The consensus sleep diary: quantitative criteria for primary insomnia diagnosis

The aim of the study was to put forward quantitative criteria for the Consensus Sleep Diary, to differentiate people with insomnia from normal sleepers.

In this retrospective study, we analyzed 295 sleep diaries of patients with primary insomnia (43% were male, ages ranging between 17 and 76 years) collected in two clinical centers for insomnia and 536 sleep diaries of normal sleepers (47% were male, ages ranging between 15 and 82 years). We considered the following sleep parameters: time in bed, sleep onset latency, total sleep time, wake after sleep onset, sleep efficiency, number of awakenings, terminal wakefulness, and subjective feeling of rest. Using the Youden index, we calculated the quantitative criteria that performed best for each sleep parameter. Finally, we created receiver operating characteristic curves to test the accuracy of each identified criterion.

Individuals with insomnia significantly differed from controls on all sleep indices (p < .001). Differentiation between individuals with insomnia from controls was optimal for terminal wakefulness (>15 minutes, area under the curve [AUC] = 0.83), wake after sleep onset (cutoff >20 minutes, AUC = 0.81), total sleep time (<390 minutes, AUC = 0.80), and particularly sleep efficiency (<87.5%, AUC = 0.92, sensitivity = 0.80, specificity = 0.90). Time in bed was the least differentiating variable (<500 minutes, AUC = 0.57).

The quantitative criteria of the sleep diary in this study agree with the few available data in the literature. This confirms that the sleep diary could be a useful screening tool for assessing patients with primary insomnia.