Adelaide Institute for Sleep Health, Flinders Centre for Research Excellence, Flinders University of South Australia, Bedford Park, SA, 5042, Australia; School of Psychology, Flinders University of South Australia, Bedford Park, SA, 5042, Australia.
Adelaide Institute for Sleep Health, Flinders Centre for Research Excellence, Flinders University of South Australia, Bedford Park, SA, 5042, Australia; School of Psychology, Flinders University of South Australia, Bedford Park, SA, 5042, Australia.
Sleep Med Rev. 2017 Jun;33:28-38. doi: 10.1016/j.smrv.2016.04.004. Epub 2016 May 6.
Insomnia and sleep apnoea are the two most common sleep disorders, found in 6% and 23-50% of the general population respectively. These disorders also frequently co-occur, with 39-58% of sleep apnoea patients reporting symptoms indicative of co-morbid insomnia. When these disorders co-occur, clinicians are faced with difficult treatment decisions, patients experience the additive detrimental impacts of both disorders, and the effectiveness of discrete treatments for each disorder may be impaired. A common finding is that co-morbid insomnia and sleep apnoea (COMISA) is more difficult to treat than either disorder presenting alone. Co-morbid insomnia reduces the initial acceptance of, and later adherence to, continuous positive airway pressure (CPAP) therapy for obstructive sleep apnoea. This has resulted in recent recommendations that treatment approaches should initially target COMISA patients' insomnia to remove this barrier to CPAP treatment, and improve patient outcomes. However, no randomised controlled trial outcomes investigating this treatment approach currently exist. The current article aims to review and integrate recent research examining the prevalence, characteristics, and theoretical mechanistic relationships between co-occurring insomnia and OSA, and discuss previous treatment attempts.
失眠和睡眠呼吸暂停是两种最常见的睡眠障碍，分别在普通人群中发现了 6%和 23-50%。这些障碍也经常同时发生，39-58%的睡眠呼吸暂停患者报告有共病性失眠的症状。当这些障碍同时发生时，临床医生面临着困难的治疗决策，患者经历了两种障碍的累加性不良影响，并且每种障碍的离散治疗效果可能会受到损害。一个常见的发现是，共病性失眠和睡眠呼吸暂停（COMISA）比任何一种单独出现的障碍都更难治疗。共病性失眠降低了对阻塞性睡眠呼吸暂停持续气道正压通气（CPAP）治疗的初始接受程度和后期依从性。这导致了最近的建议，即治疗方法应首先针对 COMISA 患者的失眠症，以消除 CPAP 治疗的这一障碍，并改善患者的预后。然而，目前没有调查这种治疗方法的随机对照试验结果。本文旨在综述和整合最近的研究，探讨共病性失眠和阻塞性睡眠呼吸暂停之间的患病率、特征和理论机制关系，并讨论以前的治疗尝试。
