Obstructive sleep apnea, insomnia and restless leg syndrome (COMISAR): A triple calamity

Abstract

<b>Background:</b> Obstructive sleep apnoea (OSA) is known to be coexistent with insomnia and restless leg syndrome (RLS). Comorbid patients are likely to have severe disturbance in sleep, poor quality of life and poor compliance to continuous positive airway pressure compared to OSA alone. No study has evaluated the prevalence and consequences of the triple combination of OSA, insomnia and RLS. <b>Aims and Objectives:</b> 1) To determine the prevalence of comorbid insomnia and RLS among OSA patients. 2) To compare the demographic characteristics and presence of comorbidities among patients of OSA with insomnia and RLS overlap versus OSA alone. <b>Methods:</b> It was a prospective observational study involving 250 patients of suspected OSA. OSA was confirmed in 189 patients after type-I polysomnography. Insomnia and RLS were diagnosed based on the ICSD-3 criteria. <b>Results:</b> The prevalence of insomnia and RLS among OSA was 15.3% (29/189) and 32.3% (61/189) respectively. Overlap of insomnia, RLS and OSA (COMISAR) was seen in 8.5% (16/189). The overlap patients had lower ESS score (12.3 vs 14.8), lower apnoea-hypopnoea index (28.5 vs 35.2) compared to OSA alone. The prevalence of comorbidities such as diabetes, hypertension, hypothyroidism, obstructive airway disease and depression was higher among overlap patients. <b>Conclusions:</b> The prevalence of insomnia, RLS and OSA overlap is high (8.46%). These patients have a significantly higher prevalence of depression and chronic obstructive airway disease and a higher prevalence of cardiovascular comorbidities. Thus, it is advisable to screen all patients of OSA for the presence of triple calamity of insomnia, RLS and OSA i.e. COMISAR.