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Author / Affiliation / Email Article Menu Font Type: Arial Georgia Verdana Open AccessArticle by François-Xavier Chalet 1,*, Paul Saskin 2, Ajay Ahuja 2, Jeffrey Thompson 3, Abisola Olopoenia 3, Kushal Modi 3, Charles M. Morin 4 and Emerson M. Wickwire 5,6 1 Idorsia Pharmaceuticals Ltd., Hegenheimermattweg 91, 4123 Allschwil, Switzerland 2 Idorsia Pharmaceuticals US Inc., One Radnor Corporate Center, Suite 101, 100 Matsonford Rd, Radnor, PA 19087, USA 3 Cerner Enviza, 51 Valley Stream Pkwy, Malvern, PA 19355, USA 4 Department of Psychology, Cervo Brain Research Centre, Laval University, Québec City, QC G1V 0A6, Canada 5 Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA 6 Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA * Author to whom correspondence should be addressed. Submission received: 15 February 2023 / Revised: 15 March 2023 / Accepted: 20 March 2023 / Published: 22 March 2023 Abstract: Little is known about the associations between insomnia severity, insomnia symptoms, and key health outcomes. Using 2020 United States National Health and Wellness Survey (NHWS) data, we conducted a retrospective, cross-sectional analysis to determine the associations between insomnia severity and a number of health outcomes germane to patients (health-related quality of life (HRQoL), employers and government (workplace productivity), and healthcare payers (healthcare resource utilization (HCRU)). The Insomnia Severity Index (ISI) questionnaire was used to evaluate overall insomnia severity. HRQoL was assessed using the physical and mental component summary scores of the Short Form-36v2 (SF-36v2) questionnaire, and health utility status was measured using the Short Form-6D (SF-6D) and EuroQoL-5D (EQ-5D) questionnaires. Workplace productivity was measured using the Work Productivity and Activity Impairment (WPAI) questionnaire. After adjusting for confounders, greater insomnia severity was significantly associated with worsened quality of life, decreased productivity, and increased HCRU in an apparent linear fashion. These findings have important implications for future research, including the need for specific assessment of insomnia symptoms and their impact on key health outcomes. 1. IntroductionInsomnia, defined as difficulty initiating and/or maintaining sleep with associated daytime consequence, is the most common sleep disorder among adults. In the United States (US), 10–15% of the population experiences chronic insomnia disorder, defined as frequency of difficulty sleeping of three or more nights per week, and duration for three or more months, with associated daytime insomnia symptoms [1,2,3]. Chronic insomnia is associated with a broad range of adverse consequences, including increased rates of poorer mental health outcomes (e.g., depression, anxiety, chronic pain, substance abuse, suicide), poorer physical health outcomes (e.g., cardiovascular disease, diabetes, stroke) and worsened health-related quality of life (HRQoL) [4]. In addition to those consequences for patients and their families, insomnia is also associated with a substantial economic burden that is borne by payers, by employers, and by society. For example, untreated insomnia is associated with increased healthcare resource utilization (HCRU) and other related costs (borne by payers), as well as increased absenteeism and diminished workplace productivity costs (i.e., presenteeism; borne