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Sleep maintenance insomnia complaints predict poor CPAP adherence: A clinical case series
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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“Importantly, recent research indicates that OSA patients with comorbid insomnia are less likely to accept and use CPAP therapy compared to OSA patients without insomnia [19][20][21][22][23][24].”
In the citing paper
“Since this time, a large number of case studies [69], pilot studies [70,71], chart-reviews [65,72], treatment trials [44,49,50], and cluster analyses [41,42] have examined the effect of co-morbid insomnia symptoms on reduced CPAP outcomes in OSA patients.”
From Co-morbid insomnia and sleep apnea (COMISA): Prevalence, consequences, methodological considerations, and recent randomized controlled trials (2019) · cites this paper as [72]
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Metadata
- Authors
- Wickwire, E. M., Smith, M. T., Birnbaum, S., & Collop, N. A.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Wickwire, Emerson M.
- Venue
- Sleep Medicine
- Publisher
- Elsevier BV
- Published
- 2010-09
- Volume
- 11
- Issue
- 8
- Pages
- 772-776
- ISSN
- 1389-9457 (ISSN-L)
- 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
- 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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