0646 THE PREVALENCE OF HYPERSOMNOLENCE, ITS CORRELATES AND ASSOCIATED ROLE IMPAIRMENT IN THE NATIONAL COMORBIDITY SURVEY REPLICATION (NCS-R)

Abstract

Introduction: The prevalence of hypersomnolence in the U.S. and associated socio-demographic characteristics are not well studied. Its comorbidity with insomnia and relationship with psychiatric, alcohol and drug use disorders, use of prescription medications and impact on functional impairment is poorly delineated. Methods: The National Comorbidity Survey Replication (NCSR) is a nationally representative community household survey of individuals ≥18 years. As part of this survey, subjects (n=5,962) were queried about their sleep in the NCS-R Part II questionnaire. Socio-demographic characteristics and prescription medication use were assessed. Subjects were administered the WHO Composite International Diagnostic Interview (WHO-CIDI) to determine various DSM-IV diagnoses and the WHO Disability Assessment Schedule 2.0 (WHO-DAS II) to evaluate for functional impairment. The prevalence of 12-month hypersomnolence, defined per DSM-5 as a subjective sense of sleepiness during the daytime associated with lapses into sleep, not feeling rested despite getting adequate sleep, or having difficulty waking in the morning, was determined. Odds ratios were used to assess associations with various socio-demographic characteristics, insomnia, DSM-IV diagnoses, prescription medication use, alcohol and drug abuse/dependence as well as functional impairment. Results: The prevalence of hypersomnolence in U.S. adults was 23.34% (SE=0.88). Tetrachoric correlations among constituent symptoms were high (0.56 to 0.97; all p<0.05). Among socio-demographic characteristics, being female (OR=1.41; CI:1.20-1.61), ≤45 years (OR=1.35; CI:1.10-1.66), having a low/low-average family income (OR=1.36; CI:1.13-1.65) and being unemployed (OR=1.38; CI:1.11- 1.70) were associated with a higher risk of hypersomnolence. Insomnia (OR=5.65; CI:4.55-7.02), DSM-IV anxiety disorders (OR=2.78; CI:2.34-3.31), mood disorders (OR=2.72; CI:2.18-3.39), conduct and oppositional disorders (OR=2.11; CI:1.52-2.93), and substance use disorders (OR=1.56; CI:1.27-1.91) were significantly comorbid with hypersomnolence after accounting for socio-demographic characteristics and other DSM-IV diagnoses. Hypersomnolence was significantly associated with functional impairment (OR=2.01; CI:1.30-3.12). Among medication classes, antidepressants (OR=1.77; CI:1.43- 2.19), benzodiazepines (OR=1.50; CI:1.15-1.95) and buspirone (OR=2.78; CI:1.46-5.27) were associated with increased rates of hypersomnolence. Conclusion: Hypersomnolence is common in the general population, especially in younger, female, lower income and unemployed subgroups. Hypersomnolence is comorbid with multiple psychiatric and substance abuse disorders, particularly insomnia, anxiety and depression, as well as antidepressant and benzodiazepine use. Finally, hypersomnolence is associated with significant functional impairment.