Lundetræ Ragnhild Stokke, Saxvig Ingvild West, Aurlien Harald, Lehmann Sverre, Bjorvatn Bjørn
Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
Centre for Sleep Medicine, Haukeland University Hospital, Bergen, Norway.
Front Psychol. 2021 Jul 22;12:691495. doi: 10.3389/fpsyg.2021.691495. eCollection 2021.
Obstructive sleep apnea (OSA) and insomnia are the two most common sleep disorders. Continuous positive airway pressure (CPAP) is considered first-line treatment for OSA. In the present study, we assess the effect of CPAP on symptoms and prevalence of insomnia in patients with OSA. We hypothesized a decrease in insomnia symptoms from CPAP initiation to follow-up, and that this decrease would depend on CPAP adherence.
The sample included 442 patients diagnosed with OSA [mean age 54.9 years (SD = 12.1), 74.4% males] who started treatment with CPAP at a university hospital. OSA was diagnosed according to standard respiratory polygraphy. Mean apnea-hypopnea index (AHI) was 30.1 (SD = 21.1) at baseline. Insomnia was assessed prior to CPAP treatment (baseline) and at follow-up after a median of 19.9 weeks (range 6-52 weeks) with the Bergen Insomnia Scale (BIS). CPAP adherence was defined as an average use of ≥ 4 h per night, whereas non-adherence was defined as < 4 h per night.
There was a significant decrease in BIS scores from baseline (mean = 18.8, SD = 9.8) to follow-up (mean = 12.9, SD = 9.9), < 0.001. Cohen's (0.65) indicated a moderate effect size. The reduction in BIS scores was depending on CPAP adherence (interaction effect (1,440) = 12.4, < 0.001), with larger reduction in the adherent group than in the non-adherent group. The proportion of patients with chronic insomnia was significantly reduced from 51.1% at baseline to 33.0% at follow-up ( < 0.001).
Overall, there was a significant reduction in insomnia symptoms from baseline to follow-up. The improvement was significant in both adherence groups, but the degree of improvement was larger among patients who were adherent to CPAP. Furthermore, there was a significant reduction in the prevalence of chronic insomnia at follow-up compared to baseline. This suggests that CPAP effectively reduces both the presence of insomnia and the severity of insomnia symptoms in some patients with OSA.
阻塞性睡眠呼吸暂停（OSA）和失眠是两种最常见的睡眠障碍。持续气道正压通气（CPAP）被认为是OSA的一线治疗方法。在本研究中，我们评估CPAP对OSA患者失眠症状和患病率的影响。我们假设从开始使用CPAP到随访期间失眠症状会减轻，并且这种减轻将取决于CPAP的依从性。
样本包括442名在大学医院开始接受CPAP治疗的被诊断为OSA的患者[平均年龄54.9岁（标准差=12.1），74.4%为男性]。根据标准呼吸多导睡眠图诊断OSA。基线时平均呼吸暂停低通气指数（AHI）为30.1（标准差=21.1）。在CPAP治疗前（基线）以及中位19.9周（范围6 - 52周）后的随访时，使用卑尔根失眠量表（BIS）评估失眠情况。CPAP依从性定义为每晚平均使用≥4小时，而非依从性定义为每晚<4小时。
从基线（平均=18.8，标准差=9.8）到随访（平均=12.9，标准差=9.9），BIS评分显著降低，P<0.001。科恩效应量（0.65）表明效应大小为中等。BIS评分的降低取决于CPAP依从性（交互效应（1,440）=12.4，P<0.001），依从组的降低幅度大于非依从组。慢性失眠患者的比例从基线时的51.1%显著降至随访时的33.0%（P<0.001）。
总体而言，从基线到随访，失眠症状有显著减轻。两个依从组的改善都很显著，但CPAP依从性好的患者改善程度更大。此外，与基线相比，随访时慢性失眠的患病率显著降低。这表明CPAP能有效减轻部分OSA患者的失眠症状及失眠的严重程度。
