Daytime testing after laboratory or home-based polysomnography: comparisons of middle-aged insomnia sufferers and normal sleepers.

Many studies have shown only modest differences between insomnia sufferers and matched, non-complaining normal controls in regard to their levels of daytime sleepiness and diurnal performances. The current study was conducted to determine whether such daytime comparisons might be affected by the setting (home vs. sleep lab) in which study participants sleep on the nights before such testing. The study used a counter-balanced, matched-group design in which participants underwent three consecutive nocturnal polysomnographs (PSG) conducted either in the sleep lab or in their homes prior to undergoing daytime multiple sleep latency test (MSLT) and computer-administered performance testing. The study participants were 35 (18 women and 17 men) middle-aged (40-59 years) non-complaining normal sleepers and 33 middle-aged insomnia sufferers (17 women and 16 men) who met structured interview criteria for persistent primary insomnia. Use of a hierarchical linear statistical model showed only insomnia sufferers who underwent nocturnal home PSG were more alert on the MSLT than were normal sleepers who underwent lab PSG. However, these insomnia sufferers showed a greater propensity toward attention lapses on selected reaction time tests than did either of the two normal control groups (i.e. either those who slept in the lab or those who slept at home). The results suggest the nocturnal sleep setting (home vs. lab) may affect subsequent MSLT and performance test comparisons of insomnia sufferers and normal sleepers.