Insomnia and sleep-disordered breathing

Lloyd Rigler Sleep Apnea Research Laboratory, Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Sleep Medicine (Impact Factor: 3.15). 01/2008; 8 Suppl 4:S21-5. DOI: 10.1016/S1389-9457(08)70005-4
Source: PubMed


Approximately half of patients with sleep-disordered breathing (SDB) also experience insomnia. The relationship between these two common sleep disorders is complex and unclear but patients with both SDB and insomnia have poorer sleep quality and are more likely to have psychiatric disorders than those with SDB alone. SDB is more common in men than women; however, the incidence of comorbid insomnia is greater in women with SDB than in men. The management of comorbid SDB and insomnia involves the screening of patients with insomnia or psychiatric disorders for SDB; although interviews may be effective in diagnosing SDB in patients with insomnia, polysomnography can diagnose veiled SDB. To address comorbid SDB and insomnia therapies should be aimed at both disorders. Patients should first be encouraged to improve their sleep hygiene and make lifestyle changes to improve sleep. Treatments for SDB include continuous positive airway pressure and oral appliances, while upper airway surgery may improve sleep outcomes in some patients. The use of pharmacological drugs such as hypnotics for the treatment of insomnia in patients with SDB remains controversial.

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Available from: Peretz Lavie, Apr 13, 2014
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    • "Consistent with recent reports (Björnsdóttir et al., 2012; Hagen et al., 2009; Krakow et al., 2013; Krell & Kapur, 2005; Lavie, 2007; Lichstein et al., 2013; Luyster et al., 2010), and our first hypothesis, the present study finds an important presence of poor sleep and insomnia in patients diagnosed with sleep apnea. Seventy-six percent of OSA patients endorsed DIMS symptoms and 38% meet criteria for a diagnosis of insomnia. "
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    ABSTRACT: The aims of this study were to examine the presence, type, and severity of insomnia complaints in obstructive sleep apnea (OSA) patients and to assess the utility of the Sleep Symptom Checklist (SSC) for case identification in primary care. Participants were 88 OSA patients, 57 cognitive-behavioral therapy for insomnia (CBT-I) patients, and 14 healthy controls (Ctrl). Each completed a sleep questionnaire as well as the SSC, which includes insomnia, daytime functioning, psychological, and sleep disorder subscales. Results showed that OSA patients could be grouped according to 3 insomnia patterns: no insomnia (OSA), n = 21; insomnia (OSA-I), n = 30, with a subjective complaint and disrupted sleep; and noncomplaining poor sleepers (OSA-I-NC), n = 37. Comparisons among the OSA, CBT-I, and Ctrl groups demonstrate distinct profiles on the SSC subscales, indicating its potential utility for both case identification and treatment planning.
    Full-text · Article · Oct 2015 · Behavioral Sleep Medicine
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    • "Finally, it is noteworthy that studies have found an increased prevalence of insomnia in adults with SDB.98,99 Of a random sample of patients diagnosed with SDB, Krakow and associates99 found that 50% also had clinically significant signs of insomnia, and that those patients with both SDB and insomnia had more medical and psychiatric disorders and consumed more sedatives and psychotropic medications compared to SDB patients without insomnia. "
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    ABSTRACT: Although the physiological and psychological mechanisms involved in the development of sleep disorders remain similar throughout history, factors that potentiate these mechanisms are closely related to the "zeitgeist", ie, the sociocultural, technological and lifestyle trends which characterize an era. Technological advancements have afforded modern society with 24-hour work operations, transmeridian travel and exposure to a myriad of electronic devices such as televisions, computers and cellular phones. Growing evidence suggests that these advancements take their toll on human functioning and health via their damaging effects on sleep quality, quantity and timing. Additional behavioral lifestyle factors associated with poor sleep include weight gain, insufficient physical exercise and consumption of substances such as caffeine, alcohol and nicotine. Some of these factors have been implicated as self-help aids used to combat daytime sleepiness and impaired daytime functioning. This review aims to highlight current lifestyle trends that have been shown in scientific investigations to be associated with sleep patterns, sleep duration and sleep quality. Current understanding of the underlying mechanisms of these associations will be presented, as well as some of the reported consequences. Available therapies used to treat some lifestyle related sleep disorders will be discussed. Perspectives will be provided for further investigation of lifestyle factors that are associated with poor sleep, including developing theoretical frameworks, identifying underlying mechanisms, and establishing appropriate therapies and public health interventions aimed to improve sleep behaviors in order to enhance functioning and health in modern society.
    Preview · Article · Mar 2012 · Nature and Science of Sleep
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    • "The relationship between these two common sleep disorders is complex and unclear, but patients with both SDB and insomnia have poorer sleep quality, and the incidence of comorbid insomnia is greater in women with SDB than in men [7] [8] [9] [10] [11]. Therefore, the analysis of the decreased SP in the insomnia + SDB group has clinical relevance. "
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