Comorbid insomnia in sleep-related breathing disorders: an under-recognized association

Abstract

Therefore, we have reviewed published studies that investigated insomnia in patients with different types of SBD; obstructive sleep apnea, central sleep apnea, and hypoventilation syndromes, as well as studies that assessed SBD in patients with insomnia. In addition, we reviewed the effects of SBD treatment modalities on insomnia and the effects of insomnia treatments on SBD.

Sleep, Psychosocial Functioning, and Device-Specific Adjustment in Patients with Implantable Cardioverter Defibrillators (ICDs)

“…The prevalence rate of OSA in our sample (40.5%) is consistent with previous findings in the literature (40–77%; Fries et al, 1999; Grimm et al, 2013; Mehra et al, 2006; Serizawa et al, 2008; Tomaello et al, 2010), although our rate of OSA and comorbid insomnia (11.9%) is low relative to previously reports in ICD patients with nocturnal ventricular arrhythmias (22–54.9%; Al-Jawder & Bahammam, 2011). Our prevalence rate for insomnia within the sample (28.6%) is lower but somewhat comparable to previous findings in heart failure patients (44%; Taylor et al, 2007), and suggests that insomnia is a considerable problem with these patients as a less-recognized and/or treated condition that until recently has received little attention (Cross et al, 2010).…”

Comorbid insomnia and sleep apnea: a prevalent but overlooked disorder

“…Despite the realization that this comorbidity was under-recognized and had implications for disease-related outcomes, little has changed in the ensuing years [4]. In this issue of Sleep and Breathing, there are three articles in veteran populations which substantially further our understanding of this disorder.…”

Insomnia and excessive daytime sleepiness in obstructive sleep apnea: only different clinical phenotypes?

“…When suspicion of OSA exists, physicians should not defer a sleep study for patients simply because they deny excessive daytime sleepiness by clinical history or score low on the Epworth sleepiness scale (ESS). Insomnia is another sleep disorder commonly associated with obstructed breathing during sleep, but this association has received less focus compared to excessive daytime sleepiness [7,8]. Inconsistencies in the definitions and assessments of insomnia across studies hinder our understanding of the prevalence of co-morbid insomnia in OSA and limit the ability to compare findings across studies.…”

“…The main change is that non-restorative sleep is no longer part of the insomnia diagnosis in DSM-V/ICSD-3. Nonrestorative sleep is reported to be more common in OSA patients than problems with sleep initiation and maintenance [7,8]. Hence, the new insomnia criteria will probably reduce the reported prevalence of insomnia in OSA patients.…”

“…The relationship between these two common sleep disorders is complex and in many points unclear. Based on published studies, there is a higher incidence of breathing disorders in insomniac patients than there is in the general population [7,8,12]. Lichstein et al [13] demonstrated that high proportions of individuals, particularly the elderly, present this combined condition of undiagnosed sleep apnea and insomnia.…”