Insonnia e Apnea del Sonno

Study Notes

COMISA is a prevalent and debilitating disorder, resulting in additive impairments to sleep, daytime functioning, and quality of life.
Complex diagnostic and treatment decisions are required by clinicians.
Christian Guilleminault and colleagues first recognized COMISA in 1973, but research interest was limited for decades.
Research interest in COMISA significantly increased in 1999 and 2001 with studies reporting a 30%-50% co-morbid prevalence rate.

Prevalence estimates vary based on diagnostic criteria utilized, sample characteristics, and research methodology.
Studies suggest that 39%-58% of OSA patients report insomnia symptoms, and 29%–67% of insomnia patients exhibit OSA characteristics.
The co-occurrence of OSA and insomnia is relatively high, but varies based on specific diagnoses, tools, and populations.
A meta-analysis found that 35% of insomnia patients have an AHI of ≥5, and 29% have an AHI of ≥15.

COMISA patients experience considerable impairments to daytime functioning, including emotional and cognitive impairments.
These patients commonly experience increased anxiety, depression, and difficulty concentrating compared to those with OSA or insomnia alone.
COMISA results in a greater overall decrease in quality of life and sleep quality compared to those with either condition alone.
Research indicates additive impairments to sleep, daytime functioning, and emotional well-being in COMISA individuals.

Shared symptoms between OSA and insomnia can complicate diagnosis and measurement.
Existing insomnia measures may not adequately capture insomnia symptoms in the presence of OSA.
Questionnaire measures may be misclassifying patients due to overlapping daytime and nocturnal symptoms, leading to incorrect diagnoses.

CPAP therapy is commonly used to treat OSA.
Research highlights the possibility of increased CPAP adherence with cognitive-behavioral therapy for insomnia (CBTi).
Initial CBTi treatment before CPAP therapy appears beneficial for COMISA patients.
Combined CBTi and CPAP therapy may improve insomnia symptoms, leading to increased CPAP acceptance.

Further study is needed to validate and refine insomnia measures in the presence of OSA.
Investigations into the bi-directional relationships between OSA and insomnia are crucial.
Research exploring the effects of CPAP on insomnia symptoms and vice-versa is needed.
Continued study of different treatment combinations and sequences is crucial for developing effective intervention strategies for COMISA.