Symptoms of Insomnia among Patients with Obstructive Sleep Apnea Before and After Two Years of Positive Airway Pressure Treatment
Open accessAbstract
STUDY OBJECTIVES: To assess the changes of insomnia symptoms among patients with obstructive sleep apnea (OSA) from starting treatment with positive airway pressure (PAP) to a 2-y follow-up. DESIGN: Longitudinal cohort study. SETTING: Landspitali--The National University Hospital of Iceland. PARTICIPANTS: There were 705 adults with OSA who were assessed prior to and 2 y after starting PAP treatment. INTERVENTION: PAP treatment for OSA. MEASUREMENTS AND RESULTS: All patients underwent a medical examination along with a type 3 sleep study and answered questionnaires on health and sleep before and 2 y after starting PAP treatment. The change in prevalence of insomnia symptoms by subtype was assessed by questionnaire and compared between individuals who were using or not using PAP at follow-up. Symptoms of middle insomnia were most common at baseline and improved significantly among patients using PAP (from 59.4% to 30.7%, P < 0.001). Symptoms of initial insomnia tended to persist regardless of PAP treatment, and symptoms of late insomnia were more likely to improve among patients not using PAP. Patients with symptoms of initial and late insomnia at baseline were less likely to adhere to PAP (odds ratio [OR] 0.56, P = 0.007, and OR 0.53, P < 0.001, respectively). CONCLUSION: Positive airway pressure treatment significantly reduced symptoms of middle insomnia. Symptoms of initial and late insomnia, however, tended to persist regardless of positive airway pressure treatment and had a negative effect on adherence. Targeted treatment for insomnia may be beneficial for patients with obstructive sleep apnea comorbid with insomnia and has the potential to positively affect adherence to positive airway pressure.
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The available literature on insomnia prevalence in obstructive sleep apnea has significant shortcomings.
“The available literature addressing the prevalence of insomnia in patients with OSA (Table VII.I.1)588,943–956 suffers from several significant shortcomings.”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [943]
The Introduction (page unavailable) says few studies have assessed the relative prevalence of insomnia subtypes in patients with OSA, supporting a specific gap in the literature. It does not characterize the literature on overall insomnia prevalence as suffering from several significant shortcomings; its statement that findings are mixed concerns PAP adherence, not prevalence. (LLM, conf=0.78)
Experimental — accuracy not yet measuredReported prevalence of insomnia symptoms in obstructive sleep apnea varies from 7% to 68%, with most estimates between 36% and 58%.
“For insomnia symptoms, the prevalence varied from 7% to 68% with most estimates being in the range of 36%–58%.”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [943]
The Introduction reports that studies have found insomnia symptoms in roughly 40–60% of patients with obstructive sleep apnea, and the Prevalence of Insomnia at Baseline section reports 68.3% in this cohort. Our copy does not report a 7% lower bound or establish that most estimates fall specifically between 36% and 58%. (LLM, conf=0.87)
Experimental — accuracy not yet measuredMost studies found insomnia disorder rates in obstructive sleep apnea clustered between 29% and 50%.
“Notably, the majority of studies found rates that were clustered in the range of 29%–50%.”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [943]
The Introduction (page unavailable) says several studies found insomnia symptoms in 40–60% of patients with OSA, supporting the general point that insomnia is common in this population. It does not say that a majority of studies found rates of 29–50%, and it discusses symptoms rather than diagnosed insomnia disorder. The Prevalence of Insomnia at Baseline section (page unavailable) likewise measures symptoms, not disorder rates across studies. (LLM, conf=0.86)
Experimental — accuracy not yet measuredStudies with the lowest insomnia prevalence rates tended to be general population studies.
“Notably, the studies with the lowest prevalence rates tended to be the general population studies.”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [943]
The Introduction (page unavailable) says insomnia symptoms are more prevalent in patients with obstructive sleep apnea than in the general population. That supports the direction of the comparison, but the paper does not establish that general-population studies tended to have the lowest rates across the studies the citing sentence refers to. (LLM, conf=0.82)
Experimental — accuracy not yet measuredOver time CPAP can improve the sleep of patients with comorbid insomnia, particularly those who predominantly report difficulties with frequent awakenings from sleep.
“Others have reported that over time CPAP can improve the sleep of patients with comorbid insomnia, particularly those who predominantly report difficulties with frequent awakenings from sleep [53].”
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 [112]
Reported rates of insomnia disorder diagnosis in patients with obstructive sleep apnea range from 6.4% to 74%.
“The reported rates of an insomnia disorder diagnosis in patients with OSA ranged from 6.4% to 74%.”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [943]
The Introduction reports a 40–60% prevalence of insomnia symptoms among patients with OSA, and ‘Prevalence of Insomnia at Baseline’ reports symptoms in 68.3% of this cohort. Our copy does not report rates of insomnia disorder diagnosis ranging from 6.4% to 74% (searched for those figures and diagnostic prevalence). (LLM, conf=0.76)
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Self-citation
- Authors
- Björnsdóttir, E., Janson, C., Sigurdsson, J. F., Gehrman, P., Perlis, M., Juliusson, S., Arnardottir, E. S., Kuna, S. T., Pack, A. I., Gislason, T., & Benediktsdóttir, B.
- Affiliations
- University of Iceland (IS)
- Uppsala University (SE)
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- University of Pennsylvania (US)
- Department of Otolaryngology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
- Philadelphia VA Medical Center (US)
- Corresponding author
- Björnsdóttir, Erla
- Venue
- Sleep
- Publisher
- Oxford University Press (OUP)
- Published
- 2013-12-01
- Volume
- 36
- Issue
- 12
- Pages
- 1901-1909
- ISSN
- 0161-8105 (ISSN-L)
- 1550-9109
- PMC
- PMC3825440
- OpenAlex
- W2021441532
- Semantic Scholar
- 47501392edff4070a6d8b75c9531043f62dd4d68
- Cited by
- 174
- References
- 24
- Citations by year
- 2026: 8 · 2025: 20 · 2024: 16 · 2023: 15 · 2022: 15 · 2021: 17 · 2020: 9 · 2019: 19 · 2018: 17 · 2017: 13 · 2016: 8 · 2015: 10 · 2014: 6
- FWCI
- 5.56
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- SLEEP (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Hirsla (Landspítali University Hospital) (submittedVersion)
- Funders
- Pfizer
- University of Pennsylvania
- ResMed
- Landspítali Háskólasjúkrahús
- Háskóli Íslands
- National Institutes of Health (HL94307)
- National Heart, Lung, and Blood Institute (R01HL072067, HL72067, P01HL094307, HL94307)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Health Professions › Complementary and Manual Therapy › Temporomandibular Joint Disorders
- Keywords
- obstructive sleep apnea, insomnia, positive airway pressure, CPAP adherence, insomnia symptoms, comorbid insomnia, treatment outcomes
- MeSH terms
- Female, Humans, Disorders of Excessive Somnolence, Sleep Initiation and Maintenance Disorders, Longitudinal Studies, Male, Middle Aged, Patient Compliance, Quality of Life, Surveys and Questionnaires, Treatment Outcome, Polysomnography, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure
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