The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023

Journal of Sleep Research, Journal Year: 2023, Volume and Issue: 32(6)

Published: Nov. 28, 2023

Summary Progress in the field of insomnia since 2017 necessitated this update European Insomnia Guideline. Recommendations for diagnostic procedure and its comorbidities are: clinical interview (encompassing sleep medical history); use questionnaires diaries (and physical examination additional measures where indicated) (A). Actigraphy is not recommended routine evaluation (C), but may be useful differential‐diagnostic purposes Polysomnography should used to evaluate other disorders if suspected (i.e. periodic limb movement disorder, sleep‐related breathing disorders, etc.), treatment‐resistant (A) indications (B). Cognitive‐behavioural therapy as first‐line treatment chronic adults any age (including patients with comorbidities), either applied in‐person or digitally When cognitive‐behavioural sufficiently effective, a pharmacological intervention can offered Benzodiazepines (A), benzodiazepine receptor agonists daridorexant low‐dose sedating antidepressants (B) short‐term (≤ 4 weeks). Longer‐term these substances initiated some cases, considering advantages disadvantages Orexin antagonists periods up 3 months longer cases Prolonged‐release melatonin ≥ 55 years Antihistaminergic drugs, antipsychotics, fast‐release melatonin, ramelteon phytotherapeutics are Light exercise interventions adjunct therapies

Language: Английский

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International Consensus Statement on Obstructive Sleep Apnea

International Forum of Allergy & Rhinology, Journal Year: 2022, Volume and Issue: 13(7), P. 1061 - 1482

Published: Sept. 7, 2022

Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation determination key factors important clinical management adult OSA patient. Toward this goal, an international collaborative multidisciplinary experts in evaluation treatment have produced International Consensus statement Obstructive Sleep Apnea (ICS:OSA).

Language: Английский

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Multinight Prevalence, Variability, and Diagnostic Misclassification of Obstructive Sleep Apnea

American Journal of Respiratory and Critical Care Medicine, Journal Year: 2021, Volume and Issue: 205(5), P. 563 - 569

Published: Dec. 14, 2021

Rationale: Recent studies suggest that obstructive sleep apnea (OSA) severity can vary markedly from night to night, which may have important implications for diagnosis and management. Objectives: This study aimed assess OSA prevalence multinight in-home recordings the impact of night-to-night variability in on diagnostic classification a large, global, nonrandomly selected community sample consumer database people purchased novel, validated, under-mattress analyzer. Methods: A total 67,278 individuals aged between 18 90 years underwent nightly monitoring over an average approximately 170 nights per participant July 2020 March 2021. was defined as mean apnea–hypopnea index (AHI) more than 15 events/h. Outcomes were global likelihood misclassification single night's AHI value. Measurements Main Results: More 11.6 million data collected analyzed. 22.6% (95% confidence interval, 20.9–24.3%). The misdiagnosis with based ranged 20% 50%. Misdiagnosis error rates decreased increased (e.g., 1-night F1-score = 0.77 vs. 0.94 14 nights) remained stable after monitoring. Conclusions: Multinight using noninvasive sensor technology indicates moderate severe 20%, diagnosed single-night be misclassified. These findings highlight need consider variation

Language: Английский

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Comorbid insomnia and sleep apnoea is associated with all-cause mortality

European Respiratory Journal, Journal Year: 2021, Volume and Issue: 60(1), P. 2101958 - 2101958

Published: Dec. 2, 2021

Background Increased mortality has been reported in people with insomnia and those obstructive sleep apnoea (OSA). However, these conditions commonly co-occur the combined effect of comorbid (COMISA) on risk is unknown. This study used Sleep Heart Health Study (SHHS) data to assess associations between COMISA all-cause risk. Methods Insomnia was defined as difficulties falling asleep, maintaining and/or early morning awakenings from ≥16 times per month, daytime impairments. OSA an apnoea–hypopnoea index ≥15 events·h −1 . if both were present. Multivariable adjusted Cox proportional hazards models determine association (n=1210) over 15 years follow-up. Results 5236 participants included. 2708 (52%) did not have insomnia/OSA (reference group), 170 (3%) had insomnia-alone, 2221 (42%) OSA-alone 137 COMISA. a higher prevalence hypertension (OR 2.00, 95% CI 1.39–2.90) cardiovascular disease (CVD) 1.70, 1.11–2.61) compared reference group. Insomnia-alone associated but CVD Compared group, 47% (hazard ratio 1.47, 1.06–2.07) increased mortality. The consistent across multiple definitions insomnia. Conclusions rates at baseline, no insomnia/OSA.

Language: Английский

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The effect of cognitive behavioural therapy for insomnia in people with comorbid insomnia and sleep apnoea: A systematic review and meta‐analysis

Journal of Sleep Research, Journal Year: 2023, Volume and Issue: 32(6)

Published: March 5, 2023

Summary Comorbid insomnia and sleep apnoea (COMISA) is a highly prevalent debilitating disorder. Cognitive behavioural therapy for (CBTi) may be an appropriate treatment COMISA; however, no previous study has systematically reviewed meta‐analysed literature reporting on the effect of CBTi in people with COMISA. A systematic search was conducted across PsychINFO PubMed ( n = 295). In all, 27 full‐text records were independently by at least two authors. Forward‐ backward‐chain referencing, hand‐searches used to identify additional studies. Authors potentially eligible studies contacted provide COMISA subgroup data. total, 21 studies, including 14 independent samples 1040 participants included. Downs Black quality assessments performed. meta‐analysis nine primary measuring Insomnia Severity Index indicated that associated large improvement severity (Hedges’ g −0.89, 95% confidence interval [CI] −1.35, −0.43). Subgroup meta‐analyses effective untreated obstructive (OSA) (five Hedges’ −1.19, CI −1.77, −0.61) treated OSA (four −0.55, −0.75, −0.35). Publication bias evaluated examining Funnel plot (Egger's regression p 0.78). Implementation programmes are required embed management pathways clinics worldwide currently specialise alone. Future research should investigate refine interventions COMISA, identifying most components, adaptations, developing personalised approaches this condition.

Language: Английский

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The association of co‐morbid insomnia and sleep apnea with prevalent cardiovascular disease and incident cardiovascular events

Journal of Sleep Research, Journal Year: 2022, Volume and Issue: 31(5)

Published: Feb. 15, 2022

Summary Insomnia and obstructive sleep apnea commonly co‐occur (co‐morbid insomnia apnea), their co‐occurrence has been associated with worse cardiometabolic mental health. However, it remains unknown if people co‐morbid are at a heightened risk of incident cardiovascular events. This study used longitudinal data from the Sleep Heart Health Study ( N = 5803) to investigate potential associations between disease prevalence baseline event incidence over ~11 years follow‐up. was defined as self‐reported difficulties initiating and/or maintaining AND daytime impairment. Obstructive an apnea–hypopnea index ≥ 15 events per hr sleep. Co‐morbid both conditions were present. Data 4160 participants for this analysis. The no insomnia/obstructive apnea, only, only 53.2%, 3.1%, 39.9% 1.9%, respectively. 75% (odd ratios [95% confidence interval]; 1.75 [1.14, 2.67]) increase in likelihood having after adjusting pre‐specified confounders. In unadjusted model, twofold (hazard ratio, 95% interval: 2.00 [1.33, 2.99]) incidence. covariates, not significantly ratio 1.38 [0.92, 2.07]). Comparable findings obtained when alternative definition (difficulties without impairment) used.

Language: Английский

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

Nature and Science of Sleep, Journal Year: 2022, Volume and Issue: Volume 14, P. 1817 - 1828

Published: Oct. 1, 2022

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

Language: Английский

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The causal associations of altered inflammatory proteins with sleep duration, insomnia and daytime sleepiness

SLEEP, Journal Year: 2023, Volume and Issue: 46(10)

Published: Aug. 2, 2023

Growing evidence linked inflammation with sleep. This study aimed to evaluate the associations and causal effects of sleep traits including insomnia, excessive daytime sleepiness (EDS), duration (short: <7 h; normal: 7-9 long: ≥9 h), levels C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukins.Standard procedures quantitative analysis were applied estimate expression differences for each in compared groups. Then, a two-sample Mendelian randomization (MR) was performed explore their relationships published genome-wide association summary statistics. The inverse-variance weighted used as primary method, followed by several complementary approaches sensitivity analyses.A total 44 publications 51 879 participants included analysis. Our results showed that CRP, interleukin-1β (IL-1β), IL-6, TNF-α higher from 0.36 0.58 (after standardization) insomnia controls, while there no significant difference between EDS controls. Besides, U/J-shaped CRP IL-6 durations. In MR analysis, demonstrated on (estimate: 0.017; 95% confidence intervals [CI], [0.003, 0.031]) short -0.006; CI, [-0.011, -0.001]). Also, found be associated long 0.006; [0.000, 0.013]). These consistent analyses.There are high inflammatory profiles extremes duration. Meanwhile, elevated have longer Further studies can focus related upstream downstream mechanisms.

Language: Английский

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Approach the Patient With Obstructive Sleep Apnea and Obesity

The Journal of Clinical Endocrinology & Metabolism, Journal Year: 2023, Volume and Issue: 109(3), P. e1267 - e1279

Published: Sept. 27, 2023

Abstract Obstructive sleep apnea (OSA) and obesity are highly prevalent bidirectionally associated. OSA is underrecognized, however, particularly in women. By mechanisms that overlap with those of obesity, increases the risk developing, or having poor outcomes from, comorbid chronic disorders impairs quality life. Using 2 illustrative cases, we discuss relationships between type diabetes, dyslipidemia, cardiovascular disease, cognitive disturbance, mood disorders, lower urinary tract symptoms, sexual function, reproductive disorders. The differences men women, phenotypic variability OSA, highlighted. When probability high due to consistent comorbidities, both, a diagnostic study advisable. Continuous positive airway pressure mandibular advancement splints improve symptoms. Benefits for comorbidities variable depending on nightly duration use. contrast, weight loss optimization lifestyle behaviors consistently beneficial.

Language: Английский

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A comprehensive evaluation of insomnia, obstructive sleep apnea and comorbid insomnia and obstructive sleep apnea in US military personnel

SLEEP, Journal Year: 2022, Volume and Issue: 45(12)

Published: Aug. 25, 2022

Abstract Study Objectives The aim of this study was to characterize the sleep disorders insomnia, obstructive apnea (OSA), and comorbid insomnia OSA (COMISA) in active duty military personnel. Methods Prospective observational 309 personnel with a mean age 37.17 years (SD = 7.27). Participants served four branches U.S. (47.9% Air Force, 38.8% Army, 11.3% Navy, 1.9% Marines). Sleep diagnoses were rendered after video-polysomnography clinical evaluation. Validated self-report measures assessed severity, excessive daytime sleepiness, quality, disruptive nocturnal behaviors, nightmare disorder, shift work disorder (SWD), impairment, fatigue, posttraumatic stress (PTSD) symptoms, anxiety, depression, traumatic brain injury (TBI). General linear models Pearson chi-square tests used for between-group differences data analyses. Results Insomnia diagnosed 32.7%, 30.4% COMISA 36.9%. Compared alone, those only had significantly greater sleep-related rates poorer quality (all Ps &lt; .05). They also reported symptoms PTSD, depression There no significant among three diagnostic groups on SWD, or TBI. Conclusions Military overall report worsened disorders, psychiatric than OSA. highlight importance comprehensive assessment sleep, clinically disturbances.

Language: Английский

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