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Sleep maintenance insomnia complaints predict poor CPAP adherence: A clinical case series

Wickwire, Emerson M., Smith, Michael T., Birnbaum, Sandra, Collop, Nancy A.·2010·Sleep Medicine

DOI 10.1016/j.sleep.2010.03.012

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Abstract

Background Although CPAP is a highly efficacious treatment for obstructive sleep apnea (OSA), low adherence presents a significant challenge for sleep medicine clinicians. The present study aimed to evaluate the relationship between insomnia symptoms and CPAP use. We hypothesized that pre-treatment insomnia complaints would be associated with poorer CPAP adherence at clinical follow-up.Methods This was a retrospective chart review of 232 patients (56.5% men, mean age=53.6+/-12.4years) newly diagnosed with OSA (mean AHI=41.8+/-27.7) and prescribed CPAP in the Johns Hopkins Sleep Disorder Center. Difficulty initiating sleep, difficulty maintaining sleep, and early morning awakening were measured via three self-report items. CPAP use was measured via objective electronic monitoring cards.Results Thirty-seven percent of the sample reported at least one frequent insomnia complaint, with 23.7% reporting difficulty maintaining sleep, 20.6% reporting early morning awakening and 16.6% reporting difficulty initiating sleep. After controlling for age and gender, sleep maintenance insomnia displayed a statistically significant negative relationship with average nightly minutes of CPAP use (p<.05) as well as adherence status as defined by the Centers for Medicaid and Medicare Services (p<.02).Conclusions To our knowledge, these are the first empirical data to document that insomnia can be a risk factor for poorer CPAP adherence. Identifying and reducing insomnia complaints among patients prescribed CPAP may be a straightforward and cost-effective way to increase CPAP adherence.

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Authors: Wickwire, E. M., Smith, M. T., Birnbaum, S., & Collop, N. A.
Affiliations: Johns Hopkins University (US)
Corresponding author: Wickwire, Emerson M.
ORCID: Wickwire, Emerson M.
Smith, Michael T.
Collop, Nancy A.
Venue: Sleep Medicine
Publisher: Elsevier BV
Published: 2010-09
Volume: 11
Issue: 8
Pages: 772-776
ISSN: 1389-9457 (ISSN-L)
DOI: 10.1016/j.sleep.2010.03.012
OpenAlex: W2049525773
Cited by: 149
References: 40
Citations by year: 2026: 5 · 2025: 13 · 2024: 8 · 2023: 10 · 2022: 15 · 2021: 8 · 2020: 11 · 2019: 12 · 2018: 10 · 2017: 8 · 2016: 5 · 2015: 4 · 2014: 10 · 2013: 16 · 2012: 8
FWCI: 6.50
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Sleep Medicine (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Health Sciences › Dentistry › Oral Surgery › Temporomandibular Joint Disorders
Keywords: sleep maintenance insomnia, CPAP adherence, obstructive sleep apnea, insomnia symptoms, early morning awakening, difficulty initiating sleep
MeSH terms: Adult, Aged, Female, Follow-Up Studies, Humans, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Patient Compliance, Predictive Value of Tests, Retrospective Studies, Risk Factors, Logistic Models, Treatment Outcome, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure

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Sleep maintenance insomnia complaints predict poor CPAP adherence: A clinical case series

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