Bastien Lechat1, Kelly A Loffler1, Douglas M Wallace2,3, Amy Reynolds1, Sarah L Appleton1, Hannah Scott1, Andrew Vakulin1,4, Nicole Lovato1,4, Robert Adams1,4, Danny J Eckert1, Peter G Catcheside1, Alexander Sweetman1,4. 1. Adelaide Institute for Sleep Health and FHMRI Sleep Health, Flinders University, Adelaide, South Australia, Australia. 2. Department of Neurology, Sleep Medicine Division, University of Miami Miller School of Medicine, Miami, FL, USA. 3. Neurology Service, Bruce W. Carter Department of Veterans Affairs Medical Centre, Miami, FL, USA. 4. National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia.
Abstract
Purpose: Insomnia symptoms and sleep apnea frequently co-occur and are associated with worse sleep, daytime function, mental health and quality of life, compared to either insomnia or obstructive sleep apnea (OSA) alone. This study aimed to investigate the association of symptoms of co-morbid insomnia and sleep apnea (COMISA) with all-cause mortality. Patients and Methods: Wisconsin Sleep Cohort data were analysed to assess potential associations between COMISA symptoms and all-cause mortality. Nocturnal insomnia symptoms were defined as difficulties initiating sleep, maintaining sleep, and/or early morning awakenings "often" or "almost always", and/or regular sedative-hypnotic medicine use. OSA was defined as an apnea-hypopnea index ≥5/hr sleep. Participants were classified as having neither insomnia symptoms nor OSA, insomnia symptoms alone, OSA alone, or COMISA symptoms. Associations between the four groups and all-cause mortality over 20 years of follow-up were examined via multivariable adjusted Cox regression models. Results: Among 1115 adult participants (mean ± SD age 55 ± 8 years, 53% males), 19.1% had COMISA symptoms. After controlling for sociodemographic and behavioral factors, COMISA symptoms were associated with an increased risk of all-cause mortality compared to no insomnia symptoms or OSA (HR [95% CI]; 1.71 [1.00-2.93]). OSA alone (0.91 [0.53, 1.57]) and insomnia symptoms alone (1.04 [0.55, 1.97]) were not associated with increased mortality risk. Conclusion: Co-morbid insomnia symptoms and sleep apnea is associated with increased all-cause mortality risk. Future research should investigate mechanisms underpinning COMISA and the effectiveness of different treatment approaches to reduce mortality risk for this common condition.
Purpose: Insomnia symptoms and sleep apnea frequently co-occur and are associated with worse sleep, daytime function, mental health and quality of life, compared to either insomnia or obstructive sleep apnea (OSA) alone. This study aimed to investigate the association of symptoms of co-morbid insomnia and sleep apnea (COMISA) with all-cause mortality. Patients and Methods: Wisconsin Sleep Cohort data were analysed to assess potential associations between COMISA symptoms and all-cause mortality. Nocturnal insomnia symptoms were defined as difficulties initiating sleep, maintaining sleep, and/or early morning awakenings "often" or "almost always", and/or regular sedative-hypnotic medicine use. OSA was defined as an apnea-hypopnea index ≥5/hr sleep. Participants were classified as having neither insomnia symptoms nor OSA, insomnia symptoms alone, OSA alone, or COMISA symptoms. Associations between the four groups and all-cause mortality over 20 years of follow-up were examined via multivariable adjusted Cox regression models. Results: Among 1115 adult participants (mean ± SD age 55 ± 8 years, 53% males), 19.1% had COMISA symptoms. After controlling for sociodemographic and behavioral factors, COMISA symptoms were associated with an increased risk of all-cause mortality compared to no insomnia symptoms or OSA (HR [95% CI]; 1.71 [1.00-2.93]). OSA alone (0.91 [0.53, 1.57]) and insomnia symptoms alone (1.04 [0.55, 1.97]) were not associated with increased mortality risk. Conclusion: Co-morbid insomnia symptoms and sleep apnea is associated with increased all-cause mortality risk. Future research should investigate mechanisms underpinning COMISA and the effectiveness of different treatment approaches to reduce mortality risk for this common condition.
Authors: Suzanne M Bertisch; Benjamin D Pollock; Murray A Mittleman; Daniel J Buysse; Lydia A Bazzano; Daniel J Gottlieb; Susan Redline Journal: Sleep Date: 2018-06-01 Impact factor: 5.849
Authors: Erla Bjornsdottir; Brendan T Keenan; Bjorg Eysteinsdottir; Erna Sif Arnardottir; Christer Janson; Thorarinn Gislason; Jon Fridrik Sigurdsson; Samuel T Kuna; Allan I Pack; Bryndis Benediktsdottir Journal: J Sleep Res Date: 2014-11-27 Impact factor: 3.981
Authors: Bastien Lechat; Sarah Appleton; Yohannes Adama Melaku; Kristy Hansen; R Doug McEvoy; Robert Adams; Peter Catcheside; Leon Lack; Danny J Eckert; Alexander Sweetman Journal: Eur Respir J Date: 2022-07-13 Impact factor: 33.795