Predictors and patterns of insomnia symptoms in OSA before and after PAP therapy
Abstract
Objective Identify factors that predict improvement versus persistence of insomnia symptoms following treatment of obstructive sleep apnea (OSA) with positive airway pressure (PAP) therapy.Methods Archival data from 68 PAP-treated sleep apnea patients aged 25-83 were analyzed using nonparametric tests and stepwise regression to assess the relationships between insomnia symptoms, multiple OSA variables, and PAP use over time.Results Pretreatment insomnia symptom severity (ISS; b = -0.72, p < 0.001), PAP average use (b = -0.01, p = 0.01) and respiratory disturbance index (RDI; b = -0.02, p = 0.03) predict change in insomnia following PAP therapy. Forty-five percent (24/53) of the subjects with moderate to severe insomnia at pretreatment reported no/mild symptoms after PAP therapy and were considered improved. Improved subjects had lower pretreatment ISS (p < 0.001), higher RDI (p = 0.01), and higher average PAP use (p < 0.035) than subjects with persistent insomnia. Number of medications and comorbidities were similar between improved and persistent groups. New onset of insomnia symptoms occurred in 13% (2/15) of the patients with no/mild pretreatment insomnia.Conclusions Although ISS declines following PAP treatment, 55% of OSA patients have persistent moderate to severe symptoms despite treatment. More severe OSA is linked to higher likelihood of insomnia improvement and the effect of PAP therapy on insomnia may be mediated by OSA severity. Persistent insomnia is unrelated to medication use or comorbidities and may represent an independent, self-sustaining disorder requiring targeted intervention.
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The ISI is a brief and valuable questionnaire measure of insomnia presence and severity, which has been utilized in several hundred insomnia treatment studies, including COMISA research.
“The ISI [54] is a brief, and valuable questionnaire measure of insomnia presence and severity, which has been utilized in several hundred insomnia treatment studies, including COMISA research [52,63,64,65].”
From Co-morbid insomnia and sleep apnea (COMISA): Prevalence, consequences, methodological considerations, and recent randomized controlled trials (2019) · cites this paper as [63]
The ISI 'nocturnal' score has recently been investigated in other insomnia research and has previously been utilized in several COMISA treatment studies.
“This ‘nocturnal’ score has also recently been investigated in other insomnia research [66,67], and has previously been utilized in several COMISA treatment studies [52,63,64].”
From Co-morbid insomnia and sleep apnea (COMISA): Prevalence, consequences, methodological considerations, and recent randomized controlled trials (2019) · cites this paper as [63]
Although some studies report no association, the majority of research suggests that the presence of insomnia symptoms reduces CPAP acceptance and use.
“Although some studies report no association [63,73,74], the majority of research suggests that the presence of insomnia symptoms reduces CPAP acceptance and use.”
From Co-morbid insomnia and sleep apnea (COMISA): Prevalence, consequences, methodological considerations, and recent randomized controlled trials (2019) · cites this paper as [63]
Previous research has reported a reduction in sleep maintenance insomnia complaints among COMISA patients who are able to tolerate CPAP therapy.
“Indeed, previous research has reported a reduction in sleep maintenance insomnia complaints among COMISA patients who are able to tolerate CPAP therapy [63,112].”
From Co-morbid insomnia and sleep apnea (COMISA): Prevalence, consequences, methodological considerations, and recent randomized controlled trials (2019) · cites this paper as [63]
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Verbraecken, J. A. (2021) · Elsevier eBooks · doi:10.1016/b978-0-08-102723-3.00133-5
The Management of COMISA (Comorbid Insomnia and Sleep Apnea)
Liao, T.-W., & Chuang, L. (2025) · Springer eBooks · doi:10.1007/978-981-95-2648-2_23
A scalable framework for population-level precision health: Insights from sleep disorders
Cawiding, O. R., Kim, D., Joo, E. Y., & Kim, J. K. (2026) · Sleep Medicine · doi:10.1016/j.sleep.2026.108898
- Authors
- Glidewell, R. N., Renn, B. N., Roby, E., & Orr, W. C.
- Affiliations
- University of Colorado Colorado Springs (US)
- University of Oklahoma Health Sciences Center (US)
- Corresponding author
- Glidewell, Robert N.
- ORCID
- Renn, Brenna N.
- Venue
- Sleep Medicine
- Publisher
- Elsevier BV
- Published
- 2014-08
- Volume
- 15
- Issue
- 8
- Pages
- 899-905
- ISSN
- 1389-9457 (ISSN-L)
- OpenAlex
- W2027880236
- Cited by
- 61
- References
- 39
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 5 · 2023: 2 · 2022: 5 · 2021: 8 · 2020: 3 · 2019: 8 · 2018: 6 · 2017: 8 · 2016: 2 · 2015: 3 · 2014: 1
- FWCI
- 3.10
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Sleep Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Keywords
- obstructive sleep apnea, insomnia, positive airway pressure, treatment response, chronic insomnia, OSA severity, respiratory disturbance index, PAP adherence, comorbidities, medication use
- MeSH terms
- Adult, Aged, Aged, 80 and over, Female, Humans, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Severity of Illness Index, Treatment Outcome, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure
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