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.
Highlights
While we demonstrated that initial treatment with cognitive and behavioral therapy for insomnia (CBTi) was effective in improving initial acceptance and use of continuous positive airway pressure (CPAP) therapy [64], Alessi and colleagues [79] reported that concurrent delivery of CBTi increased CPAP use, while Ong and colleagues [88] reported no difference between initial or concurrent CBTi administration on CPAP outcomes, and Bjorvatn and colleagues [84] reported no effect of the concurrent administration of a CBTi book on insomnia or CPAP outcomes
co-morbid insomnia and sleep apnea (COMISA) was first identified by Guilleminault and colleagues in 1973, there was a lack of research attention until the publication of two papers in 1999 and 2001 indicating a 30%–50%
Subsequent research indicated that COMISA patients experience greater impairment of sleep, daytime functioning, and quality of life, compared to patients with either insomnia, or obstructive sleep apnea (OSA) alone
Summary
Insomnia and obstructive sleep apnea (OSA) are the two most common sleep disorders, which both include nocturnal sleep disturbances, impairments to daytime functioning, mood, and quality of life, Brain Sci. 2019, 9, 371; doi:10.3390/brainsci9120371 www.mdpi.com/journal/brainsci. The estimated prevalence of insomnia varies widely according to diagnostic criteria and specific populations of interest, it is thought that 6%–10% of the general population suffer from chronic insomnia disorder, which includes clinically significant and frequent nocturnal sleep disturbances and impaired daytime functioning [6,7]. The combination of frequent respiratory events and arousals from sleep throughout the night severely fragments sleep architecture, resulting in perceptions of chronically non-restorative sleep, reduced quality of life, excessive daytime sleepiness, and increased risk of motor-vehicle accidents [17,18,19]. CPAP therapy requires patients to wear pressurized nasal/oro-nasal masks throughout the night, and is limited by poor patient acceptance and disappointing long-term adherence [23]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
