ideation, the Modified Overt Aggression Scales, the auditory hallucination rating scale, the Hamilton Rating Scale of Depression and the Positive and Negative Syndrome Scale.Results: In our sample, 39.8% of the subjects had suicidal ideation, and 60.6% of them had suffered from childhood trauma. Patients with suicidal ideation had a higher Insomnia Severity Index score, Physical neglect score, the Childhood Trauma Questionnaire-Short Form total score (all P < 0.05) compared to those without. The logistic regression analysis revealed that physical neglect in Childhood Trauma Questionnaire was significantly associated with suicidal ideation (OR = 5.46, P < 0.05, 95% CI = 0.007–0.483). Further stepwise multiple linear regression identified that insomnia (β = 0.272, P = 0.011) and physical neglect (β = 0.257, P = 0.017) were strong risk factors for the severity of suicidal ideation in patients with schizophrenia. Mediation analysis showed that insomnia played a complete mediating role between physical neglect and suicidal ideation.Conclusion: Our results indicate that childhood maltreatment of physical neglect is a strong independent risk factor for suicidal ideation in schizophrenia. The risk is probably aggravated by the poor quality of sleep. Early screening and psychosocial treatment are recommended for psychotic individuals with a trauma history.

Evaluation of habitual sleep and factors influencing it in patients awaiting acute or planned abdominal surgery

Background and aims: This study aimed to clarify the incidence and severity of habitual sleep disturbances in patients undergoing surgery. Methods: A survey was conducted to collect data in a cohort of patients awaiting abdominal surgery. The Insomnia Severity Index score was used as primary measurement, while the Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index scores were used as secondary measurements. Findings: Overall, 119 patients were included in the analysis. The habitual sleep in the study cohort revealed high incidence of sleep difficulties and insomnia. Female sex and incidence of anxiety and depression were significantly related to all three scores, while age and employment were associated with Epworth Sleepiness Scale and Insomnia Severity Index scores, respectively. Conclusions: Female sex, experiencing depression or anxiety had severe negative impact on sleep in patients scheduled for elective or planned surgery. The prevalence of sleep problems in patients should be considered for optimising sleep to improve rehabilitation and reduce stress associated with surgery.

P103 Impact of the COVID-19 pandemic on the sleep of patients of a multidisciplinary sleep clinic

Introduction This study aimed to assess the impact of the COVID-19 pandemic on the sleep of adult patients of a multidisciplinary sleep clinic. Methods Patients were invited to complete online surveys: Survey 1 in October 2020 (increased COVID-19 restrictions) followed by Survey 2 in February 2021 (after easing of restrictions for a COVIDSafe summer). Results Of the 746 patients invited to participate, 73 completed and 8 partially returned Survey 1 (mean age 50.1 years, range 21–83 years, 58% female). Subsequently, 46 completed and 5 partially answered Survey 2. In Survey 1, 22/74 (29.7%) reported reduced sleep quantity and 31/75 (41.3%) indicated worse sleep quality compared with prior to the pandemic. In Survey 2, 33/46 (71.7%) described unchanged sleep quantity whilst 5/46 (10.9%) reported increased sleep quantity since easing COVID-19 restrictions. 36/46 (78.3%) indicated unchanged sleep quality whereas 5/46 (10.9%) described improved sleep quality since easing restrictions. However, 9/46 (19.6%) reported that their sleep remained worse compared with pre-pandemic. For patients who completed both surveys, there was no significant change in Insomnia Severity Index scores (Survey 1 mean 13.6, Survey 2 mean 12.9, mean difference -0.67 [95%CI -2.02, 0.68], p=0.32) or PROMIS Sleep-Related Impairment 8a T-scores (Survey 1 mean 59.0, Survey 2 mean 59.5, mean difference 0.44 [95%CI -1.55, 2.42], p=0.66). Discussion The COVID-19 pandemic has negatively affected the sleep of 44% of patients. Following easing of restrictions, symptoms of insomnia and sleep-related impairment did not change significantly, and 19.6% reported that their sleep was not back to their pre-pandemic baseline.

Insomnia incidence in myocardial infarction with and without obstructive coronary arteries

Background Insomnia can either be a primary problem or it may be associated with other psychological conditions, ranging from anxiety to depression. Some studies have reported that pts with MINOCA (myocardial infarction with non-obstructive coronary arteries) have more emotional disorders than the rest of pts with myocardial infarction (MI). However, a relationship with insomnia has not been yet described. The aim of this study is to compare insomnia levels between patients with MINOCA and the rest of MI patients using a validated scale: Insomnia Severity Index (ISI) (Figure 1). Methods We performed an analytical and observational study in which all consecutive MI pts from July 2017 to December 2020 were recruited. We used the latest definitions of MINOCA according to the 2020 ESC Guidelines. A group of experts reviewed all MINOCA cases in order to exclude those who did not fulfil criteria. Therefore, takotsubo syndrome and pts with myocarditis were excluded. ISI questionnaire was completed by each patient during admission. Total score ranges from 0 to 28 points. Depending on the final score, pts could have no clinically significant insomnia (0–7 points), subthreshold insomnia (8–14 points), clinical insomnia of moderate severity (15–21 points) and severe clinical insomnia (22–28 points). Follow up analysis included major adverse cardiovascular events (MACE: cardiovascular readmission, myocardial reinfarction, stroke and death from any cause). Survival analysis is based on Cox regression. Median follow-up was 25±23 months. Results From a total of 413 consecutive MI pts, 244 (59%) completed the questionnaire. Of them, 32 (13%) were MINOCA pts. There were no statistically significant differences in insomnia levels between both groups (Table 1). Even in absolute terms, both groups presented same mean levels: MINOCA mean value 7.6±6 points vs rest of MI 7.7±6 points, p=0.8. When separated by sex, women in the MI group had higher punctuation levels than men (24% of moderate clinical insomnia in women vs 8.9% of men, p=0.03). Punctuation in ISI questionnaire showed no significant differences in MACE in MINOCA pts (HR 0.9, CI 95% (0.7–1.2)), nor in the rest of MI pts (HR 0.9, CI 95% (0.9–1.03)). Conclusions Levels of insomnia were similar in MINOCA pts than in the rest of MI pts. Follow up showed no differences in MACE between both groups regarding insomnia according to ISI. Women had higher punctuation levels than men, with more clinical insomnia in a moderate grade. Subjective emotions could lead to mistaken findings, making it necessary to use ISI questionnaire or other objective validated scales to correctly study some disorders and their distribution in different populations. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Spanish Society of Cardiology Table 1. Insomnia severity index Figure 1. ISI Questionnaire

Impact of COVID-19 pandemic on psychological health and quality of sleep: An online survey from Kolkata

Background: As a preventive measure to combat COVID-19 pandemic, India has undergone “lockdown” since March 25, 2020. The pandemic and lockdown can impose a psychological impact in the form of fear, anxiety, stress and insomnia etc. Aims and Objective: The aim of the current study is to assess the magnitude of anxiety, depression, stress and poor sleep quality among the adult population of Kolkata, West Bengal amidst COVID-19 pandemic. Materials and Methods: By this online survey using Google forms, a total of 435 responses were received. The online questionnaire comprises of Socio-demographic characteristics, COVID—19 Anxiety Scale (CAS), Perceived Stress Scale 4 (PSS 4), Patient Health Questionnaire-9 (PHQ 9) and Insomnia Severity Index (ISI). Results: COVID-19 related anxiety were almost similar across age groups, sex, marital and educational status. PSS score was found higher in ≤25 years and >40 years age group, those not currently married, students and homemakers. Patient Health Questionnaire scores were found significantly different across all background characteristics categories except for the level of education whereas Insomnia Severity index Scale scores were found significantly more among subjects not currently married and among subjects who were working from home. Conclusions: The current study provides evidence towards the negative psychological impact of the pandemic and reminds us about the need for widespread psychiatric services during and after pandemic.

БЕЗСОННЯ ЯК ФАКТОР РИЗИКУ РОЗВИТКУ МОЗКОВОГО ІНСУЛЬТУ

Мета: вивчити вплив порушень сну на розвиток мозкового інсульту. Матеріали і методи. Проведено анкетування 98 пацієнтів із мозковим інсультом задля вивчення впливу порушень сну на розвиток мозкового інсульту в інсультному відділенні та у відділенні інтенсивної терапії та кризових станів Комунального некомерційного підприємства «Тернопільська обласна клінічна психоневрологічна лікарня» Тернопільської обласної ради. Стан порушень сну вивчено за допомогою пітсбурзького опитувальника якості сну (PSQI) та визначення індексу тяжкості безсоння (Insomnia Severity Index – ISI). Результати. Встановлено, що у третини пацієнтів похилого віку (34,4 %) нічний сон тривав менше 7 год, індекс тяжкості безсоння становив (16,13±1,25) бала (помірні порушення сну), переважала частка помірних порушень сну (в (43,75±1,04) %) і відзначалася наявність виражених порушень сну (в (18,75±1,66) %). Пацієнти, старші 60 років, склали найбільшу групу з виявленим мозковим інсультом (65,3 %), при цьому гіпертонічну хворобу виявляли у них в 68,8 % випадків, що свідчить про вплив порушення сну на розвиток артеріальної гіпертензії та мозкового інсульту. Лікування порушень сну повинно стати складовою у профілактиці серцево-судинних захворювань, церебро­васкулярної патології та мозкового інсульту. На думку провідних експертів для лікування порушень сну найкраще використовувати когнітивно-поведінкову терапію. Висновки. Враховуючи доведений вплив порушень сну (інсомнії) на розвиток цереброваскулярних захво­рювань, необхідно впровадити в систему громадського здоров’я низку інформаційно-просвітницьких заходів для їх профілактики та покращення рівня знань про психологічну освіту/гігієну сну. З метою виявлення та корекції неправильних переконань стосовно сну і хибних уявлень про безсоння та його наслідки забезпечити консультацію психолога або психотерапевта пацієнтам з гіпертонічною хворобою, особам, старшим 60 років, та всім пацієнтам, які скаржаться на порушення сну.