Exploring the Latest Advances in Treatment of Insomnia - Episode 7
Drs Paul Doghramji and Leslie Citrome review the use of the Insomnia Daytime Symptoms and Impacts Questionnaire (IDSIQ) to assess treatment efficacy.
Paul Doghramji, MD, FAAFP: A lot of clinical studies have been done, especially with the sleeping medications that have come out in the last 20 years or so, and there are a lot of patient-reported outcomes in assessing treatment efficacy. Are they important?
Leslie Citrome, MD, MPH: I think so. For depression, we’ve learned to use the PHQ-9 [Patient Health Questionnaire-9], haven’t we? PHQ-9 is a way of a patient telling us how they feel in terms of their mood as well as other symptoms associated with major depressive disorder, and it provides an educational resource for the patient to learn about their illness. In a similar vein, having patient-reported outcomes will get the patient involved in assessing how they’re doing in terms of improvement in their insomnia and associated impairments.
Paul Doghramji, MD, FAAFP: Excellent. There’s something new that’s come out, Leslie. I’d like you to review this. It’s called the Insomnia Daytime Symptoms and Impact Questionnaire, IDSIQ. Can you discuss what this tool is and how it’s used?
Leslie Citrome, MD, MPH: The IDSIG is derived from an older scale and places it in the modern age, so to speak. It was intended to support the development program of a specific orexin receptor antagonist that was approved this year. It looks at different domains of daytime functioning, looking at issues such as sleepiness, mood, and cognition. It has these 3 domains of sleepiness, mood, and alertness or cognition. It helps us get a full understanding of a person’s ability to perform during the daytime with the presumption that they’ve had a good night’s sleep the night before.
Paul Doghramji, MD, FAAFP: It’s a way of assessing next-day functioning. As far as I know, this is the first time that this has ever been done with sleeping medication. Is that correct?
Leslie Citrome, MD, MPH: The IDSIQ is unique in that regard with the development of this particular dual orexin receptor antagonist. Various other patient-reported outcomes have been used in the past, but not ones as finely tuned as this. We’ve had, for example, the Patient Global Impression of Change and various questions being asked about the speed of falling asleep and remaining asleep and the satisfaction with one’s sleep. That information has been collected for a very long time, but there has not been the same degree of attention on next-day functioning.
Paul Doghramji, MD, FAAFP: That’s a very important thing because, as we said earlier with insomnia, patients report not only trouble getting to sleep and staying asleep and that sort of stuff but also that they don’t function very well during the day. You even talked about presenteeism and sleepiness during the day. Here’s a tool that’s developed to specifically assess how well or how sleepy somebody is during the day.
Transcript edited for clarity