Journal Article

All-Cause Mortality in People with Co-Occurring Insomnia Symptoms and Sleep Apnea: Analysis of the Wisconsin Sleep Cohort

Scott, Hannah, Eckert, Danny J, Lechat, Bastien, Vakulin, Andrew, Loffler, Kelly A, Appleton, Sarah L, Adams, Robert, Catcheside, Peter G, Reynolds, Amy, Lovato, Nicole, Sweetman, Alexander, Wallace, Douglas M

2022

Overview

Purpose: Insomnia symptoms and sleep apnea frequently co-occur and are associated with worse sleep, daytime function, mental health and quality of life, compared to either insomnia or obstructive sleep apnea (OSA) alone. This study aimed to investigate the association of symptoms of co-morbid insomnia and sleep apnea (COMISA) with all-cause mortality. Patients and Methods: Wisconsin Sleep Cohort data were analysed to assess potential associations between COMISA symptoms and all-cause mortality. Nocturnal insomnia symptoms were defined as difficulties initiating sleep, maintaining sleep, and/or early morning awakenings \"often\" or \"almost always\", and/or regular sedative-hypnotic medicine use. OSA was defined as an apneahypopnea index [greater than or equal to]5/hr sleep. Participants were classified as having neither insomnia symptoms nor OSA, insomnia symptoms alone, OSA alone, or COMISA symptoms. Associations between the four groups and all-cause mortality over 20 years of follow-up were examined via multivariable adjusted Cox regression models. Results: Among 1115 adult participants (mean[+ or -] SD age 55 [+ or -] 8 years, 53% males), 19.1% had COMISA symptoms. After controlling for sociodemographic and behavioral factors, COMISA symptoms were associated with an increased risk of all-cause mortality compared to no insomnia symptoms or OSA (HR [95% CI]; 1.71 [1.00-2.93]). OSA alone (0.91 [0.53, 1.57]) and insomnia symptoms alone (1.04 [0.55, 1.97]) were not associated with increased mortality risk. Conclusion: Co-morbid insomnia symptoms and sleep apnea is associated with increased all-cause mortality risk. Future research should investigate mechanisms underpinning COMISA and the effectiveness of different treatment approaches to reduce mortality risk for this common condition. Keywords: sleep disordered breathing, Wisconsin Sleep Cohort, COMISA, obstructive, sleep apnea, insomnia, respiratory

• Publisher: Dove Medical Press Limited,Taylor & Francis Ltd,Dove Press,Dove,Dove Medical Press
• Subject: Analysis / Anesthesia / Chronic illnesses / COMISA / Health aspects / Insomnia / Mental health / Mortality / obstructive / obstructive sleep apnea / Original Research / Quality of life / respiratory / Self report / Sleep apnea / Sleep apnea syndromes / sleep disordered breathing / Sleep disorders / Sociodemographics / Statistical analysis / Wisconsin Sleep Cohort