Insomnia heterogeneity: characteristics to consider for data-driven multivariate subtyping

• Published in: Sleep medicine reviews Vol. 36; pp. 71 - 81
• Main Authors: Benjamins, Jeroen S., PhD, Migliorati, Filippo, PhD, Dekker, Kim, MSc, Wassing, Rick, MSc, Moens, Sarah, MSc, Blanken, Tessa F., MSc, te Lindert, Bart H.W., MSc, Mook, Jeffrey Sjauw, Van Someren, Eus J.W., PhD
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-12-2017
• Subjects: Disease history; Fatigue - psychology; Humans; Insomnia; Internet; Latent class analysis; Life events; Life Style; Models, Statistical; Multivariate methodology; Neurology; Personality; Phenotype; Quality of Life; Questionnaires; Sleep Initiation and Maintenance Disorders - classification; Sleep Medicine; Subtype; Surveys and Questionnaires; Traits; DSM-IV; SCS; DFD; ICD-10; APS; SPQ-BR; Difficulty initiating sleep; Patient health questionnaire; PVT; RRS; TEPS; Autism spectrum quotient; ID; BCPQ; International classification of sleep disorders; RAND-36; DSM-5; Amsterdam resting state questionnaire; Positive and negative affect scale; Periodic leg movement disorder; FSS; Dysfunctional beliefs and attitudes about sleep; NSR; DBAS; Self-consciousness scale; OSAS; Adhd self-report scale; ETSRS; life events; PSWQ; Fatigue severity scale; Diagnostic and statistical manual of mental disorders, fifth edition; ADHD; Highly sensitive person; S-ASQ; traits; International classification of diseases, tenth edition; multivariate methodology; Schizotypal personality questionnaire-brief revised; Center for epidemiological studies – depression; DSM-IV-TR; Electroencephalography; Bedtime counterfactual processing questionnaire; PHQ-9; Inventory of depressive symptoms; Multidimensional fatigue inventory; PSAS; ARSQ; SD; RLS; disease history; Diagnostic and statistical manual of mental disorders, fourth revised edition; Three factor eating questionnaire; Difficulty maintaining sleep; ISI; ASQ; SR; phenotype; 36-item short form survey from the RAND medical outcomes study; ESS; HADS; FIRST; Dream recall frequency scale; DIS; ACS; International restless legs syndrome study group; Hospital anxiety and depression scale; International classification of sleep disorders, third edition; CIDI; CES-D; HAS; REM; PSQI; Epworth sleepiness scale; ICSD2; Hyperarousal scale; Temporary experience of pleasure scale; Anxiety and preoccupation about sleep questionnaire; Ruminative responses scale; Perfectionism inventory; PLMS; Duke structured interview for diagnosing sleep disorders; Ford insomnia response to stress test; latent class analysis; Composite international diagnostic interview; International personality item pool; FFM; ICSD3; Behavioral inhibition system/behavioral activation system; Sleep registry; DSISD; Munich chronotype questionnaire; Netherlands sleep registry; EMA; IDS; Mood and anxiety symptom questionnaire; community detection; Insomnia disorder; Web screening questionnaire; Pittsburgh sleep quality index; Arousal predisposition scale; Obstructive sleep apnea syndrome; HSP; Compass of shame scale; EEG; Short autism spectrum quotient; IPIP; SF-36; Diagnostic and statistical manual of mental disorders, fourth edition text-Revision; Restless legs syndrome; International classification of sleep disorders, second edition; PLMD; MCTQ; Global rumination scale; TFEQ; TCI; Daytime functioning diary; Five factor model; internet; Pre-sleep arousal scale; Temperament and character inventory; BIS/BAS; GRS; ICSD; Insomnia severity index; CoSS; Penn state worry questionnaire; Periodic leg movements in sleep; Diagnostic and statistical manual of mental disorders, fourth edition; MASQ; MFI; APSQ; subtype; Standard deviation; Experienced temperature sensitivity and regulation survey; Action control scale; Attention deficit hyperactivity disorder; PANAS; DMS; ASRS; insomnia; questionnaires; Rapid eye movement; WSQ; 4DSQ; DSM-IV-R; PI; DRFS; Early morning awakening; Four-dimensional symptom questionnaire; IRLSSG; Psychomotor vigilance task; Phenotype; Life events; Insomnia; Multivariate methodology; Questionnaires; Internet; Latent class analysis; Disease history; Subtype; Traits
• ISSN: 1087-0792; 1532-2955
• DOI: 10.1016/j.smrv.2016.10.005

Summary Meta-analyses and systematic reviews have reported surprisingly few consistent insomnia-characteristics with respect to cognitions, mood, traits, history of life events and family history. One interpretation of this limited consistency is that different subtypes of insomnia exist, each with its own specific multivariate profile of characteristics. Because previously unrecognized subtypes will be differentially represented in individual studies and dilute effect sizes of subtype-dependent characteristics of importance, they are unlikely to be reported consistently in individual studies, let alone in meta-analyses. This review therefore aims to complement meta-analyses by listing previously reported psychometric characteristics of insomnia, irrespective of the degree of consistency over studies. The review clearly indicates that characteristics of insomnia may not be limited to sleep. Reports suggest that at least some individuals with insomnia may deviate from people without sleep complaints with respect to demographics, mental and physical health, childhood trauma, life events, fatigue, sleepiness, hyperarousal, hyperactivity, other sleep disorders, lifetime sleep history, chronotype, depression, anxiety, mood, quality of life, personality, happiness, personality, worry, rumination, self-consciousness, sensitivity, dysfunctional beliefs, self-conscious emotion regulation, coping, nocturnal mentation, wake resting-state mentation, physical activity, food intake, temperature perception and hedonic evaluation. The value of this list of characteristics is that (1) internet has now made it feasible to asses them all in a large sample of people suffering from insomnia, and (2) statistical methods like latent class analysis and community detection can utilise them for a truly bottom-up data-driven search for subtypes. The supplement to this review provides a blueprint of this multivariate approach as implemented in the Sleep registry platform ( www.sleepregistry.nl ), that allows for bottom-up subtyping and fosters cross-cultural comparison and worldwide collaboration on insomnia subtype finding - and beyond.