Comorbidity between sleep apnea and insomnia

Benetó, A; Gomez-Siurana, E.; Rubio-Sanchez, Pilar

doi:10.1016/j.smrv.2008.09.006

Cited by 146 publications

(127 citation statements)

References 51 publications

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“…9,10,15,39,58 Insomnia in particular has been linked to sleep disordered breathing, with worsened sleep quality, anxiety, depression, and CPAP adherence. 27,28,[59][60][61] Given the potential for poorer clinical outcomes in this already compromised population, identification and early interventions targeting common barriers to CPAP use should be prioritized. A multi-modal approach should be used to improve CPAP adherence.…”

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confidence: 99%

The Impact of Posttraumatic Stress Disorder on CPAP Adherence in Patients with Obstructive Sleep Apnea

Collen

Lettieri

Hoffman

2012

Journal of Clinical Sleep Medicine

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Introduction:Obstructive sleep apnea (OSA) is a common comorbid condition in patients with posttraumatic stress disorder (PTSD); insuffi ciently treated OSA may adversely impact outcomes. Sleep fragmentation and insomnia are common in PTSD and may impair CPAP adherence. We sought to determine the impact of combat-related PTSD on CPAP adherence in soldiers. Methods: Retrospective case-control study. Objective measures of CPAP use were compared between OSA patients with and without PTSD. Groups were matched for age, BMI, and apnea-hypopnea index (AHI). Results: We included 90 patients (45 Control, 45 PTSD). Among the cohort, mean age was 39.9 ± 11.2, mean BMI 27.9 ± 8.0, mean ESS 13.6 ± 5.7, and mean AHI 28.2 ± 22.4. There was a trend towards a higher rate of comorbid insomnia among patients with PTSD (25.8% vs. 11.1%, p = 0.10). PTSD was associated with signifi cantly less use of CPAP. Specifi cally, CPAP was used on 61.4% ± 22.2% of nights in PTSD patients compared with 76.8% ± 16.4% in patients without PTSD (p = 0.001). Mean nightly use of CPAP was 3.4 ± 1.2 h in the PTSD group compared with 4.7 ± 2.2 h among controls (p < 0.001). Regular use of CPAP (> 4 h per night for > 70% of nights) was also lower among PTSD patients (25.2% vs. 58.3%, p = 0.01). Conclusion: Among soldiers with OSA, comorbid PTSD was associated with signifi cantly decreased CPAP adherence. Given the potential for adverse clinical outcomes, resolution of poor sleep quality should be prioritized in the treatment of PTSD and potential barriers to CPAP adherence should be overcome in patients with comorbid OSA. Keywords: Posttraumatic stress order, sleep apnea, obstructive sleep apnea, CPAP, CPAP compliance, CPAP adherence, sleep disordered breathing, deployment related sleep disorders Citation: Collen JF; Lettieri CJ; Hoffman M. The impact of posttraumatic stress disorder on CPAP adherence in patients with obstructive sleep apnea.

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confidence: 99%

The Impact of Posttraumatic Stress Disorder on CPAP Adherence in Patients with Obstructive Sleep Apnea

Collen

Lettieri

Hoffman

2012

Journal of Clinical Sleep Medicine

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“…The association between OSAS and pre-existing insomnia is responsible for debilitating daytime symptoms, such as excessive daytime sleepiness, impaired cognitive performance or concentration and decreased night-time sleep quality [5]. It has been hypothesised that sympathetic hyperstimulation in insomnia patients can potentially increase the cardiovascular risk associated with OSAS [8]. Suppressing abnormal respiratory events over a long period using the standard treatment, positive airway pressure (PAP) [9], might permit assessment of the evolution of insomnia under PAP, which, to the best of our knowledge, has not yet been attempted.…”

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confidence: 99%

Insomnia related to sleep apnoea: effect of long-term auto-adjusting positive airway pressure treatment

et al. 2012

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Insomnia related to sleep apnoea (IA) is highly prevalent, and its proper treatment is still debated. The aim of this study was to test the hypothesis that long-term auto-adjusting positive airway pressure (APAP) treatment improves IA symptoms.80 patients (mean¡SD age 54.9¡10.6 yrs, respiratory disturbance index (RDI) 45.0¡24.6 events?h -1 ) receiving APAP treatment were followed prospectively for 24 months. Somnolence and depression were assessed at baseline (T0) with the Epworth and the QD2A scales, respectively. Nightly APAP use was measured after 24 months of treatment (T24). The assessment of insomnia at T0 and T24 used the insomnia severity index (ISI). The combination of ISIT0 o15 and ISIT0-ISIT24 o9 defined the APAPresponding insomnia (APAP-RI) group. A logistic regression analysis identified the factors independently associated with the APAP-RI group.The ISI (13.7¡5.7 versus 8.2¡6.3) decreased significantly from T0 to T24 (p50.0001) for the patients as a whole, with a mean decrease of 13.5¡2.9. Among the 39 insomniac subjects (T0), 20 belonged to the APAP-RI group (51%). The Epworth score (OR 1.536, 95% CI 1.093-2.159; p50.01) and the RDI (OR 1.080, 95% CI 1.010-1.154; p50.02) increased the risk of belonging to the APAP-RI group.IA symptoms improved with APAP treatment, and improvement was associated with the initial severity of the disease and somnolence in our population.

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“…These prevalence estimates are in line with other recent studies, which have found insomnia to be present in 21%-39% of those with insomnia and for SDB to co-occur in 7%-69% of those with insomnia. 70 Although difficulty maintaining sleep is the most frequent insomnia complaint among adults with comorbid insomnia and SDB, other insomnia complaints are common; 71 in our sample, we found a wide variety of insomnia complaints among the women with SDB and insomnia. The causal pathway for the insomnia/SDB combination is likely bidirectional: although the frequent awakenings from SDB events may induce insomnia, 72 the fragmented and ''light'' sleep that is characteristic of insomnia may predispose to SDB.…”

Section: Discussionmentioning

confidence: 48%

Sleep Hygiene Behaviors Among Midlife Women with Insomnia or Sleep-Disordered Breathing: The SWAN Sleep Study

Kline

Irish

Buysse

et al. 2014

Journal of Women's Health

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Background: Insomnia and sleep-disordered breathing (SDB) are the most common sleep disorders among midlife women. Although promoting sleep hygiene behaviors may be a useful behavioral approach for the management of insomnia or SDB, the frequency with which women engage in these behaviors is unclear. Methods: Participants were from the Study of Women's Health Across the Nation (SWAN) Sleep Study (N = 321; age range = 48-58 years). Out of the full sample, 10.3% (n = 33) met Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition diagnostic criteria for insomnia, 15.3% (n = 49) had clinically significant SDB (apnea-hypopnea index ‡ 15), and 4.7% (n = 15) met criteria for both insomnia and SDB, resulting in an overall prevalence of 15.0% (n = 48) for insomnia and 19.9% (n = 64) for SDB. Participants provided diary-based assessments of sleep hygiene behaviors for 14-35 days. Two positive behaviors (sufficient exercise, regular morning out-of-bed time) and four negative behaviors (taking long daytime naps, caffeine consumption near bedtime, alcohol consumption near bedtime, smoking) were examined. These behaviors were compared between women with and without insomnia or SDB following adjustment for sociodemographic factors and mental and physical health indices. Results: Women with insomnia engaged in significantly fewer negative sleep hygiene behaviors than women without insomnia (1.61 -0.15 vs. 2.09 -0.09 behaviors; p < 0.01); specifically, women with insomnia were less likely to take long naps (odds ratio [OR] = 0.30, 95% confidence interval [CI]: 0.12-0.74) or consume caffeine near bedtime (OR = 0.44,. In contrast, women with SDB were less likely to be physically active than women without SDB (OR = 0.52, 95% CI: 0.27-0.98), but no other differences in sleep hygiene behaviors were observed. Conclusions: These data suggest that insomnia in midlife women is not associated with poor sleep hygiene. Increasing physical activity may be a valuable recommendation for midlife women with SDB.

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Comorbidity between sleep apnea and insomnia

Cited by 146 publications

References 51 publications

The Impact of Posttraumatic Stress Disorder on CPAP Adherence in Patients with Obstructive Sleep Apnea

The Impact of Posttraumatic Stress Disorder on CPAP Adherence in Patients with Obstructive Sleep Apnea

Insomnia related to sleep apnoea: effect of long-term auto-adjusting positive airway pressure treatment

Sleep Hygiene Behaviors Among Midlife Women with Insomnia or Sleep-Disordered Breathing: The SWAN Sleep Study

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