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Co-Morbid Insomnia and Sleep Apnea (COMISA): Prevalence, Consequences, Methodological Considerations, and Recent Randomized Controlled Trials.

Published on Dec 12, 2019in Brain Sciences2.786
· DOI :10.3390/BRAINSCI9120371
Alexander Sweetman5
Estimated H-index: 5
(Flinders University),
Leon Lack38
Estimated H-index: 38
(Flinders University),
Célyne H. Bastien27
Estimated H-index: 27
(Laval University)
Abstract
Co-morbid insomnia and sleep apnea (COMISA) is a highly prevalent and debilitating disorder, which results in additive impairments to patients’ sleep, daytime functioning, and quality of life, and complex diagnostic and treatment decisions for clinicians. Although the presence of COMISA was first recognized by Christian Guilleminault and colleagues in 1973, it received very little research attention for almost three decades, until the publication of two articles in 1999 and 2001 which collectively reported a 30%–50% co-morbid prevalence rate, and re-ignited research interest in the field. Since 1999, there has been an exponential increase in research documenting the high prevalence, common characteristics, treatment complexities, and bi-directional relationships of COMISA. Recent trials indicate that co-morbid insomnia symptoms may be treated with cognitive and behavioral therapy for insomnia, to increase acceptance and use of continuous positive airway pressure therapy. Hence, the treatment of COMISA appears to require nuanced diagnostic considerations, and multi-faceted treatment approaches provided by multi-disciplinary teams of psychologists and physicians. In this narrative review, we present a brief overview of the history of COMISA research, describe the importance of measuring and managing insomnia symptoms in the presence of sleep apnea, discuss important methodological and diagnostic considerations for COMISA, and review several recent randomized controlled trials investigating the combination of CBTi and CPAP therapy. We aim to provide clinicians with pragmatic suggestions and tools to identify, and manage this prevalent COMISA disorder in clinical settings, and discuss future avenues of research to progress the field.
  • References (91)
  • Citations (8)
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References91
Newest
While in ancient Greece, incubation rooms were dedicated to the interpretation of dreams, sleep was also studied by famous philosophers such as Aristotle. In 350 B.C.E., he wrote an essay titled “On Sleep and Sleepiness”. (...)
1 CitationsSource
#1Alexander Sweetman (Flinders University)H-Index: 5
#2Leon Lack (Flinders University)H-Index: 38
Last. Jan RobinsonH-Index: 1
view all 13 authors...
Insomnia and obstructive sleep apnoea (OSA) frequently co-occur and may be causally related through sleep fragmentation and/or hyperarousal mechanisms. Previous studies suggest that OSA treatment can improve insomnia severity. However, the effect of insomnia treatment on OSA severity has not been investigated. We performed a randomised controlled trial to investigate the effect of cognitive behavioural therapy for insomnia (CBTi) on OSA severity, controlling for potential sleep-stage and posture...
1 CitationsSource
#1Danny J. Eckert (Flinders University)H-Index: 37
#2Alexander Sweetman (Flinders University)H-Index: 5
Citation:Eckert DJ, Sweetman A. Impaired central control of sleep depth propensity as a common mechanism for excessive overnight wake time: implications for sleep apnea, insomnia and beyond. J Clin...
2 CitationsSource
#1Alexander Sweetman (Flinders University)H-Index: 5
#2Leon Lack (Flinders University)H-Index: 38
Last. R. Doug McEvoy (Flinders University)H-Index: 30
view all 13 authors...
STUDY OBJECTIVES: Insomnia and obstructive sleep apnea (OSA) commonly co-occur which makes OSA difficult to treat with continuous positive airway pressure (CPAP). We conducted a randomized controlled trial in participants with OSA and co-occurring insomnia to test the hypothesis that initial treatment with cognitive and behavioral therapy for insomnia (CBT-i), versus treatment as usual (TAU) would improve insomnia symptoms and increase subsequent acceptance and use of CPAP. METHODS: One hundred ...
7 CitationsSource
#1Alexander Sweetman (Flinders University)H-Index: 5
#2Leon Lack (Flinders University)H-Index: 38
Last. Doug McEvoy (Flinders University)H-Index: 3
view all 3 authors...
CITATIONSweetman A, Lack L, McEvoy D. Refining the measurement of insomnia in patients with obstructive sleep apnea. J Clin Sleep Med. 2019;15(12):1717–1719.
2 CitationsSource
#1Douglas M. Wallace (UM: University of Miami)H-Index: 14
view all 2 authors...
Study Objectives:The Insomnia Severity Index (ISI) has been used to define insomnia symptoms in individuals with obstructive sleep apnea (OSA). However, whether distinct ISI profiles exist in indiv...
3 CitationsSource
#1Emer Van Ryswyk (Flinders University)H-Index: 2
#1Emer Van Ryswyk (Flinders University)H-Index: 7
Last. Ching Li Chai-Coetzer (Flinders University)H-Index: 13
view all 19 authors...
STUDY OBJECTIVES: Poor adherence to continuous positive airway pressure (CPAP) commonly affects therapeutic response in obstructive sleep apnea (OSA). We aimed to determine predictors of adherence to CPAP among participants of the Sleep Apnea and cardioVascular Endpoints (SAVE) trial. METHODS: SAVE was an international, randomized, open trial of CPAP plus usual care versus usual care (UC) alone in participants (45-75 years) with co-occurring moderate-to-severe OSA (≥12 episodes/h of ≥4% oxygen d...
3 CitationsSource
Last. Dirk A.A. Pevernagie (UGent: Ghent University)H-Index: 2
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Both obstructive sleep apnoea (OSA) and chronic insomnia disorder are highly prevalent in the general population. Whilst both disorders may occur together by mere coincidence, it appears that they share clinical features and that they may aggravate each other as a result of reciprocally adverse pathogenetic mechanisms. Comorbidity between chronic insomnia disorder and OSA is a clinically relevant condition that may confront practitioners with serious diagnostic and therapeutic challenges. Curren...
2 CitationsSource
#1Xiaowen Ji (Laval University)H-Index: 1
#2Célyne H. Bastien (Laval University)H-Index: 27
Last. Michael A. Grandner (UA: University of Arizona)H-Index: 37
view all 5 authors...
Abstract Objective Insomnia and depression are closely related. However, few studies have investigated whether certain insomnia symptoms differentially relate to certain depressive symptoms. The present study aimed to examine relationship between specific types of insomnia symptoms (sleep symptoms, daytime symptoms, and perception symptoms) and specific symptoms of depression. Design Cross-sectional, observational study data from the Sleep, Health, Activity, Diet and Environment and Social Facto...
5 CitationsSource
#1Julie L. Otte (IUPUI: Indiana University – Purdue University Indianapolis)H-Index: 7
#1Julie L. Otte (IUPUI: Indiana University – Purdue University Indianapolis)H-Index: 14
Last. Janet S. Carpenter (IUPUI: Indiana University – Purdue University Indianapolis)H-Index: 40
view all 9 authors...
OBJECTIVE: Women's sleep at menopause is widely reported to be problematic. The Insomnia Severity Index (ISI) is a commonly used tool for quantifying sleep problems in clinical and research settings, but psychometric properties in postmenopausal women have not been reported. Our study aim was to examine the factor structure of the ISI in a large and diverse sample of midlife women with hot flashes. METHODS: Baseline data were from 899 women enrolled in one of the three clinical trials using simi...
3 CitationsSource
Cited By8
Newest
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#1Y. Yu (University of Cambridge)
#1Yizhou Yu (University of Cambridge)
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Poor sleep is a major public health problem with implications for a wide range of critical health outcomes, including cardiovascular disease, obesity, mental health, and neurodegenerative disease.1,2 The most prevalent sleep disorders are insomnia and sleep apnoea. While questionnaires aimed at detecting and quantifying sleep problems have been used for years and proven to be reliable,3-6 they are often very extensive and scientifically worded. Here, we propose that the general population can us...
Source
While in ancient Greece, incubation rooms were dedicated to the interpretation of dreams, sleep was also studied by famous philosophers such as Aristotle. In 350 B.C.E., he wrote an essay titled “On Sleep and Sleepiness”. (...)
1 CitationsSource
#1Alexander Sweetman (Flinders University)H-Index: 5
#2Leon Lack (Flinders University)H-Index: 38
Last. Jan RobinsonH-Index: 1
view all 13 authors...
Insomnia and obstructive sleep apnoea (OSA) frequently co-occur and may be causally related through sleep fragmentation and/or hyperarousal mechanisms. Previous studies suggest that OSA treatment can improve insomnia severity. However, the effect of insomnia treatment on OSA severity has not been investigated. We performed a randomised controlled trial to investigate the effect of cognitive behavioural therapy for insomnia (CBTi) on OSA severity, controlling for potential sleep-stage and posture...
1 CitationsSource
#1Alexander Sweetman (Flinders University)H-Index: 5
#2R. Doug McEvoy (Flinders University)H-Index: 30
Last. Leon Lack (Flinders University)H-Index: 38
view all 14 authors...
STUDY OBJECTIVES: While cognitive and behavioral therapy for insomnia (CBTi) is an effective treatment in patients with co-morbid moderate and severe obstructive sleep apnea (OSA), there is concern that the bedtime restriction component of CBTi might dangerously exacerbate daytime sleepiness in such patients. We examined randomized controlled trial data to investigate the effect of OSA severity, and pre-treatment daytime sleepiness on week-to-week changes in daytime sleepiness and sleep paramete...
1 CitationsSource
#1Grace W. Pien (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 21
#2Lichuan Ye (NU: Northeastern University)H-Index: 10
Last. Allan I. Pack (UPenn: University of Pennsylvania)H-Index: 78
view all 9 authors...
Study Objectives: Distinct clinical phenotypes of obstructive sleep apnea (OSA) have been identified: Disturbed Sleep, Minimally Symptomatic, and Sleepy. Determining whether these phenotypes respond differently to standard treatment helps us to create a foundation for personalized therapies. We compared responses to positive airway pressure (PAP) therapy in these clinical OSA phenotypes. Methods: The study sample included 706 patients from the Icelandic Sleep Apnea Cohort with moderate-to-severe...
33 CitationsSource
#1Amal M Osman (UNSW: University of New South Wales)H-Index: 2
#2Sophie G. Carter (UNSW: University of New South Wales)H-Index: 3
Last. Danny J. Eckert (UNSW: University of New South Wales)H-Index: 37
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: The prevalence of obstructive sleep apnea (OSA) continues to rise. So too do the health, safety, and economic consequences. On an individual level, the causes and consequences of OSA can vary substantially between patients. In recent years, four key contributors to OSA pathogenesis or "phenotypes" have been characterized. These include a narrow, crowded, or collapsible upper airway "anatomical compromise" and "non-anatomical" contributors such as ineffective pharyngeal dilator muscle function ...
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#1Mehmet Sezai Tasbakan (Ege University)H-Index: 8
#2Canan Gunduz (Ege University)H-Index: 3
Last. Ozen K. Basoglu (Ege University)H-Index: 16
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Purpose Obstructive sleep apnea (OSA) is a common sleep disorder affecting health-related quality of life (QoL), and OSA severity is not a reliable indicator for QoL. The aim of this study was (1) to evaluate the impact of gender on QoL and (2) to identify the predictors of QoL in OSA patients.
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