The relationship between obstructive sleep apnea syndrome and insomnia: implications for treatment

Obstructive sleep apnea syndrome (OSAS) is a sleep-disordered breathing condition that causes disrupted sleep. Although OSAS is most often associated with daytime hypersomnolence, a number of OSAS patients complain of insomnia, i.e., disorders of initiating or maintaining sleep. If the insomnia in patients with OSAS is secondary to the medical condition, then it would be expected to abate with the successful treatment of OSAS. If, however, the insomnia is primarily of a psychological nature, thus considered primary or psychophysiological insomnia, little to no change in insomnia symptoms would be expected after the treatment of OSAS. The present study examined the relations between OSAS and insomnia and attempted to determine if insomnia is secondary to OSAS by studying changes in insomnia over the course of treatment for OSAS with continuous positive airway pressure (CPAP). Forty-one individuals participated in the baseline assessment and a smaller sample of participants (n = 15) were followed over the course of OSAS treatment. All participants underwent a nocturnal diagnostic polysomnography (PSG) and self-monitored insomnia, daily functioning, sleep hygiene practices, and somatic and cognitive pre-sleep arousal for a one-week period prior to, and after, CPAP treatment. Baseline and post-treatment analyses provided evidence suggesting that OSAS and insomnia are independent sleep disorders. There was no association between sleep apnea severity and any self-reported measure of insomnia. Furthermore, there were no significant changes in insomnia after successful treatment of OSAS with CPAP. There were however, significant reductions in both somatic and cognitive arousal, constructs known to be closely associated with insomnia, after CPAP treatment. It is possible that somatic and cognitive arousal decreased as a function of decreased worry and anxiety about the sleep disruption typically caused by OSAS. Another potential explanation of why insomnia did not improve after CPAP treatment involves the significant correlation (r = .59) between CPAP interference and sleep-onset insomnia. These results suggest that a longer adjustment time to the CPAP stimulus might be necessary before definitive conclusions are reached regarding the proposed lack of association between OSAS and insomnia. Implications for the assessment and treatment of comorbid OSAS and insomnia are discussed

Examination of a Method for Increasing Adjustment to and Compliance With Nasal Continuous Positive Airway Pressure (CPAP) in Persons With Obstructive Sleep Apnea Syndrome.

Obstructive sleep apnea syndrome (OSAS) is a serious medical condition that occurs during sleep and consists of episodes of complete (respiratory pauses) or partial obstruction (hypoventilation) of the upper airway. Approximately 80% of persons diagnosed with OSAS are prescribed nasal Continuous Positive Airway Pressure (CPAP) treatment, which has proven to be the treatment of choice for OSAS. However, noncompliance with CPAP treatment in OSAS patients is a widely recognized problem, and many persons refuse CPAP as a treatment option or fail to use it reliably. Investigations of CPAP use in OSAS patients have generally found that nightly use averages less than five hours. Few interventions have been scientifically evaluated for improving CPAP compliance. The current study evaluated a method of introducing OSAS patients to CPAP prior to the administering CPAP titration in the laboratory. Participants in the treatment groups underwent a 30-minute CPAP habituation trial, with a range of pressures, prior to the polysomnography with CPAP. It was hypothesized that the participants who experienced CPAP habituation would have better sleep quality during CPAP, would be more likely to accept CPAP, and would use CPAP more on a nightly basis than control participants who experienced the usual laboratory procedures for introducing CPAP (CPAP education) to OSAS patients. There were no statistically significant differences for any of the dependent variables between participants who experienced CPAP habituation and participants who experienced CPAP education. Men were found to use CPAP 1.61 hours more on a nightly basis than women (p = .03). This difference is most likely attributable to severity, as men were observed to have an A+HI that was twice the observed A+HI of women participants. Overall, CPAP acceptance and compliance for the complete sample was comparable to what has been reported in the CPAP treatment literature

Weight and metabolic effects of cpap in obstructive sleep apnea patients with obesity

<p>Abstract</p> <p>Background</p> <p>Obstructive sleep apnea (OSA) is associated with obesity, insulin resistance (IR) and diabetes. Continuous positive airway pressure (CPAP) rapidly mitigates OSA in obese subjects but its metabolic effects are not well-characterized. We postulated that CPAP will decrease IR, ghrelin and resistin and increase adiponectin levels in this setting.</p> <p>Methods</p> <p>In a pre- and post-treatment, within-subject design, insulin and appetite-regulating hormones were assayed in 20 obese subjects with OSA before and after 6 months of CPAP use. Primary outcome measures included glucose, insulin, and IR levels. Other measures included ghrelin, leptin, adiponectin and resistin levels. Body weight change were recorded and used to examine the relationship between glucose regulation and appetite-regulating hormones.</p> <p>Results</p> <p>CPAP effectively improved hypoxia. However, subjects had increased insulin and IR. Fasting ghrelin decreased significantly while leptin, adiponectin and resistin remained unchanged. Forty percent of patients gained weight significantly. Changes in body weight directly correlated with changes in insulin and IR. Ghrelin changes inversely correlated with changes in IR but did not change as a function of weight.</p> <p>Conclusions</p> <p>Weight change rather than elimination of hypoxia modulated alterations in IR in obese patients with OSA during the first six months of CPAP therapy.</p

Compliance with COVID-19 Mitigation Measures in the United States

The COVID-19 mitigation measures require a fundamental shift in human behavior. The present study assesses what factors influence Americans to comply with the stay at home and social distancing measures. It analyzes data from an online survey, conducted on April 3, 2020, of 570 participants from 35 states that have adopted such measures. The results show that while perceptual deterrence was not associated with compliance, people actually comply less when they fear the authorities. Further, two broad processes promote compliance. First, compliance depended on people’s capacity to obey the rules, opportunity to break the rules, and self-control. As such, compliance results from their own personal abilities and the context in which they live. Second, compliance depended on people’s intrinsic motivations, including substantive moral support and social norms. This paper discusses the implications of these findings for ensuring compliance to effectively mitigate the virus

Influence of Motivational Text Messages on Adherence to Continuous Positive Airway Pressure Therapy

Obstructive sleep apnea (OSA) is a condition affecting an estimated 22% of men and 17% of women. Individuals with OSA have periodic bouts of apneas and hypopneas while sleeping that negatively impacts their sleep quality and neurohormonal function. As a result, individuals with OSA are at increased risk for diseases including diabetes, cancer, stroke, myocardial infarction, and depression. Continuous positive airway pressure (CPAP) therapy is an effective treatment for but adherence rates are low at an estimated 60%.The purpose of this pilot study was to examine the effects of a four-week text message-based intervention on an individual\u27s CPAP device adherence, OSA symptom management, and outcome expectations when compared to participants receiving generic text messages. Participants were randomized to an experimental group (EG) (n=29) or to a control group (CG) (n=28). The EG received one motivational text message every week for four weeks based on concepts derived from the theory of planned behavior (TPB). The CG received one text message every week for four weeks with objective information (average use in hours per week). Total mask-on time and CPAP adherence status were measured using CPAP device real-time data. Symptom management and CPAP use expectations were evaluated using Apnea Belief Scale (ABS), Epworth Sleepiness Scale (ESS), and Functional Outcomes of Sleep Questionnaire-10 (FOSQ-10).There was no significant difference in total mask-on time between the two groups (p=.64). The proportion of participants classified as adherent did not differ between the two groups (p=.17). Differences in ABS, ESS, and FOSQ-10 scores between groups were also not significant (ANOVA, ABS: p =.47; ESS: p =.81; FOSQ: p =0.97).The pilot study identified trends toward improved CPAP adherence with use of TPB-based text messages. For example, the experimental group’s adherence rate was 14.8% higher than control group’s adherence rate. The lack of significance in the 3 instruments may have occurred because they measured actual behavior (CPAP use) and not what effect the intervention had on changing the behavior. More research is needed to elucidate the impact of TPB-based text messages on improving CPAP adherence and outcomes for individuals with OSA

Psychological and Clinical Predictors of Compliance With Continuous Positive Airway Pressure Therapy for Obstructive Sleep Apnoea: A Prospective Study

Objectives: To assess the level of knowledge and understanding, among healthcare professionals, about the activities of clinical psychologists and to assess perception of need for the clinical psychology service within a general hospital. Differences between high/regular and occasional/non-referring departments were examined in relation to the above objectives with a view towards explaining variations in referral rates to the Department of Clinical Psychology. Design and Subjects: A semi-structured interview, containing items aimed at addressing the above objectives, was administered to fifteen hospital based medical and surgical consultants representing different departments. Setting: A General Hospital in Central Scotland. Results: High/regular referring departments displayed a greater level of knowledge and understanding of clinical psychology practice than occasional/non-referring departments. The occasional/non-referring departments demonstrated more cautious attitudes than high/regular referring departments towards psychological input to the care of patients. Overall, most departments indicated that they would be interested in learning more about the clinical psychology service and what it could offer their departments. Conclusions: The study identified a generally low level of awareness and understanding of psychological issues among the departmental representatives within the general hospital. This highlighted the need for education about the role of clinical psychology in general hospitals and improved communication between the psychology service and other departments in the hospital. The survey identified that these moves would generally be welcomed by departments, suggesting that lower referral rates were more likely to be a result of poor understanding rather than hostility or mistrust towards psychological methods. A larger scale study should be carried out to investigate the generality of these findings

Personality Correlates of Compliance with Continuous Positive Airway Pressure for Treatment of Sleep Apnea

Unlike many chronic illnesses with less than optimal treatment efficacy, the treatment for obstructive sleep apnea (OSA), continuous positive airway pressure (CPAP), is extremely efficacious. However, treatment compliance for OSA is a serious problem for a number of unclear reasons. Because OSA has serious consequences, ranging from daytime sleepiness to life threatening cardiovascular problems, researchers have attempted to identify noncompliant users and to create interventions that promote compliance. Despite the plethora of research, inconsistent and unreplicable results prevail. There appear to be no demographic or personality correlates that consistently predict compliance and researchers have struggled to find an intervention that is practical and effective.   This thesis focuses on identifying personality correlates that may predict treatment compliance. Many traditional, frequently used personality inventories such as the MMPI-2 have been researched in conjunction with CPAP compliance prediction. Other inventories that focus on more specific aspects of personality, such as the BIS/BAS, which measures regulation of inhibitory and appetitive motives, have never been used in research on treatment compliance for any chronic disease. Similarly, the Ways of Coping (WAYS) inventory, which measures coping processes, has been used in one CPAP compliance study. This thesis utilizes the following inventories to predict CPAP compliance: a broad personality inventory that has been researched with chronic treatment regimens other than CPAP, the Mini IPIP, and two less researched and more specific inventories, the BIS/BAS and the WAYS.  M.A

Adherencia al tratamiento con CPAP en pacientes con síndrome de apnea obstructiva del sueño

Las apneas son el cese de la respiración de al menos 10 segundos de duración (apnea) durante el sueño. Si añadimos la somnolencia aparece el Síndrome de la Apnea Obstructiva del Sueño (SAOS) Existen diversos factores de riesgo de padecer SAOS como la edad, sexo, obesidad, etc. Además la apnea es un gran factor de riesgo de padecer enfermedades cardiovasculares. El tratamiento mas efectivo del SAOS es dormir conectado a una mascarilla nasal o facial a la que se aplica una presión positiva aérea continua (CPAP) procedente de una turbina eléctrica. La condición para que la CPAP demuestre eficacia es que el uso de la misma sea diario y durante un mínimo de 4 h por noche. El objetivo de este estudio es estudiar la adherencia al tratamiento de pacientes con SAOS y que factores influyen en dicha adherencia. La población de estudio es la cohorte de SAOS de Zaragoza, se han estudiado diversas variables antropométricas así como sus hábitos tóxicos, antecedente clínicos previos, etc. Y se ha tenido en cuenta su consumo de CPAP a través de la empresa suministradora. Después de realizar el análisis estadístico llegamos a la conclusión de que el uso de CPAP durante el sueño de los pacientes con apnea del sueño aumenta con los años de tratamiento (objetivo primario) y que se observa una estabilidad individual de su uso en el tiempo y de que los principales factores que determinan la adherencia al tratamiento de la CPAP son el grado de sobrepeso/obesidad y el tiempo de seguimiento (objetivo secundario) En resumen, los pacientes con SAOS en tratamiento con CPAP muestran una adherencia al tratamiento que aumenta principalmente con el tiempo de seguimiento y parte con su nivel de sobrepeso/obesidad