Network analysis to estimate central insomnia symptoms among daytime workers at-risk for insomnia

Abstract Although insomnia complaints are associated with mental health problems and reduced work productivity, the central insomnia symptoms in workers at-risk for insomnia remain unclear. This study aimed to identify the central insomnia symptoms among daytime workers at risk for insomnia. The participants were 881 Japanese daytime workers at-risk for insomnia with a mean age of 49.33 ± 9.92 years. At-risk for insomnia was defined as an Athens Insomnia Scale score of six or higher. The Athens Insomnia Scale was used as a screening for at-risk insomnia because it has higher sensitivity and specificity than other insomnia screening scales. The Insomnia Severity Index is recommended as a mechanism of insomnia and an outcome measure; therefore, a network analysis was conducted with the seven items of the Insomnia Severity Index. The important variables in the connections between insomnia symptoms were estimated from centrality indices, which were interpretable only for strength. The strength value results suggest that difficulty staying asleep and worry about sleep problems were the central insomnia symptoms. The connections were stronger for difficulty staying asleep and problem waking up too early, difficulty staying asleep and difficulty falling asleep, and interference with daytime functions and noticeable to others. Worry about sleep problems was strongly associated with variables other than nocturnal insomnia symptoms. Therefore, difficulty staying asleep and worry about sleep problems are important variables in daytime workers at-risk for insomnia and are key points for improvement or exacerbation of insomnia symptoms