Comorbid Insomnia and Obstructive Sleep Apnea (COMISA): Current Concepts of Patient Management

Ragnoli, Beatrice; Pochetti, Patrizia; Raie, Alberto; Malerba, Mario

doi:10.3390/ijerph18179248

Cited by 50 publications

(36 citation statements)

References 93 publications

(134 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One latest clinical study also found that trazodone reduces AHI and increases the awakening threshold of obstructive sleep apnea after ischemic stroke 18 . It might be another advantage of Trazodone in clinical application as the higher prevalency of insomnia symptoms in patients with OSA (40–60%) compared to that observed in the general population 42 . Further, it is worth discussing whether trazodone is more suitable for comorbid insomnia and OSA patients to improve their sleep quality or to improve their compliance with continuous positive airway pressure (CPAP) treatment.…”

Section: Discussionmentioning

confidence: 99%

Trazodone changed the polysomnographic sleep architecture in insomnia disorder: a systematic review and meta-analysis

Zheng

et al. 2022

Sci Rep

View full text Add to dashboard Cite

Trazodone has been widely prescribed for off-label use as a sleep aid. Identifying how trazodone impacts the performance of polysomnographic sleep architecture in insomnia disorder will provide additional data that can be used to guide clinical application. To assess the efficacy of trazodone in altering the polysomnographic sleep architecture in insomnia disorder so that sleep can be facilitated. PubMed, EMBASE, Web of Science, PsycINFO, Cochrane Library, Chinese Biomedical Literature Database (SinoMed), China National Knowledge Infrastructure, Wanfang Database, and the China Science and Technology Journal Database were searched for articles published between inception and June 2022. RCTs in patients with insomnia disorder applying trazodone in one arm of interventions at least 1 week, and reporting PSG parameters in the outcomes were eligible. RoB 2 was used to evaluate the risk of bias. The results of quality of evidence assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. When I2 < 50%, the fixed effects model was used. When I2 ≥ 50%, the random effects model was used. The mean differences (MD) or standardized mean differences (SMD) and odds ratios (OR) with 95% confidence intervals (CIs) were estimated. Eleven randomized controlled trials were selected and participants were 466. Risk of bias was low in 5 trials (45.5%), and was moderate in 6 (54.5%). Compared with the control group, trazodone significantly increased total sleep time (TST, min) (MD = 39.88, 95% CI 14.44–65.32, P = 0.002) and non-rapid eye movement stage 3 (N3, mixed min and %) (SMD = 1.61, 95% CI 0.69–2.53, P = 0.0006); trazodone significantly decreased latency to onset of persistent sleep (LPS, min) (MD = − 19.30, 95% CI − 37.28 to − 1.32, P = 0.04), non-rapid eye movement stage 1 (N1, mixed min and %) (SMD = − 0.62, 95% CI − 1.13 to − 0.12, P = 0.02), the number of awakenings (NAs, including both arousal times and arousal index) (SMD = − 0.67, 95% CI − 0.91 to − 0.42, P < 0.00001), and waking time after persistent sleep onset (WASO, mixed min and %) (SMD = − 0.42, 95% CI − 0.81, − 0.03, P = 0.04), with no obvious effect on non-rapid eye movement stage 2 (N2, mixed min and %) (SMD = − 0.15, 95% CI − 0.41 to 0.11, P = 0.25), rapid eye movement (REM, mixed min and %) (SMD = 0.22, 95% CI − 0.26 to 0.70, P = 0.37), rapid eye movement latency (REML, min) (MD = 2.33, 95% CI − 27.56 to 32.22, P = 0.88), or apnea–hypopnea index (AHI) (MD = − 4.21, 95% CI − 14.02 to 5.59, P = 0.40). Daytime drowsiness (OR = 2.53, 95% CI 1.14–5.64, P = 0.02) and decreased appetite (OR = 2.81, 95% CI 1.14–6.92, P = 0.02) occurred with greater frequency in the trazodone group as compared to the control group, and the differences were significant. The results of quality of evidence were very low in TST, N3 and AHI, were low in LPS, WASO and REM, and were moderate in N1 and NAs. The sources of heterogeneity in TST and N3 were not found out from sensitive and subgroup analysis and there was no high quality of evidence in outcomes by GRADE Assessment. Trials with combination of other therapy could be a problem in this meta-analysis as the possibility of interactions were found from sungroup analysis. Trazodone could improve sleep by changing the sleep architecture in insomnia disorder, but it should be used with caution due to the adverse events that may occur.PROSPERO registration register name: The effect of trazodone on polysomnography sleep architecture in patients with insomnia: a systematic review and meta-analysis protocol; Registration Number CRD42020215332.

show abstract

Section: Discussionmentioning

confidence: 99%

Trazodone changed the polysomnographic sleep architecture in insomnia disorder: a systematic review and meta-analysis

Zheng

et al. 2022

Sci Rep

View full text Add to dashboard Cite

show abstract

“…However, although the implementation of an adequate combined treatment of comorbid insomnia disorder could open new perspectives to allow a better cardiovascular outcome in apnoeic individuals [ 54 ], it seems essential to take into account the specific features of this particular subpopulation for the choice of this combined treatment in order to avoid the establishment of treatments with a negative impact for the management of OSAS [ 55 ]. Indeed, since most pharmacological treatments for comorbid insomnia disorder may have a deleterious effect on respiratory parameters in apnoeic individuals, cognitive–behavioural therapy for insomnia combined with optimal treatment of OSAS (lifestyle changes plus continuous positive airway pressure therapy/mandibular advancement devices/surgery) seems to be the best therapeutic option for apnoeic individuals with comorbid insomnia disorder [ 56 , 57 ]. Finally, alongside this combined treatment of comorbid insomnia disorder in apnoeic individuals, it is essential to establish adequate therapeutic strategies for conventional cardiovascular risk factors in order to allow integrated cardiovascular management in this particular subpopulation [ 58 ].…”

Section: Discussionmentioning

confidence: 99%

Risk of Cardiovascular Disease in Apnoeic Individuals: Role of Comorbid Insomnia Disorder

Hein

Wacquier

Lanquart

et al. 2022

Life

View full text Add to dashboard Cite

Given the limited data available, the aim of this study was to examine the 10-year cardiovascular disease (CVD) risk associated with comorbid insomnia disorder and its specific subtypes in apnoeic individuals. Data from 1104 apnoeic individuals recruited from the database of the Erasme Hospital Sleep Laboratory were analysed. Only apnoeic individuals with a Framingham Risk Score ≥10% were included in the group at moderate-to-high 10-year CVD risk. Logistic regression analyses were conducted to examine the risk of 10-year CVD risk associated with comorbid insomnia disorder and its specific subtypes in apnoeic individuals. Moderate-to-high 10-year CVD risk was present in 59.6% of the apnoeic individuals in our sample. After adjustment for the main confounding factors, multivariate logistic regression analyses revealed that comorbid insomnia disorder and, more particularly, its subtype with short sleep duration were significantly associated with moderate-to-high 10-year CVD risk in apnoeic individuals. In this study, we demonstrate that comorbid insomnia disorder and, more specifically, its subtype with short sleep duration appear to have a negative cumulative effect on 10-year CVD risk in apnoeic individuals, which justifies more systematic research and adequate therapeutic management of this disorder to allow for better cardiovascular disease prevention in this particular subpopulation.

show abstract

“…The OSA MSB subgroup was less numerous, which could result in a relatively more narrow IQR of AC and AD. Explanation of these wide ranges remains beyond the scope of this study; however, it is now widely discussed that the comorbidity of different sleep disorders is a relatively common phenomenon [ 53 , 54 , 55 ]. Participants in this study were not checked for comorbid PLM disorder or insomnia, but it was previously reported that such disorders are likely to contribute to increased MA in sleep [ 29 , 56 ].…”

Section: Discussionmentioning

confidence: 99%

Sleep Bruxism Contributes to Motor Activity Increase during Sleep in Apneic and Nonapneic Patients—A Polysomnographic Study

et al. 2022

View full text Add to dashboard Cite

Background: Jaw motor activity (MA) in sleep bruxism (SB) has been demonstrated to accompany lower limb movements. However, it remains unknown whether SB activity coexists with other types of movements and what the possible underlying mechanisms of such temporal coexistence are. In obstructive sleep apnea (OSA), increased movement activity is also reported, including SB activity; however, no studies have compared MA in apneic and nonapneic SB patients. Aim: This cross-sectional study focused on the phenomenon of “big body movements” in patients with either SB or OSA (or both) and intended to identify the primary factors contributing to their appearance, using polysomnography (PSG) recording. Methods: A whole-night videoPSG was carried out in 287 participants, and 124 apneic and 146 nonapneic participants were selected for the study. In both groups, participants were further divided into no SB, moderate SB, and severe SB (SSB) subgroups based on their bruxism episode index (BEI). MA was recorded using a built-in sensor of the central PSG unit located on the participant’s chest during the examination. Results: The presence of SB was related to the higher intensity of MA in both apneic and nonapneic participants, though in general the MA level was higher in apneic participants, with the highest level observed in SSB apneic participants. Conclusions: SB might contribute to MA. The prevalence of SB might be higher in nonapneic patients due to phasic and mixed SB activity, whereas the SB phenotype seems to be less relevant in apneic patients. SB activity is likely to increase MA in non-REM 1 sleep.

show abstract

Comorbid Insomnia and Obstructive Sleep Apnea (COMISA): Current Concepts of Patient Management

Cited by 50 publications

References 93 publications

Trazodone changed the polysomnographic sleep architecture in insomnia disorder: a systematic review and meta-analysis

Trazodone changed the polysomnographic sleep architecture in insomnia disorder: a systematic review and meta-analysis

Risk of Cardiovascular Disease in Apnoeic Individuals: Role of Comorbid Insomnia Disorder

Sleep Bruxism Contributes to Motor Activity Increase during Sleep in Apneic and Nonapneic Patients—A Polysomnographic Study

Contact Info

Product

Resources

About