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Worldwide and regional prevalence rates of co-occurrence of insomnia and insomnia symptoms with obstructive sleep apnea: A systematic review and meta-analysis
Abstract
Recent investigations have established that patients with obstructive sleep apnea (OSA) and insomnia have greater daytime impairments and reduced quality of life compared to those with either disorder alone. The present study reviewed current data on the co-occurrence prevalence of insomnia and insomnia symptoms with OSA and assessed its worldwide and regional prevalence based on World Health Organization (WHO) regions. A total of 37 studies were included in the analysis. The overall prevalence rates of insomnia, any insomnia complaints, difficulty falling asleep (DFA), difficulty maintaining sleep (DMS) and early morning awakening (EMA) found in OSA patients were 38%, 36%, 18%, 42%, and 21%, respectively. According to the regional classification of the WHO, the rates of DFA, DMS and EMA in OSA patients in the Western Pacific Region were lower than those in the European Region and the Region of the Americas. We also analyzed the pooled prevalence rates of OSA based on different apnea-hypopnea index (AHI) criteria in insomnia patients. The rates were 35% (AHI≥5) and 29% (AHI≥15), respectively. Regional differences of DFA, DMS and EMA in OSA patients may be related to sex, age and body mass index.
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“Most recently, Zhang and colleagues conducted a systematic review and meta-analysis including 37 studies investigating the co-morbidity of insomnia and OSA, and reported that 35% of insomnia patients have an AHI of ≥5, and 29% have an AHI of ≥15, while 38% of OSA patients meet insomnia criteria [43].”
From Co-morbid insomnia and sleep apnea (COMISA): Prevalence, consequences, methodological considerations, and recent randomized controlled trials (2019) · cites this paper as [43]
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International Consensus Statement on Obstructive Sleep Apnea
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Sweetman, A., Lack, L., & Bastien, C. (2019) · Brain Sciences · doi:10.3390/brainsci9120371 · Cited by 253
“Most recently, Zhang and colleagues conducted a systematic review and meta-analysis including 37 studies investigating the co-morbidity of insomnia and OSA, and reported that 35% of insomnia patients have an AHI of ≥5, and 29% have an AHI of ≥15, while 38% of OSA patients meet insomnia criteria [43].”
BackgroundBi-directional relationships between co-morbid insomnia and sleep apnea (COMISA)
Sweetman, A., Lack, L., McEvoy, R. D., Smith, S., Eckert, D. J., Osman, A., Carberry, J. C., Wallace, D., Nguyen, P. D., & Catcheside, P. (2021) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2021.101519 · Cited by 203
Alimoradi, Z., Jafari, E., Broström, A., Ohayon, M. M., Lin, C., Griffiths, M. D., Blom, K., Jernelöv, S., Kaldo, V., & Pakpour, A. H. (2022) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2022.101646 · Cited by 193
Metadata
- Authors
- Zhang, Y., Ren, R., Lei, F., Zhou, J., Zhang, J., Wing, Y.-K., Sanford, L. D., & Tang, X.
- Affiliations
- Sichuan University (CN)
- Chinese University of Hong Kong (HK)
- Eastern Virginia Medical School (US)
- Corresponding author
- Sanford, Larry D.
- Tang, Xiangdong
- ORCID
- Venue
- Sleep Medicine Reviews
- Publisher
- Elsevier BV
- Published
- 2019-06
- Volume
- 45
- Pages
- 1-17
- ISSN
- 1087-0792 (ISSN-L)
- OpenAlex
- W2911231313
- Cited by
- 238
- References
- 100
- Citations by year
- 2026: 32 · 2025: 39 · 2024: 30 · 2023: 37 · 2022: 28 · 2021: 49 · 2020: 14 · 2019: 8
- FWCI
- 3.67
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Sleep Medicine Reviews (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Basic Research Program of China (2015CB856406)
- National Institutes of Health (MH64827)
- National Natural Science Foundation of China (81770087, 81530002, 81629002)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Keywords
- obstructive sleep apnea, insomnia, insomnia symptoms, comorbidities, prevalence, regional variation, WHO regions, difficulty falling asleep, difficulty maintaining sleep, early morning awakening, apnea-hypopnea index, body mass index, sex differences, age differences
- MeSH terms
- Adult, Female, Humans, Disorders of Excessive Somnolence, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Severity of Illness Index, Sleep Apnea Syndromes, Comorbidity, Prevalence, Sleep Apnea, Obstructive
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