A case of obstructive sleep apnea syndrome presenting as paradoxical insomnia
Open accessAbstract
A 63-year-old female with obstructive sleep apnea syndrome (OSAS) presented with clinical features indistinguishable from paradoxical insomnia (PI). Her main complaint was chronic insomnia. Her subjective sleep latency was 2-3 h, subjective sleep time was less than 3 h, despite spending 8 h in bed, and she reported near constant awareness of her surroundings while lying in bed. Her body mass index (BMI) was 22.67 kg/m(2), and her neck circumference was 34.5 cm. Nocturnal polysomnography (NPSG) findings indicated severe OSAS. Her total sleep time (TST) was 359 min, sleep latency 13 min, and her apnea/hypopnea index (AHI) was 74.6/h. The aim of this report is to evaluate the association between PI and OSAS cases confirmed by NPSG.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
A large number of case studies, pilot studies, chart-reviews, treatment trials, and cluster analyses have examined the effect of co-morbid insomnia symptoms on reduced CPAP outcomes in OSA patients.
“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 [69]
The Abstract identifies this as a case report about insomnia symptoms in a patient with obstructive sleep apnea, supporting its citation as a case study. But the Case section says the patient refused CPAP, so the report does not examine whether insomnia reduced CPAP outcomes. (LLM, conf=0.88)
Experimental — accuracy not yet measuredAlthough several early pilot studies and a randomized controlled trial reported mixed findings, more recent quasi-experimental and RCT data support the effectiveness of CBTi in COMISA patients.
“Although several early pilot studies and a randomized controlled trial (RCT) reported mixed findings [69,75,76,77], more recent quasi-experimental and RCT data support the effectiveness of CBTi in COMISA patients [52,64,78,79].”
From Co-morbid insomnia and sleep apnea (COMISA): Prevalence, consequences, methodological considerations, and recent randomized controlled trials (2019) · cites this paper as [69]
The Case section (page not provided) reports that one patient with insomnia and obstructive sleep apnea did not improve despite good compliance with CBT, consistent with an unsuccessful early treatment result. But this is a case report, not a pilot study or randomized controlled trial, and it does not establish that those studies had mixed findings. The later effectiveness claim has a separate citation group. (LLM, conf=0.82)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Principles and Practice of Sleep Medicine
Kryger, M. H., Roth, T. G., & Dement, W. C. (2011) · Elsevier eBooks · doi:10.1016/c2009-0-59875-3 · Cited by 5,118 · see citing works
The International Classification of Sleep Disorders
Daroff, R. B. (1991) · Neurology · doi:10.1212/wnl.41.1.160 · Cited by 5,025 · see citing works
Young, T. (2002) · Archives of Internal Medicine · doi:10.1001/archinte.162.8.893 · Cited by 1,304 · see citing works
Principles And Practice Of Sleep Medicine
Ayvazian, L. F. (1989) · American Review of Respiratory Disease · doi:10.1164/ajrccm/140.4.1172a · Cited by 554 · see citing works
(1976) · American Journal of Psychiatry · doi:10.1176/ajp.133.12.1382 · Cited by 549 · see citing works
Relationship between reported and measured sleep times: the sleep heart health study (SHHS)
Silva, G. E., Goodwin, J. L., Sherrill, D. L., Arnold, J. L., Bootzin, R. R., Smith, T., Walsleben, J. A., Baldwin, C. M., & Quan, S. F. (2007) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.26974 · Cited by 295 · see citing works
The distribution and clinical significance of sleep time misperceptions among insomniacs
Edinger, J. D., & Fins, A. I. (1995) · SLEEP · doi:10.1093/sleep/18.4.232 · Cited by 226 · see citing works
Sleep apnea: Clinical investigations in humans
Banno, K., & Kryger, M. H. (2007) · Sleep Medicine · doi:10.1016/j.sleep.2007.03.003 · Cited by 219 · see citing works
Subtyping primary insomnia: is sleep state misperception a distinct clinical entity?
Edinger, J. D., & Krystal, A. D. (2003) · Sleep Medicine Reviews · doi:10.1053/smrv.2002.0253 · Cited by 185 · see citing works
Physiological Activation in Patients With Sleep State Misperception
Bonnet, M. H., & Arand, D. L. (1997) · Psychosomatic Medicine · doi:10.1097/00006842-199709000-00011 · Cited by 181 · see citing works
Occult sleep apnea in a recruited sample of older adults with insomnia
Lichstein, K. L., Riedel, B. W., Lester, K. W., & Aguillard, R. N. (1999) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.67.3.405 · Cited by 143 · see citing works
Severe obstructive sleep apnea—I: Onset, clinical course, and characteristics
Kales, A., Cadieux, R. J., Bixler, E. O., Soldatos, C. R., Vela‐Bueno, A., Misoul, C. A., & Locke, T. (1985) · Journal of Chronic Diseases · doi:10.1016/0021-9681(85)90137-7 · Cited by 129 · see citing works
Chung, K. (2005) · Respiration · doi:10.1159/000087668 · Cited by 129 · see citing works
Management of chronic insomnia in elderly persons.
Bain, K. (2006) · The American Journal of Geriatric Pharmacotherapy · doi:10.1016/j.amjopharm.2006.06.006 · Cited by 124 · see citing works
Paradoxical insomnia: The role of CAP and arousals in sleep misperception
Parrino, L., Milioli, G., Paolis, F. D., Grassi, A., & Terzano, M. G. (2009) · Sleep Medicine · doi:10.1016/j.sleep.2008.12.014 · Cited by 113 · see citing works
Antidepressants for the Treatment of Insomnia
Wiegand, M. (2012) · Drugs · doi:10.2165/0003495-200868170-00001 · Cited by 101 · see citing works
Reynolds, C. F., Kupfer, D. J., Buysse, D. J., Coble, P. A., & Yeager, A. (1991) · American Journal of Psychiatry · doi:10.1176/ajp.148.4.432 · Cited by 93 · see citing works
Quetiapine in primary insomnia: a pilot study
Wiegand, M. H., Landry, F., Brückner, T., Pohl, C., Veselý, Z., & Jähn, T. (2007) · Psychopharmacology · doi:10.1007/s00213-007-0968-8 · Cited by 83 · see citing works
McCall, W. V., Turpin, E., Reboussin, D. M., Edinger, J. D., & Haponik, E. F. (1995) · SLEEP · doi:10.1093/sleep/18.8.646 · Cited by 67 · see citing works
Clinical Characteristics of Obstructive Sleep Apnea in Community‐Dwelling Older Adults
Endeshaw, Y. W. (2006) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2006.00924.x · Cited by 67 · see citing works
Subjective Total Insomnia: An Example of Sleep State Misperception
McCall, W. V., & Edinger, J. D. (1992) · SLEEP · doi:10.1093/sleep/15.1.71 · Cited by 60 · see citing works
Hypersomnolence, insomnia and the pathophysiology of upper airway resistance syndrome
Gold, A. R., Gold, M. S., Harris, K. W., Espeleta, V. J., Amin, M. M., & Broderick, J. E. (2008) · Sleep Medicine · doi:10.1016/j.sleep.2007.08.013 · Cited by 57 · see citing works
Effects of Age on the Clinical Features of Men with Obstructive Sleep Apnea Syndrome
Chung, S., Yoon, I., Lee, C. H., & Kim, J. (2009) · Respiration · doi:10.1159/000218143 · Cited by 45 · see citing works
Self-citationSubjective insomnia without objective findings: A pseudo diagnostic classification?
Trinder, J. C. (1988) · Psychological Bulletin · doi:10.1037/0033-2909.103.1.87 · Cited by 45 · see citing works
Why We Steep: The Functions of Sleep in Humans and Other Mammals
Reynolds, C. F., & Buysse, D. J. (1991) · American Journal of Psychiatry · doi:10.1176/ajp.148.7.944-a · Cited by 15 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Sweetman, A., Lack, L., & Bastien, C. (2019) · Brain Sciences · doi:10.3390/brainsci9120371 · Cited by 253 · see citing works
“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.”
BackgroundDeveloping a successful treatment for co-morbid insomnia and sleep apnoea
Sweetman, A. M., Lack, L. C., Catcheside, P. G., Antic, N. A., Chai-Coetzer, C. L., Smith, S. S., Douglas, J. A., & McEvoy, R. D. (2017) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2016.04.004 · Cited by 185 · see citing works
Sweetman, A., Lack, L., Lambert, S., Gradisar, M., & Harris, J. (2017) · Sleep Medicine · doi:10.1016/j.sleep.2017.09.003 · Cited by 84 · see citing works
Sweetman, A., Farrell, S., Wallace, D. M., & Crawford, M. (2023) · Journal of Sleep Research · doi:10.1111/jsr.13847 · Cited by 68 · see citing works
Nam, H., Lim, J., Kim, J.-S., Lee, K., Koo, D. L., & Lee, C. (2016) · Journal of Clinical Neurology · doi:10.3988/jcn.2016.12.2.230 · Cited by 38 · see citing works
Comorbid Insomnia: Reciprocal Relationships and Medication Management
Glidewell, R., Moorcroft, W., & Lee-Chiong, T. (2010) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2010.08.012 · Cited by 12 · see citing works
COMISA (Comorbid Insomnia and Sleep Apnea): a Practical Approach
Brock, M. S., Foster, S. N., Motamedi, V., & Mysliwiec, V. (2018) · Current Sleep Medicine Reports · doi:10.1007/s40675-018-0127-2 · Cited by 9 · see citing works
The Optimizing Strategies for Prescription of Sleeping Pills for Insomnia Patients
Chung, S., & Youn, S. (2017) · Sleep Medicine Research · doi:10.17241/smr.2017.00024 · Cited by 7 · see citing works
Self-citationMild Obstructive Sleep Apnea Tends to Be Associated with Sleep State Misperception
Lee, J.-H., Jeon, S., & Lee, H. (2020) · Chronobiology in Medicine · doi:10.33069/cim.2020.0020 · Cited by 2 · see citing works
Sleep Instability in Paradoxical Insomnia is Associated with Perception of SleepPreprint
Lo, E., Tsai, H.-J., & Yang, A. C. (2022) · medRxiv · doi:10.1101/2022.08.23.22279121 · Cited by 1 · see citing works
Haslam, A. X., Romero, A. C., Torrez, C. A. E., & Espinoza, M. R. (2025) · Clinical Case Reports · doi:10.1002/ccr3.70883
- Authors
- An, H., & Chung, S.
- Affiliations
- Asan Medical Center (KR)
- Corresponding author
- Chung, Seockhoon
- Venue
- Psychiatry Investigation
- Publisher
- Korean Neuropsychiatric Association
- Published
- 2010
- Volume
- 7
- Issue
- 1
- Pages
- 75
- ISSN
- 1738-3684 (ISSN-L)
- PMC
- PMC2848777
- OpenAlex
- W2157221988
- Cited by
- 11
- References
- 25
- Citations by year
- 2025: 1 · 2023: 1 · 2022: 1 · 2020: 1 · 2019: 1 · 2018: 1 · 2017: 2 · 2016: 2
- FWCI
- 0.22
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Psychiatry Investigation (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
- Keywords
- obstructive sleep apnea, paradoxical insomnia, chronic insomnia, nocturnal polysomnography, apnea-hypopnea index, misdiagnosis, sleep latency
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
