Changing Faces of Obstructive Sleep Apnea: Treatment Effects by Cluster Designation in the Icelandic Sleep Apnea Cohort

Pien, Grace W.; Ye, Lichuan; Keenan, Brendan T.; Maislin, Greg; Björnsdóttir, Erla; Arnardóttir, Erna Sif; Benediktsdóttir, Bryndís; Gíslason, Þórarinn; Pack, Allan I.

doi:10.1093/sleep/zsx201

Cited by 133 publications

(98 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[40]. Between 2013 and 2018, a number of large cluster analyses of OSA samples also identified that 32%-54% of OSA patients indicate symptoms of 'disturbed sleep', characterized by nocturnal insomnia symptoms, more frequent use of sedative-hypnotic medications, and lower use of CPAP therapy [26,27,41,42]. Most recently, Zhang and colleagues conducted a systematic review and meta-analysis including 37 studies investigating the co-morbidity of insomnia and OSA, and reported that 35% of insomnia patients have an AHI of ≥5, and 29% have an AHI of ≥15, while 38% of OSA patients meet insomnia criteria [43].…”

Section: Comisa Prevalencementioning

confidence: 99%

“…Barthlen and colleagues were among the first to describe the association of insomnia symptoms and reduced CPAP adherence among two patients with severe OSA and insomnia symptoms [68]. Since this time, a large number of case studies [69], pilot studies [70,71], chart-reviews [65,72], treatment trials [44,49,50], and cluster analyses [41,42] have examined the effect of co-morbid insomnia symptoms on reduced CPAP outcomes in OSA patients. Although some studies report no association [63,73,74], the majority of research suggests that the presence of insomnia symptoms reduces CPAP acceptance and use.…”

Section: Traditional Treatment Approachesmentioning

confidence: 99%

See 1 more Smart Citation

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

2019

View full text Add to dashboard Cite

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.

show abstract

Section: Comisa Prevalencementioning

confidence: 99%

Section: Traditional Treatment Approachesmentioning

confidence: 99%

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

2019

View full text Add to dashboard Cite

show abstract

“…It is challenging to speculate why the early quitters also reported reduced nasal obstruction. However, it has been shown recently that there is a decrease in symptoms in general, even amongst non‐users to some extent (Pien et al, ).…”

Section: Discussionmentioning

confidence: 99%

PAP treatment in patients with OSA does not induce long‐term nasal obstruction

Värendh

Andersson

Björnsdóttir

et al. 2018

Journal of Sleep Research

Self Cite

View full text Add to dashboard Cite

We hypothesized that positive airway pressure treatment would induce nasal obstruction and decrease nasal cavity due to mucosal swelling. We further hypothesized that subjective and objective nasal obstruction at baseline would negatively affect positive airway pressure adherence. A total of 728 patients with sleep apnea were investigated in the Icelandic Sleep Apnea Cohort at baseline and 2 years after starting positive airway pressure. Patients underwent home sleep apnea testing at baseline. Questionnaires were answered and acoustic rhinometry was completed at baseline and follow‐up. The proportion of patients reporting subjective nocturnal nasal obstruction was reduced (baseline: 35% versus follow‐up: 24%; p < 0.001). Small interior nasal dimensions increased (p < 0.001) independent of adherence to treatment. Small nasal volume at baseline was a determinant for becoming a non‐user of positive airway pressure treatment (odds ratio 2.22, confidence interval 95% 1.35–3.67, p = 0.002). Subjective nasal obstruction decreased 2 years after initiating positive airway treatment in sleep apnea, and objectively small nasal dimensions increased. Small nasal volume at baseline was a negative predictor for positive airway pressure treatment adherence. Maybe most importantly, positive airway pressure treatment did not cause long‐term objective or subjective nasal obstruction.

show abstract

“…Over the last several decades, we have witnessed substantial increases in the granularity of the morbid phenotype of OSA, and such observations have prompted us to rethink some of the stricter early concepts. Among them, rather than viewing OSA as a single disease model that is applicable to all patients, we have formulated the conceptual framework of distinct phenotypes of OSA that may be driven by different mechanisms, link to different clinical manifestations, and display divergent responses to therapy [1][2][3][4][5][6]. In this contextual setting, the aspirational goals of the field are to first and foremost identify those OSA patients likely to benefit from treatment and administer the correct intervention, i.e.…”

mentioning

confidence: 99%

The ageing brain in sleep apnoea: paradoxical resilience, survival of the fittest, or simply comparing apples and oranges?

Gozal

2018

Eur Respir J

View full text Add to dashboard Cite

show abstract

Changing Faces of Obstructive Sleep Apnea: Treatment Effects by Cluster Designation in the Icelandic Sleep Apnea Cohort

Cited by 133 publications

References 41 publications

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

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

PAP treatment in patients with OSA does not induce long‐term nasal obstruction

The ageing brain in sleep apnoea: paradoxical resilience, survival of the fittest, or simply comparing apples and oranges?

Contact Info

Product

Resources

About