June 18, 2010 (San Antonio, Texas) — Suicidal ideation (SI) rates are 2- to 4-fold higher among patients undergoing treatment for sleep disorders compared with the general population, according to research presented here at SLEEP 2010: Associated Professional Sleep Societies 24th Annual Meeting.
The 4-fold increase may be exaggerated because the study was drawn from patients who sought treatment at a clinic, said Victor Ulibarri, BA, a clinical researcher at Maimonides Sleep Arts & Sciences in Albuquerque, New Mexico, who presented the findings here.
Among patients who reached a threshold that would be considered high enough to warrant further clinical investigation, the increase in SI was about 2-fold. Still, he says, the numbers are of concern, and sleep medicine may be a good outlet for some of these patients.
"We may have more to offer than psychiatrists think," Mr. Ulibarri said. "If they send their patients to us to treat sleep disorders, it may be that SI will go down."
Insomnia and Suicide
Insomnia is commonly associated with suicide attempts, but the researchers wanted to find out whether other sleep disorders also play a role. They conducted a retrospective chart review of patients presenting at a sleep clinic; 1584 patients were included in the study.
Of the participants, 211 reported SI and 1373 did not. The researchers used an intake questionnaire set to collect data on sleep, medical, and psychiatric histories, including scales of insomnia, nightmares, anxiety and depression, and suicidal ideation (DSI-SS).
SI was present in 13.3% of participants, and this group had a mean DSI-SS score of 2.92+1.68, which is equivalent to the clinical threshold requiring further assessment.
The SI group had sleep problems that were of longer duration, worse insomnia as measured by scales of insomnia, and worse perceptions of sleep quality with medium effect sizes (P values = .001; mean d, .40).
The SI group also had worse outcomes on subjective sleep indices (including total sleep time, sleep efficiency, sleep onset latency, and wake after sleep onset), although the outcomes were small (P values < .04; mean d, .21). Patients with SI had greater nightmare severity (P = .001; d, .52).
Psychiatric conditions occurred at higher frequency in the SI group, including anxiety, depression, and posttraumatic stress disorder (P values = .001).
Anxiety and depression were more severe and had large effect sizes in the SI group, as measured by anxiety and depression scores (P = .001; mean d, 1.16).
Overall, the SI rate of 13.3% in the study population was more than 4 times greater than the 3% rate that is estimated for the general population, and SI was associated with worse sleep measures.
The 13.3% of the population included participants who answered tested positive for SI on 1 of the 4 questions on the DSI-SS. The clinical threshold for further treatment is answering 3 of 4 questions positively. Among the study participants, there was a 2-fold increase in participants who reached that threshold compared with the general population.
The authors suggest their findings need to be corroborated at other sleep centers.
Comorbid Problems
The results provide more evidence that psychological disorders and sleep problems are closely interconnected.
"A lot of psychological illnesses also have sleep problems and sleep symptoms as a characteristic, a diagnostic criteria, or a comorbid condition," said Donna Arand, PhD, clinical director of the Sleep Disorder Center at the Kettering Medical Center in Dayton, Ohio, who attended the presentation.
"Now that there is a lot of emphasis on nonpharmacological therapies for insomnia, this is bringing a lot of that psychiatric population into sleep clinics saying, 'Hey, there is something that can be done apart from medications that haven't worked for me, because there are some newer behavioral treatments available,' " Dr. Arand told Medscape Neurology.
The study did not receive commercial support. Mr. Ulibarri and Dr. Arand have disclosed no relevant financial relationships.
SLEEP 2010: Associated Professional Sleep Societies 24th Annual Meeting: Abstract 0733. Presented June 9, 2010.
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