Alexander Sweetman1, Yohannes Adama Melaku2, Leon Lack3, Amy Reynolds4, Tiffany K Gill5, Robert Adams6, Sarah Appleton2. 1. The Adelaide Institute for Sleep Health, Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, SA, 5042, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, SA, Australia. Electronic address: alexander.sweetman@flinders.edu.au. 2. The Adelaide Institute for Sleep Health, Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, SA, 5042, Australia. 3. The Adelaide Institute for Sleep Health, Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, SA, 5042, Australia; College of Education, Psychology and Social Work, Flinders University, SA, 5042, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, SA, Australia. 4. The Adelaide Institute for Sleep Health, Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, SA, 5042, Australia; Appleton Institute, CQUniversity Australia, SA, 5034, Australia. 5. Adelaide Medical School, The University of Adelaide, Adelaide, SA, 5000, Australia. 6. The Adelaide Institute for Sleep Health, Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, SA, 5042, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, SA, Australia.
Abstract
INTRODUCTION: Insomnia and obstructive sleep apnoea (OSA) are the two most prevalent sleep disorders, and frequently co-occur (COMISA) in sleep clinic samples. However, few studies have investigated the prevalence or associations of COMISA in the general population. METHODS: We used population-based online survey data from 2044 Australian adults. The prevalence and associations of insomnia, OSA and COMISA were investigated according to symptom-level, and disorder-level definitions. Insomnia was defined according to chronic difficulties initiating and/or maintaining sleep (DIMS; symptom-level), and ICSD-3 chronic insomnia disorder (disorder-level). OSA was defined according to self-reported frequent obstructive events, snoring or doctor-diagnosed OSA (symptom-level), and doctor-diagnosed OSA (disorder-level). COMISA was defined if both conditions were met (for symptom-level, and disorder-level threshold). Associations with other conditions, and general health were investigated with Poisson regression analyses. RESULTS: Chronic insomnia occurred more frequently among participants with doctor-diagnosed OSA (22.3%), compared to those without (14.3%, p = 0.010). Doctor-diagnosed OSA was more common among participants with chronic insomnia (10.2%) compared to those without (6.2%; p = 0.010). DIMS also occurred more frequently among participants with OSA symptoms (66.6%), compared to those without (47.2%; p < 0.001). Participants with symptom-level COMISA reported increased co-morbid conditions, and worse general health compared to participants with symptoms of insomnia-alone, OSA-alone, or neither insomnia/OSA. CONCLUSIONS: COMISA at symptom and disorder level were common and associated with increased medical and psychiatric co-morbidity, as well as poor general health. More investigation is required to understand bi-directional associations underpinning the high co-morbidity, and improve diagnostic and treatment approaches for COMISA to reduce associated morbidity.
INTRODUCTION:Insomnia and obstructive sleep apnoea (OSA) are the two most prevalent sleep disorders, and frequently co-occur (COMISA) in sleep clinic samples. However, few studies have investigated the prevalence or associations of COMISA in the general population. METHODS: We used population-based online survey data from 2044 Australian adults. The prevalence and associations of insomnia, OSA and COMISA were investigated according to symptom-level, and disorder-level definitions. Insomnia was defined according to chronic difficulties initiating and/or maintaining sleep (DIMS; symptom-level), and ICSD-3 chronic insomnia disorder (disorder-level). OSA was defined according to self-reported frequent obstructive events, snoring or doctor-diagnosed OSA (symptom-level), and doctor-diagnosed OSA (disorder-level). COMISA was defined if both conditions were met (for symptom-level, and disorder-level threshold). Associations with other conditions, and general health were investigated with Poisson regression analyses. RESULTS:Chronic insomnia occurred more frequently among participants with doctor-diagnosed OSA (22.3%), compared to those without (14.3%, p = 0.010). Doctor-diagnosed OSA was more common among participants with chronic insomnia (10.2%) compared to those without (6.2%; p = 0.010). DIMS also occurred more frequently among participants with OSA symptoms (66.6%), compared to those without (47.2%; p < 0.001). Participants with symptom-level COMISA reported increased co-morbid conditions, and worse general health compared to participants with symptoms of insomnia-alone, OSA-alone, or neither insomnia/OSA. CONCLUSIONS: COMISA at symptom and disorder level were common and associated with increased medical and psychiatric co-morbidity, as well as poor general health. More investigation is required to understand bi-directional associations underpinning the high co-morbidity, and improve diagnostic and treatment approaches for COMISA to reduce associated morbidity.
Authors: Bastien Lechat; Kelly A Loffler; Douglas M Wallace; Amy Reynolds; Sarah L Appleton; Hannah Scott; Andrew Vakulin; Nicole Lovato; Robert Adams; Danny J Eckert; Peter G Catcheside; Alexander Sweetman Journal: Nat Sci Sleep Date: 2022-10-13
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