Epidemiology of insomnia disorder in older persons according to the Diagnostic and Statistical Manual of Mental Disorders: a systematic review and meta-analysis

• Published in: European geriatric medicine 2023-12, Vol.14 (6), p.1261-1272
• Main Authors: Endomba, Francky Teddy, Tchebegna, Patrick Yvan, Chiabi, Edmond, Angong Wouna, Dominic Leandry, Guillet, Clément, Chauvet-Gélinier, Jean Christophe
• Format: Article
• Language: English
• Subjects: CRD; CRD42022344675; Geriatrics/Gerontology; Internal Medicine; Medicine; Medicine & Public Health; Review
• ISSN: 1878-7649; 1878-7657; 1878-7657
• DOI: 10.1007/s41999-023-00862-2

Key summary points Aim What are the prevalence and correlates of insomnia disorder in older persons according to the Diagnostic and Statistical Manual of Mental Disorders (DSM)? Findings The pooled prevalence of insomnia disorder in older persons according to the DSM was 19.6%, and varied according to the sample size, the age cutoff used, and the study quality (risk of bias). Insomnia in older persons is associated with the female gender, depression, anxiety, as well as cardiovascular, respiratory, and painful conditions. Message Further researches are needed with a focus on African populations, the widening of sample sizes, and the comparison according to the institutionalization status. Purpose There is a scarcity of summarizing data on the epidemiology of insomnia in older persons, especially when diagnosed with international criteria. This study aimed to estimate the prevalence and correlates of insomnia disorder in older persons, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM). Methods Through PubMed/MEDLINE, EMBASE, and Web of Science (WoS), we searched for relevant articles published before June 28, 2023. The risk of bias was weighed using the Joanna Briggs Institute’s (JBI’s) critical appraisal checklist for studies reporting prevalence data. For our analyses, we used a random-effect model, with subgroup analyses, meta-regression, and sensitivity analyses to explore potential sources of heterogeneity. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement. Results We included 18,270 participants across 16 studies. The male/female ratio was 0.89 (12 studies), and the mean age varied from 65.9 to 83.1 years (8 studies). The pooled prevalence of insomnia was 19.6% (95% CI = [12.3%; 28.3%]), with substantial heterogeneity. This prevalence fluctuated according to the sample size, the minimal age for inclusion, and the study quality, considering that the risk of bias was moderate for most of studies. There was a publication bias, with a very low level of certainty. Insomnia disorder was associated with the female gender, depression, anxiety, and somatic illnesses notably cardiovascular, respiratory, and painful ones. Conclusion Nearly one in every five old individuals was considered to have insomnia disorder, which was associated with the gender and the existence of mental health and/or somatic conditions. Registration We registered the protocol in the International Prospective Register o