Co-morbid insomnia and sleep apnea (COMISA): recent research and future directions

Abstract

Purpose of review Insomnia and obstructive sleep apnea have previously been viewed as completely independent conditions. However, there is now increasing recognition that insomnia and sleep apnea frequently co-occur. Co-morbid insomnia and sleep apnea (COMISA) is a highly prevalent condition that is associated with impairment of sleep, daytime function, mental health and physical health outcomes, and mortality risk. This review aims to provide an update on COMISA prevalence, consequences, treatment approaches, and future research directions. Recent findings People with COMISA experience worse sleep, mental health, physical health, quality of life and longevity compared to people with neither condition, and often compared to those with insomnia alone and sleep apnea alone. Emerging evidence suggests that cognitive behavioral therapy for insomnia is an effective treatment in the presence of treated and untreated sleep apnea, that may also improve manifestations and subsequent management of sleep apnea. Future research is required to understand the etiology of COMISA, and to develop and implement tailored treatment approaches. Summary It is important for sleep and respiratory technicians, researchers and clinicians to be aware of the high co-morbidity rates, consequences, and treatment requirements of patients with co-morbid insomnia and sleep apnea.

Effect of high-risk sleep apnea on treatment-response to a tailored digital cognitive behavioral therapy for insomnia program: a quasi-experimental trial

“…Although CPAP therapy improves stability of the upper airway during sleep and many of the associated consequences of OSA, it is limited by suboptimal acceptance and long-term use for the duration of the sleep period (Weaver and Grunstein, 2008). Co-morbid insomnia symptoms are associated with approximately a 30% reduction in initial acceptance of CPAP therapy, and a 2-h reduction in average nightly CPAP use compared to patients with OSA alone (Sweetman et al, 2023b). Two of four recent randomized controlled trials have reported that CBTi improves subsequent acceptance and use of CPAP therapy in patients with COMISA (Bjorvatn et al, 2018;Sweetman et al, 2019b;Ong et al, 2020b;Alessi et al, 2021).…”