Pharmacological management of co-morbid obstructive sleep apnoea and insomnia

Thomas, Emma; Micic, Gorica; Adams, Robert; Eckert, Danny J.

doi:10.1080/14656566.2023.2292186

Cited by 2 publications

(2 citation statements)

References 117 publications

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“…Among the therapeutic options available for COMISA, the combination of cognitive behavioral therapy for insomnia and continuous positive airway pressure therapy associated with lifestyle modifications currently remains the recommended first-line treatment [56,57]. Indeed, pharmacological treatments for insomnia are only recommended as a second line due to their potential side effects and their potential use limitations, whereas alternative treatments to continuous positive airway pressure therapy have few studied in the management of COMISA [58][59][60]. However, in the case of initiation of this combined treatment for MDD patients with COMISA, it will be necessary to anticipate the possible negative effect of MDD on compliance with cognitive behavioral therapy for insomnia and continuous positive airway pressure therapy to minimize the risk of treatment failure in this specific population subgroup [61,62].…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular Outcome in Patients with Major Depression: Role of Obstructive Sleep Apnea Syndrome, Insomnia Disorder, and COMISA

Hein,

Wacquier,

Conenna

et al. 2024

Life

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In this study, the 10-year cardiovascular risk associated with comorbid sleep disorders (insomnia disorder, obstructive sleep apnea syndrome, and COMISA [comorbid insomnia and sleep apnea]) was investigated for patients with major depression. To enable our analysis, 607 patients with major depression were selected from the data register of the Sleep Unit. High 10-year cardiovascular risk was considered present when the Framingham Risk Score was ≥10%. The 10-year cardiovascular risk associated with comorbid sleep disorders has been assessed using logistic regression analyzes. High 10-year cardiovascular risk is significant (40.4%) in patients with major depression. After successive introduction of the different confounders, multivariate logistic regressions showed that for patients with major depression high 10-year cardiovascular risk was significantly associated with COMISA but was not significantly associated with insomnia disorder or obstructive sleep apnea syndrome alone. Thus, these results highlight the existence of a negative synergistic action between insomnia disorder and obstructive sleep apnea syndrome on the 10-year cardiovascular risk in patients with major depression, which demonstrates the importance of researching and treating COMISA to improve the prognosis of this specific population subgroup characterized by higher cardiovascular morbidity and mortality.

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Section: Discussionmentioning

confidence: 99%

Cardiovascular Outcome in Patients with Major Depression: Role of Obstructive Sleep Apnea Syndrome, Insomnia Disorder, and COMISA

Hein,

Wacquier,

Conenna

et al. 2024

Life

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“…The study's primary outcomes were improvements in sleep quality and daytime sleepiness, as assessed by four questionnaires: the ISI, PSQI, ESS, and FOSQ-10. Participants completed these questionnaires at both the baseline and the end of treatment [ 31 , 32 ].…”

Section: Methodsmentioning

confidence: 99%

Effect of melatonin on insomnia and daytime sleepiness, in patients with obstructive sleep apnea and insomnia (COMISA): A randomized double-blinded placebo-controlled trial

Motlaq,

Rahimi,

Amini

2024

J Pharm Health Care Sci

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Background COMISA is a common disorder that results in nighttime awakenings ,daytime sleepiness and PAP intolerance. Cognitive behavioral therapy for insomnia is used to improve PAP adherence and no medication has been evaluated in such population yet. Melatonin with its chronobiotic and antioxidant effects may have potential benefits on COMISA consequences at the appropriate dose and time. This study aimed to evaluate the effect of melatonin on sleep quality, daytime sleepiness and PAP Compliance in patients with COMISA. Methods This double-blind placebo trial randomly assigned eligible OSA patients who suffered from insomnia despite using PAP for over a month to receive either melatonin 10 mg or placebo. The primary outcomes were measured by changes in the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and Functional Outcomes of Sleep Questionnaire (FOSQ-10) over one month. Adherence to PAP was measured by the results of the PAP device reports on the average length of time and number of nights that the device was used. Results Thirty patients were enrolled in the study after randomization. The melatonin arm showed significant improvement in all four primary outcomes compared to the placebo arm. The PSQI score was 3.836±1.839 in the melatonin arm versus 10.522±3.626 in the placebo arm (Pvalue<0.001). The ISI score was 8.476±3.568 in the melatonin arm versus 14.47±4.50 in the placebo arm (Pvalue<0.001). The ESS score was 6.854±4.334 in the melatonin arm versus 13.298±5.119 in the placebo arm (Pvalue<0.001). The FOSQ-10 score was 24.93±5.02 in the melatonin arm versus 19.87±4.24 in the placebo arm (Pvalue= 0.006). Additionally, nighttime consequences such as sleep latency and awakenings showed significant improvement in the melatonin arm. PAP devices results revealed improvement in duration of PAP use overnight. Conclusions Administering melatonin has been shown to improve self-reported sleep quality and PAP adherence in patients with COMISA. Trial registration Registration number IRCT20220105053635N1 was issued by the Iranian Registry of Clinical Trials (IRCT).

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Pharmacological management of co-morbid obstructive sleep apnoea and insomnia

Cited by 2 publications

References 117 publications

Cardiovascular Outcome in Patients with Major Depression: Role of Obstructive Sleep Apnea Syndrome, Insomnia Disorder, and COMISA

Cardiovascular Outcome in Patients with Major Depression: Role of Obstructive Sleep Apnea Syndrome, Insomnia Disorder, and COMISA

Effect of melatonin on insomnia and daytime sleepiness, in patients with obstructive sleep apnea and insomnia (COMISA): A randomized double-blinded placebo-controlled trial

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