Obstructive Sleep Apnea with Insomnia Overlap: An Under-recognized Entity

ABSTRACT

Introduction: The association between obstructive sleep apnea (OSA) and insomnia is relatively common but is underrecognized. There are important diagnostic and therapeutic implications of comorbid OSA杋nsomnia overlap but there is no data available from India. Objectives: (1) To find out the prevalence of insomnia among patients with OSA; (2) To compare the demographic characteristics, Epworth sleepiness scale (ESS) scores and the presence of comorbidities among patients of OSA with insomnia vs OSA without insomnia. Materials and methods: It was a prospective observational study involving 250 patients with suspected OSA. A total of 189 patients had OSA based on type I polysomnography and were further analyzed. Insomnia was diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria. Results: The prevalence of insomnia among OSA was 15.34% (29/189). Overlap was seen in 22.45 and 12.86% of women and men respectively among patients with OSA. The prevalence of overlap increased with decreasing severity of obesity and OSA. Those with OSA杋nsomnia overlap had significantly lower ESS scores as compared to OSA without insomnia (12.31 vs 15.24; p = 0.019). A total of 10.34% (3/29) of patients of overlap had depression whereas none from OSA alone had depression. Conclusion: There is a high prevalence of insomnia among patients with OSA (15.34%), similar to findings worldwide. Insomnia is more common among women with OSA. Overlap patients have lower ESS scores and are likely to be depressed.