Prospective Assessment of Nocturnal Awakenings in a Case Series of Treatment-Seeking Chronic Insomnia Patients: A Pilot Study of Subjective and Objective Causes

Krakow, Barry; Romero, Edward; Ulibarri, Victor A.; Кикта, С. В.

doi:10.5665/sleep.2244

Cited by 25 publications

(27 citation statements)

References 45 publications

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“…In a metaanalysis of CBTi in comorbid medical and psychiatric disorders, only 36% of patients were in remission after treatment [15]. Supporting the role that Boccult^sleep disordered breathing is present in many patients with refractory insomnia is an article by Krakow et al that reported 90% of nocturnal awakenings in patients with chronic insomnia only (no suspicion of OSA) were due to respiratory events [16]. Clearly, a higher clinical suspicion for COMISA is required in patients with sleep disturbances as their presentation is not always classic.…”

mentioning

confidence: 99%

Comorbid insomnia and sleep apnea: a prevalent but overlooked disorder

Brock

Mysliwiec

2018

Sleep Breath

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confidence: 99%

Comorbid insomnia and sleep apnea: a prevalent but overlooked disorder

Brock

Mysliwiec

2018

Sleep Breath

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“…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. 21 Our sample did not have adequate statistical power to examine the sleep hygiene behaviors of women with both insomnia and SDB.…”

Section: Discussionmentioning

confidence: 99%

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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“…The danger of OSA going undetected among insomnia patients has been previously documented. Krakow and colleagues found that in patients endorsing insomnia but no sleep-disordered breathing (SDB) symptoms, most nighttime awakenings actually followed respiratory events, unbeknownst to the patient, 63 and 50% of the sample met criteria for OSA. Fung et al found that almost half of study participants with insomnia suffered from occult SDB (AHI ≥ 15), and the presence of excessive daytime sleepiness was the distinguishing factor between occult and nonexistent SDB.…”

Section: "Mild Insomnia" Symptom Cluster Profilementioning

confidence: 99%

Characterization of Patients Who Present With Insomnia: Is There Room for a Symptom Cluster-Based Approach?

Crawford

Chirinos

Iurcotta

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: This study examined empirically derived symptom cluster profiles among patients who present with insomnia using clinical data and polysomnography. Methods: Latent profile analysis was used to identify symptom cluster profiles of 175 individuals (63% female) with insomnia disorder based on total scores on validated self-report instruments of daytime and nighttime symptoms (Insomnia Severity Index, Glasgow Sleep Effort Scale, Fatigue Severity Scale, Beliefs and Attitudes about Sleep, Epworth Sleepiness Scale, Pre-Sleep Arousal Scale), mean values from a 7-day sleep diary (sleep onset latency, wake after sleep onset, and sleep efficiency), and total sleep time derived from an in-laboratory PSG. Results:The best-fitting model had three symptom cluster profiles: "High Subjective Wakefulness" (HSW), "Mild Insomnia" (MI) and "Insomnia-Related Distress" (IRD). The HSW symptom cluster profile (26.3% of the sample) reported high wake after sleep onset, high sleep onset latency, and low sleep efficiency. Despite relatively comparable PSG-derived total sleep time, they reported greater levels of daytime sleepiness. The MI symptom cluster profile (45.1%) reported the least disturbance in the sleep diary and questionnaires and had the highest sleep efficiency. The IRD symptom cluster profile (28.6%) reported the highest mean scores on the insomnia-related distress measures (eg, sleep effort and arousal) and waking correlates (fatigue). Covariates associated with symptom cluster membership were older age for the HSW profile, greater obstructive sleep apnea severity for the MI profile, and, when adjusting for obstructive sleep apnea severity, being overweight/obese for the IRD profile. Conclusions:The heterogeneous nature of insomnia disorder is captured by this data-driven approach to identify symptom cluster profiles. The adaptation of a symptom cluster-based approach could guide tailored patient-centered management of patients presenting with insomnia, and enhance patient care. Keywords: insomnia disorder, latent profile analysis, symptom profile, symptom clusters Citation: Crawford MR, Chirinos DA, Iurcotta T, Edinger JD, Wyatt JK, Manber R, Ong JC. Characterization of patients who present with insomnia: is there room for a symptom cluster-based approach? J Clin Sleep Med. 2017;13(7):911-921. I NTRO DUCTI O NInsomnia is the experience of the difficulty falling asleep, difficulty staying asleep, or early morning awakenings. About one-third to one-half of adults complains of these symptoms. Frequently, other complaints, such as sleepiness, fatigue, and hyperarousal, will occur with nocturnal sleep disturbance. An insomnia disorder is defined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) 2 as the combination of the nocturnal sleep disturbance with one of these waking complaints at least 3 nights a week for at least 3 months. Approximately 8% to 10% of the adult population meets these criteria. 3,4Insomnia disorder is a heterogeneous condition.5 This can pose a chall...

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Prospective Assessment of Nocturnal Awakenings in a Case Series of Treatment-Seeking Chronic Insomnia Patients: A Pilot Study of Subjective and Objective Causes

Cited by 25 publications

References 45 publications

Comorbid insomnia and sleep apnea: a prevalent but overlooked disorder

Comorbid insomnia and sleep apnea: a prevalent but overlooked disorder

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

Characterization of Patients Who Present With Insomnia: Is There Room for a Symptom Cluster-Based Approach?

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