Abstract
Insomnia and obstructive sleep apnea (OSA) are often both present in patients with sleep-disordered-breathing (SDB). The coexistence of the two disorders shows an increase in cumulative morbidity and an overall greater illness severity. There is still considerable controversy regarding management decisions in this group of patients. This systematic review focused on more recent evidence regarding treatment of patients presenting with both clinical entities of comorbid insomnia and OSA (COMISA) in terms of their management, especially using combinations of positive airway pressure [PAP, namely aPAP, cPAP, adaptive servo-ventilation (ASV)] and CBTi as well as each one of these two modalities alone. As a conclusion it is necessary to specifically target distinct combinations of both insomnia (initial, middle, late) and OSA (mild, moderate, severe) phenotypes. The present review gives reason to assume that both CBTi and PAP-therapy are necessary. However, it appears that distinct treatment patterns may suit different COMISA phenotypes.
Highlights
Insomnia and obstructive sleep apnea (OSA) are often both present in patients with sleep-disordered-breathing (SDB) (1–3)
We extended the information of these two studies by reviewing literature from 2010 to 2017 focusing on the following aspects: Our primary research question was to review observational or interventional studies about the association between PAPtherapy and CBTI as exposures and insomnia as the outcome in comorbid insomnia and OSA (COMISA) patients
Three of the six studies that addressed our primary research question and two of the seven studies that analyzed the association between insomnia and adherence to positive airway pressure (PAP) used more eligibility criteria than OSA and insomnia to define their populations
Summary
Insomnia and obstructive sleep apnea (OSA) are often both present in patients with sleep-disordered-breathing (SDB) (1–3). An association between insomnia and OSA was first described in 1973 (4). Some studies have shown a high prevalence (39 to 55 %) of insomnia symptoms in patients with OSA in the past (1, 5–7). Insomnia and OSA both share a number of negative consequences, which include increased cardiovascular risk and decreased health-related quality of life (QOL) (8–11). The two disorders combined show an increase in cumulative morbidity and an overall greater illness severity (5). It is believed that OSA could either cause insomnia or exacerbate it (12)
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