Chest
Volume 120, Issue 6, December 2001, Pages 1923-1929
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Clinical Investigations
SLEEP
Prevalence of Insomnia Symptoms in Patients With Sleep-Disordered Breathing

https://doi.org/10.1378/chest.120.6.1923Get rights and content

Objective

To assess the prevalence of insomnia symptoms in patients with objectively diagnosed sleep-disordered breathing (SDB).

Design

Retrospective medical chart review of a representative sample of patients with SDB.

Setting

University sleep-disorders clinic and laboratory.

Patients

Two hundred thirty-one patients with SDB were selected from a pool of approximately 2,000 patients with sleep disorders.

Measurements

Data were extracted from intake questionnaires and polysomnographic studies.

Results

Of 231 patients with SDB diagnoses, 115 patients reported no insomnia complaints (SDB-only patients) and 116 patients reported clinically meaningful insomnia complaints (SDB-plus patients). Compared to SDB-only patients, SDB-plus patients reported significantly worse mean sleep characteristics consistent with insomnia, including sleep latency (17 min vs 65 min), total sleep time (7.2 h vs 5.6 h), and sleep efficiency (92% vs 75%). SDB-plus patients experienced significantly more psychiatric disorders, cognitive-emotional symptoms, and physical and mental symptoms that disrupted or prevented sleep. SDB-plus patients also reported greater use of sedative and psychotropic medications and had significantly more primary complaints of insomnia, restless legs or leg jerks, and poor sleep quality despite having relatively similar referral rates for sleep apnea or complaints of loud snoring.

Conclusions

Problematic insomnia symptoms were reported by 50% of a representative sample of patients with objectively diagnosed SDB. Research is needed to determine the degree to which insomnia and related symptoms and behaviors interfere with SDB treatment.

Section snippets

Patient Sample

The study was approved by the Human Research and Review Committee of the University of New Mexico Health Sciences Center. From July 1, 1997, through December 31, 1999, approximately 2,000 new patients at the University Hospital Sleep Disorders Center completed an extensive “sleep medicine history” at intake. The current study included all adult patients whose surnames began with the letters“ A”, “B”, and “C” (n = 252). Of these 252 patients, 231 received a diagnosis of SDB and constitute the

Results

Prior to the primary analysis, patients with OSA and UARS diagnoses were compared on pertinent variables to determine significant differences. There were 211 OSA patients and 20 UARS patients. As expected, significant differences were found only for AHI (OSA = 56.7[40.1] vs UARS = 2.5 [1.5]; F[1,227] = 34.5, p < 0.0001) and minSao2 (OSA = 74.0 [13.7] vs UARS = 84.2 [6.6]; F[1,225] = 10.34, p = 0.001). No other differences were found for demographic, objective, or outcome variables; therefore,

Discussion

In a university sleep-disorders clinic, insomnia symptoms were widely prevalent in a representative sample of objectively diagnosed SDB patients with OSA or UARS. Patients with SDB and insomnia suffered from more physical and mental symptoms and psychiatric disorders, all of which might contribute to or exacerbate insomnia complaints.282930 In addition, 37% of study patients received sedating and/or psychotropic medications, and SDB-plus patients accounted for twice as many medication users as

Appendix

Three modules from the sleep medicine history were used to elicit information on sleep habits, sleep breathing symptoms, and insomnia symptoms:

Acknowledgment

We thank Dr. Amanda Beck, Rose Mills, Mallory Davidson, and staff of the University of New Mexico Hospital Sleep Disorders Center for facilitating the chart reviews for this study, and Dr. Lee K. Brown for editorial advice.

References (39)

  • DP White

    A look toward the future

    Otolaryngol Clin North Am

    (1999)
  • CM Morin et al.

    Behavioral and pharmacological therapies for late-life insomnia: a randomized controlled trail

    JAMA

    (1999)
  • FJ Nieto et al.

    Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study: Sleep Heart Health Study

    JAMA

    (2000)
  • A Chesson et al.

    Practice parameters for the evaluation of chronic insomnia: an American Academy of Sleep Medicine report; Standards of Practice Committee of the American Academy of Sleep Medicine

    Sleep

    (2000)
  • T Roehrs et al.

    Sleep-wake complaints in patients with sleep-related respiratory disturbances

    Am Rev Respir Dis

    (1985)
  • DL Bliwise et al.

    Risk factors for sleep disordered breathing in heterogeneous geriatric populations

    Am Geriatr Soc

    (1987)
  • RM Coleman et al.

    Sleep-wake disorders based on a polysomnographic diagnosis: a national cooperative study

    JAMA

    (1982)
  • JD Edinger et al.

    Polysomnographic assessment of DIMS: empirical evaluation of its diagnostic value

    Sleep

    (1989)
  • A Ambrogetti et al.

    Differences in the symptoms of men and women with obstructive sleep apnoea

    Aust N Z J Med

    (1991)
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    This research was conducted at the Sleep and Human Health Institute and the University Hospital Sleep Disorders Center.

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