Abstract
ObjectiveObstructive sleep apnea (OSA) and insomnia are the two most common sleep disorders. Continuous positive airway pressure (CPAP) is considered first-line treatment for OSA. In the present study, we assess the effect of CPAP on symptoms and prevalence of insomnia in patients with OSA. We hypothesized a decrease in insomnia symptoms from CPAP initiation to follow-up, and that this decrease would depend on CPAP adherence.Materials and methodsThe sample included 442 patients diagnosed with OSA [mean age 54.9 years (SD = 12.1), 74.4% males] who started treatment with CPAP at a university hospital. OSA was diagnosed according to standard respiratory polygraphy. Mean apnea-hypopnea index (AHI) was 30.1 (SD = 21.1) at baseline. Insomnia was assessed prior to CPAP treatment (baseline) and at follow-up after a median of 19.9 weeks (range 6–52 weeks) with the Bergen Insomnia Scale (BIS). CPAP adherence was defined as an average use of ≥ 4 h per night, whereas non-adherence was defined as < 4 h per night.ResultsThere was a significant decrease in BIS scores from baseline (mean = 18.8, SD = 9.8) to follow-up (mean = 12.9, SD = 9.9), p < 0.001. Cohen’s d(0.65) indicated a moderate effect size. The reduction in BIS scores was depending on CPAP adherence (interaction effect F(1,440) = 12.4, p < 0.001), with larger reduction in the adherent group than in the non-adherent group. The proportion of patients with chronic insomnia was significantly reduced from 51.1% at baseline to 33.0% at follow-up (p < 0.001).ConclusionOverall, there was a significant reduction in insomnia symptoms from baseline to follow-up. The improvement was significant in both adherence groups, but the degree of improvement was larger among patients who were adherent to CPAP. Furthermore, there was a significant reduction in the prevalence of chronic insomnia at follow-up compared to baseline. This suggests that CPAP effectively reduces both the presence of insomnia and the severity of insomnia symptoms in some patients with OSA.
Highlights
Obstructive sleep apnea (OSA) and insomnia are the two most common sleep disorders in the general population
We hypothesized a reduced prevalence of chronic insomnia at follow-up compared to baseline
There was a significant reduction in the prevalence of patients who fulfilled the diagnosis of chronic insomnia at follow-up compared to baseline
Summary
Obstructive sleep apnea (OSA) and insomnia are the two most common sleep disorders in the general population. OSA affects at least 8–10% whereas insomnia affects about 7–16% of the population, depending on the diagnostic criteria used (Ohayon and Reynolds, 2009; Hrubos-Strøm et al, 2011; Peppard et al, 2013; Pallesen et al, 2014). OSA is characterized by breathing pauses, oxygen desaturation, and arousals during sleep (American Academy of Sleep Medicine, 2014). Symptoms such as snoring and daytime sleepiness are common. The apnea-hypopnea-index (AHI) is used to classify the severity of OSA, in which a higher AHI indicates more severe OSA. Chronic insomnia is characterized by self-reported difficulties initiating sleep, maintaining sleep, and/or early morning awakenings from sleep, which are associated with daytime impairment for a period of 3 months or more (American Psychiatric Association, 2013)
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