Abstract
People with insomnia frequently underestimate the duration of their sleep compared to objective polysomnography-measured sleep duration. Cognitive behavioural therapy for insomnia (CBT-I) is the most effective treatment for insomnia and also reduces the degree of sleep underestimation. Obstructive sleep apnoea (OSA) is a highly prevalent sleep disorder characterised by frequent narrowing (hypopnoea) and closure (apnoea) of the upper airway during sleep. Comorbid insomnia and sleep apnoea (COMISA) is a prevalent and debilitating disorder. No study has investigated subjectively (sleep diary) versus objectively (polysomnography) measured sleep discrepancies (SOSD) in individuals with COMISA before or following CBT-I. This randomised waitlist-controlled trial investigated SOSD in 145 participants with COMISA before and 6-weeks after CBT-I (n = 72) versus control (n = 73). All participants were studied prior to continuous positive airway pressure treatment for sleep apnoea. At baseline, participants underestimated their total sleep time (mean ± SD −51.9 ± 94.1 min) and sleep efficiency (−9.6 ± 18.3%), and overestimated sleep onset latency (34.5 ± 86.1 min; all p = < 0.001). Mixed models indicated a main effect of time on reduction of SOSD in both groups, but no between-group difference in the reduction of any SOSD parameters. These findings may indicate that untreated OSA contributes to a discrepancy between perceived and objective sleep parameters in people with COMISA that is not amenable to CBT-I alone (ACTRN12613001178730).
Highlights
Chronic insomnia and obstructive sleep apnoea (OSA) are the two most common sleep disorders and frequently co-occur [1,2]
All participants were diagnosed with insomnia, and Obstructive sleep apnoea (OSA) (apnoea–hypopnoea index (AHI) ≥ 15 events/h sleep, according to an overnight polysomnography study)
The results of the current study show that total sleep time, sleep onset latency, and sleep efficiency, but not wake after sleep onset, SOSD declined over time with no differences between Cognitive behavioural therapy for insomnia (CBT-I) and control groups
Summary
Chronic insomnia and obstructive sleep apnoea (OSA) are the two most common sleep disorders and frequently co-occur [1,2]. Chronic insomnia is characterised by self-reported difficulty initiating sleep, maintaining sleep, and/or early morning awakenings, combined with daytime impairments that persist for at least 3 months [1,3,4]. Chronic insomnia occurs in approximately 6–15% of the general population [4,5]. Is characterised by frequent narrowing (hypopnoea) and closure (apnoea) of the upper airway during sleep [6]. These events cause hypoxemia, cortical arousals and awakenings from sleep, and daytime impairments [6].
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