Mendes M Saldanha, dos Santos J Moutinho
Serviço de Pneumologia, Centro Hospitalar Cova da Beira, Covilhã, Portugal.
Centro de Medicina do Sono, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
Rev Port Pneumol (2006). 2015 Jul-Aug;21(4):203-8. doi: 10.1016/j.rppnen.2014.11.002. Epub 2015 Feb 11.
Obstructive sleep apnea syndrome (OSAS) and insomnia often coexist, and it is estimated that nearly half of those who suffer from the former report symptoms of the latter. The fact that these patients have no other causes of insomnia indicates that it is a sign of OSAS.
The aim of the study is to evaluate the effectiveness of nocturnal ventilatory support (NVS) in the treatment of insomnia secondary to OSAS.
In order to conduct the retrospective study, the authors reviewed the medical records of patients with insomnia and OSAS that had received NVS. Patients with psychiatric disorders, sleep movement disorders, psycho-physiological insomnia, circadian rhythm sleep disorders, inadequate sleep hygiene, use and abuse of hypnotic agents, stimulants, antidepressants, anxiolytics and alcohol, were excluded. For the selected patients, the effects of NVS in terms of clinical signs and symptoms of insomnia, apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS) score, and number of sleep hours were analyzed, before and after treatment with NVS.
After reviewing 1241 medical records, 56 patients were selected, with a mean age of 60.9±10.0 years. Twenty-two (39.3%) suffered from intermediate insomnia, 19 (33.9%) had initial insomnia, eight (14.3%) had the mixed type, and seven patients (12.5%) had terminal insomnia. The majority of patients (n=48; 85.7%) were treated with auto-titrating continuous positive airway pressure (APAP). Forty-four patients (78.6%) overcame insomnia; insomnia symptoms persisted in nine (16.1%), and three (5.4%) patients abandoned during the medical follow-up. There was an association between the type of insomnia and its resolution and, in percentage terms patients with the mixed type did not manage to overcome insomnia symptoms (75%). There was a statistically significant difference between patients that overcame insomnia and those who did not in terms of the average time which elapsed between the initiation of treatment with NVS and compliance with the adherence criteria: 161±61 days for the former, and 225±141 days for the latter (p=0.003). Before and after the NVS treatment, patients slept an average of 5.29±1.37 and 6.37±1.55h per night, respectively (p<0.001). Among the patients who overcame insomnia, six did not meet the treatment adherence criteria: five adhered more than 4h/night in less than 70% of all nights (60.6±3.2%), and one patient adhered less than 4h in all nights (3.5h/night).
NVS has proved effective in treating insomnia secondary to OSAS, and favorable results could be observed even in patients that did not meet the criteria of NVS adherence. Results suggest that all insomnia subtypes, except the mixed subtype, may derive from OSAS.
阻塞性睡眠呼吸暂停综合征（OSAS）与失眠常常并存，据估计，患有前者的患者中近一半报告有后者的症状。这些患者不存在其他失眠原因，这表明失眠是OSAS的一种表现。
本研究旨在评估夜间通气支持（NVS）治疗OSAS继发性失眠的有效性。
为进行这项回顾性研究，作者查阅了接受NVS治疗的失眠和OSAS患者的病历。排除患有精神疾病、睡眠运动障碍、心理生理性失眠、昼夜节律睡眠障碍、睡眠卫生不良、使用和滥用催眠药、兴奋剂、抗抑郁药、抗焦虑药及酒精的患者。对于选定的患者，分析了NVS治疗前后在失眠的临床体征和症状、呼吸暂停低通气指数（AHI）、爱泼华嗜睡量表（ESS）评分以及睡眠时间方面的效果。
查阅1241份病历后，选定了56例患者，平均年龄为60.9±10.0岁。22例（39.3%）患有中度失眠，19例（33.9%）患有轻度失眠，8例（14.3%）为混合型，7例（12.5%）患有重度失眠。大多数患者（n = 48；85.7%）接受了自动调压持续气道正压通气（APAP）治疗。44例（78.6%）患者克服了失眠；9例（16.1%）患者失眠症状持续存在，3例（5.4%）患者在医学随访期间放弃治疗。失眠类型与其缓解之间存在关联，从百分比来看，混合型患者未能克服失眠症状（75%）。克服失眠的患者与未克服失眠的患者在开始NVS治疗至符合依从标准之间的平均时间存在统计学显著差异：前者为161±61天，后者为225±141天（p = 0.003）。NVS治疗前后，患者每晚平均睡眠时间分别为5.29±1.37小时和6.37±1.55小时（p<0.001）。在克服失眠的患者中，6例未达到治疗依从标准：5例在不到70%的夜晚每晚使用时间超过4小时（60.6±3.2%），1例患者在所有夜晚使用时间均少于4小时（3.5小时/晚）。
NVS已被证明对治疗OSAS继发性失眠有效，即使在不符合NVS依从标准的患者中也能观察到良好效果。结果表明，除混合型外，所有失眠亚型可能都源于OSAS。
