Comorbid insomnia symptoms predict lower 6-month adherence to CPAP in US veterans with obstructive sleep apnea

Wallace, Douglas M.; Sawyer, A. M.; Shafazand, S.

doi:10.1007/s11325-017-1605-3

Cited by 70Obstructive Sleep Apnea ResearchSleep and related disordersTemporomandibular Joint Disorders

Comorbid insomnia symptoms predict lower 6-month adherence to CPAP in US veterans with obstructive sleep apnea

Wallace, Douglas M., Sawyer, A. M., Shafazand, S.·2018·Sleep And Breathing

DOI 10.1007/s11325-017-1605-3

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Abstract

Purpose There is limited information on the association between pre-treatment insomnia symptoms and dysfunctional sleep beliefs with continuous positive airway pressure (CPAP) adherence in veterans with obstructive sleep apnea (OSA). Our aims were to describe demographic and sleep characteristics of veterans with and without comorbid insomnia and determine whether pre-treatment insomnia symptoms and dysfunctional sleep beliefs predict CPAP use after 6 months of therapy.Methods Hispanic veterans attending the Miami VA sleep clinic were recruited and completed the insomnia severity index, the dysfunctional sleep belief and attitude scale (DBAS), and other questionnaires. Participants were asked to return after 7 days and 1 and 6 months to repeat questionnaires and for objective CPAP adherence download. Hierarchical regression models were performed to determine adjusted associations of pre-treatment insomnia symptoms and DBAS sub-scores on 6-month mean daily CPAP use.Results Fifty-three participants completed the 6-month follow-up visit with a mean CPAP use of 3.4 ± 1.9 h. Veterans with comorbid insomnia had lower mean daily CPAP use (168 ± 125 vs 237 ± 108 min, p = 0.04) and lower percent daily CPAP use ≥ 4 h (32 ± 32 vs 51 ± 32%, p = 0.05) compared to participants without insomnia. In adjusted analyses, pre-treatment insomnia symptoms (early, late, and aggregated nocturnal symptoms) and sleep dissatisfaction were predictive of lower CPAP use at 6 months. Pre-treatment dysfunctional sleep beliefs were not associated with CPAP adherence.Conclusions Pre-treatment nocturnal insomnia symptoms and sleep dissatisfaction predicted poorer 6- month CPAP use. Insomnia treatment preceding or concurrent with CPAP initiation may eliminate a barrier to regular use.

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Since 2017, a number of other studies have confirmed associations between COMISA and increased depressive and anxiety symptoms, daytime sleepiness, reduced quality of life, neurocognitive performance, and sleep quality compared to patients with either insomnia or OSA alone.
“Since 2017, a number of other studies have confirmed associations between COMISA and increased depressive and anxiety symptoms, daytime sleepiness, reduced quality of life, neurocognitive performance, and sleep quality compared to patients with either insomnia or OSA alone [46,47,48,49,50,51,52].”
From Co-morbid insomnia and sleep apnea (COMISA): Prevalence, consequences, methodological considerations, and recent randomized controlled trials (2019) · cites this paper as [49]

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Authors: Wallace, D. M., Sawyer, A. M., & Shafazand, S.
Affiliations: University of Miami (US)
Pennsylvania State University (US)
Corresponding author: Wallace, Douglas M.
ORCID: Wallace, Douglas M.
Sawyer, A. M.
Shafazand, S.
Venue: Sleep And Breathing
Publisher: Springer Science and Business Media LLC
Published: 2018-01-04
Volume: 22
Issue: 1
Pages: 5-15
ISSN: 1520-9512 (ISSN-L)
1522-1709
DOI: 10.1007/s11325-017-1605-3
OpenAlex: W2781497786
Cited by: 70
References: 42
Citations by year: 2026: 5 · 2025: 5 · 2024: 10 · 2023: 10 · 2022: 12 · 2021: 8 · 2020: 8 · 2019: 10 · 2018: 2
FWCI: 4.80
Type: journal article
Language: en
Open access: closed
Licence: www.springer.com/tdm (unspecified)
Locations: Sleep And Breathing (publishedVersion)
PubMed (publishedVersion)
Funders: American Sleep Medicine Foundation
Topics: Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Health Sciences › Health Professions › Complementary and Manual Therapy › Temporomandibular Joint Disorders
Keywords: obstructive sleep apnea, CPAP adherence, insomnia comorbidity, veterans, sleep dissatisfaction, CPAP therapy
MeSH terms: Female, Hispanic or Latino, Humans, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Patient Compliance, Veterans, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure

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Comorbid insomnia symptoms predict lower 6-month adherence to CPAP in US veterans with obstructive sleep apnea

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