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Applied Sciences
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Comorbid Insomnia and Sleep Apnea (COMISA): High Risk Populations, Underlying...
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Comorbid Insomnia and Sleep Apnea (COMISA): High Risk Populations, Underlying Mechanisms, Consequences, and Treatment Implications

A special issue of Applied Sciences (ISSN 2076-3417). This special issue belongs to the section "Applied Biosciences and Bioengineering".

Deadline for manuscript submissions: closed (30 November 2021) | Viewed by 7841

Special Issue Editors

Prof. Douglas Mckay Wallace

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Guest Editor
Department of Neurology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
Interests: insomnia; comorbidity; sleep apnea; positive airway pressure; adherence; health disparities.
Dr. Alexander Sweetman

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Guest Editor
The Adelaide Institute for Sleep Health and Flinders Health and Medical Research Institute: Sleep Health, Flinders University, Adelaide, Australia
Interests: insomnia; sleep apnea; cognitive behavioral therapy for insomnia; positive airway pressure; primary care.

Special Issue Information

Dear Colleagues,

Insomnia and sleep apnea are the two most common sleep disorders globally, and co-exist in up to 50% of patients presenting to sleep clinics for treatment. Comorbid insomnia and sleep apnea (COMISA) is associated with increased healthcare utilization, medical (e.g., cardiometabolic consequences) and psychiatric morbidity (e.g., mood disorders), and worse daytime functioning relative to each condition alone. Furthermore, some specific patient subgroups (e.g., women, socioeconomically deprived people) may be at greater risk for COMISA and associated negative health outcomes, but relatively little research has been devoted to this important area. Recent clinical/physiological subtyping of obstructive sleep apnea has shown that untreated sleep apnea may be a risk factor for the development of insomnia but less is known about the reverse association. Despite the high co-morbidity and negative consequences of COMISA, there are many unknowns concerning the pathophysiology and optimal therapeutic management of this condition.  A long-standing ‘piecemeal’ approach, and previous lack of collaboration between psychology and physiology-based Sleep Medicine researchers and clinicians, has directly limited our understanding of COMISA. However, recent data show that collaboration of psychology and physiology-based Sleep Medicine clinicians and multidisciplinary treatment strategies may help improve patient-centric care.

The purpose of this Special Issue is to highlight novel evidence of the prevalence and risk factors for COMISA in specific populations and subgroups, recent discoveries in the immediate and long-term consequences of COMISA, pathophysiological mechanisms underpinning COMISA, and novel treatment approaches assisting in personalizing care for patients with COMISA.

We invite you to submit your research on one or more of these topics in the form of an original research article or a mini-review.

Prof. Douglas Mckay Wallace
Dr. Alexander Sweetman
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Applied Sciences is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • insomnia disorder
  • COMISA
  • comorbid insomnia
  • obstructive sleep apnea
  • phenotype
  • comorbidity
  • secondary insomnia
  • treatment
  • continuous positive airway pressure
  • cognitive behavioral therapy for insomnia (CBT-i)

Published Papers (3 papers)

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Research

11 pages, 544 KiB  
Article
Sleep-Disordered Breathing Risk with Comorbid Insomnia Is Associated with Mild Cognitive Impairment
by Christian Agudelo, Alberto R. Ramos, Xiaoyan Sun, Sonya Kaur, Dylan F. Del Papa, Josefina M. Kather, Douglas M. Wallace and on behalf of the Alzheimer’s Disease Neuroimaging Initiative (ADNI)
Appl. Sci. 2022, 12(5), 2414; https://0-doi-org.brum.beds.ac.uk/10.3390/app12052414 - 25 Feb 2022
Cited by 1 | Viewed by 1624
Abstract
Introduction: Few studies have evaluated the combined association between SDB with comorbid insomnia and mild cognitive impairment (MCI). To test the hypothesis that SDB with comorbid insomnia is associated with greater odds of MCI than either sleep disorder independently, we used ADNI data [...] Read more.
Introduction: Few studies have evaluated the combined association between SDB with comorbid insomnia and mild cognitive impairment (MCI). To test the hypothesis that SDB with comorbid insomnia is associated with greater odds of MCI than either sleep disorder independently, we used ADNI data to evaluate cross-sectional associations between SDB risk with comorbid insomnia status and MCI. Methods: Participants with normal cognition or MCI were included. Insomnia was defined by self-report. SDB risk was assessed by modified STOP-BANG. Logistic regression models evaluated associations between four sleep disorder subgroups (low risk for SDB alone, low risk for SDB with insomnia, high risk for SDB alone, and high risk for SDB with insomnia) and MCI. Models adjusted for age, sex, BMI, APOE4 genotype, race, ethnicity, education, marital status, hypertension, cardiovascular disease, stroke, alcohol abuse, and smoking. Results: The sample (n = 1391) had a mean age of 73.5 ± 7.0 years, 44.9% were female, 72.0% were at low risk for SDB alone, 13.8% at low risk for SDB with insomnia, 10.1% at high risk for SDB alone, and 4.1% at high risk for SDB with insomnia. Only high risk for SDB with comorbid insomnia was associated with higher odds of MCI (OR 3.22, 95% CI 1.57–6.60). Conclusion: Studies are needed to evaluate SDB with comorbid insomnia as a modifiable risk factor for MCI. Full article
(This article belongs to the Special Issue Comorbid Insomnia and Sleep Apnea (COMISA): High Risk Populations, Underlying Mechanisms, Consequences, and Treatment Implications)
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13 pages, 1590 KiB  
Article
The Effect of Cognitive Behavioural Therapy for Insomnia (CBT-I) on Subjective–Objective Sleep Discrepancy in Individuals with Co-Morbid Insomnia and Sleep Apnoea: A Randomised Controlled Trial
by Darah-Bree Bensen-Boakes, Amal Osman, Leon Lack, Peter Catcheside, Nick Antic, Simon S. Smith, Ching Li Chai-Coetzer, Amanda O’Grady, Nicola Dunn, Jan Robinson, Doug McEvoy and Alexander Sweetman
Appl. Sci. 2022, 12(4), 1787; https://0-doi-org.brum.beds.ac.uk/10.3390/app12041787 - 09 Feb 2022
Cited by 4 | Viewed by 2291
Abstract
People with insomnia frequently underestimate the duration of their sleep compared to objective polysomnography-measured sleep duration. Cognitive behavioural therapy for insomnia (CBT-I) is the most effective treatment for insomnia and also reduces the degree of sleep underestimation. Obstructive sleep apnoea (OSA) is a [...] Read more.
People with insomnia frequently underestimate the duration of their sleep compared to objective polysomnography-measured sleep duration. Cognitive behavioural therapy for insomnia (CBT-I) is the most effective treatment for insomnia and also reduces the degree of sleep underestimation. Obstructive sleep apnoea (OSA) is a highly prevalent sleep disorder characterised by frequent narrowing (hypopnoea) and closure (apnoea) of the upper airway during sleep. Comorbid insomnia and sleep apnoea (COMISA) is a prevalent and debilitating disorder. No study has investigated subjectively (sleep diary) versus objectively (polysomnography) measured sleep discrepancies (SOSD) in individuals with COMISA before or following CBT-I. This randomised waitlist-controlled trial investigated SOSD in 145 participants with COMISA before and 6-weeks after CBT-I (n = 72) versus control (n = 73). All participants were studied prior to continuous positive airway pressure treatment for sleep apnoea. At baseline, participants underestimated their total sleep time (mean ± SD −51.9 ± 94.1 min) and sleep efficiency (−9.6 ± 18.3%), and overestimated sleep onset latency (34.5 ± 86.1 min; all p = < 0.001). Mixed models indicated a main effect of time on reduction of SOSD in both groups, but no between-group difference in the reduction of any SOSD parameters. These findings may indicate that untreated OSA contributes to a discrepancy between perceived and objective sleep parameters in people with COMISA that is not amenable to CBT-I alone (ACTRN12613001178730). Full article
(This article belongs to the Special Issue Comorbid Insomnia and Sleep Apnea (COMISA): High Risk Populations, Underlying Mechanisms, Consequences, and Treatment Implications)
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8 pages, 250 KiB  
Article
Cognitive and Neuroimaging Correlates of the Insomnia Severity Index in Obstructive Sleep Apnea: A Pilot-Study
by Alberto R. Ramos, Noam Alperin, Sang Lee, Kevin A. Gonzalez, Wassim Tarraf and Rene Hernandez-Cardenache
Appl. Sci. 2021, 11(12), 5314; https://0-doi-org.brum.beds.ac.uk/10.3390/app11125314 - 08 Jun 2021
Cited by 4 | Viewed by 2903
Abstract
We aim to determine the sleep correlates of age-related brain loss in a sample of middle-aged to older males with obstructive sleep apnea (OSA). We recruited consecutive treatment naïve male patients with moderate to severe OSA from January to November of 2019. We [...] Read more.
We aim to determine the sleep correlates of age-related brain loss in a sample of middle-aged to older males with obstructive sleep apnea (OSA). We recruited consecutive treatment naïve male patients with moderate to severe OSA from January to November of 2019. We excluded participants if they had dementia, stroke or heart disease. We collected demographic variables and vascular risk factors. We also obtained the insomnia severity index, the Epworth sleepiness scale and the Pittsburgh sleep quality index. We also obtained computerized neurocognitive testing with the go-no-go response inhibition test, Stroop interference test, catch game test, staged information processing speed test, verbal memory test and non-verbal memory test. We derived age and education adjusted domain-specific Z-scores for global cognition, memory, attention, processing speed and executive function. We used brain MRI T1-weighted images to derive total hippocampal and gray matter volumes. Partial correlations evaluated associations between variables from sleep questionnaires (e.g., insomnia severity index score), and polysomnographic variables (the apnea-hypopnea index, average oxygen levels during sleep) with cognitive domains and brain volumes. We examined 16 participants with an age range of 40–76 years, 73% Hispanic/Latino. The mean apnea-hypopnea index was 48.9 ± 25.5 and average oxygen saturation during sleep was 91.4% ± 6.9%. Hypertension was seen in 66% and diabetes mellitus in 27%. We found that the insomnia severity index score and average oxygen levels during sleep had the strongest correlations with brain volumes and cognition. These preliminary findings may aid in developing future strategies to improve age-related brain loss in patients with OSA. Full article
(This article belongs to the Special Issue Comorbid Insomnia and Sleep Apnea (COMISA): High Risk Populations, Underlying Mechanisms, Consequences, and Treatment Implications)
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