0391 UNTREATED SLEEP APNEA MASKED BY SLEEPING PILLS UNDERMINES EFFICACY OF INSOMNIA THERAPY

Abstract

Introduction: Chronic insomnia is treated with sleeping pills or cognitive behavioral therapy for insomnia (CBTI). Unrefreshing sleep and frequent nocturnal awakenings also commonly occur in obstructive sleep apnea (OSA). The high incidence of comorbid OSA may be overlooked and can undermine the efficacy of insomnia treatment. Methods: A retrospective chart review was performed on 199 patients presenting with chronic insomnia from October 2013 to November 2016 who enrolled in CBTI with a sleep physician at a community-based clinic. Self-reported sleep logs were used to track sleep measures. CBTI failure was defined as final sleep efficiency <80%. Patients with symptoms and signs of OSA were encouraged to undergo diagnostic sleep studies (home sleep apnea testing or diagnostic polysomnography) and those with apnea-hypopnea indices (AHI) >5 were identified. Results: The population consisted of 63% women (125 subjects) and 37% men (74 subjects). The average age was 60.7 years (ranging from 12 to 90 years). The average body mass index (BMI) was 26.7. The average Epworth sleepiness scale score at presentation was 6.0. Sleeping pills were used at baseline in 77.4% (154 subjects). Improvements were seen from baseline to program conclusion in averaged measures of sleep: sleep-onset latency (45.19 to 22.15 minutes), wakefulness after sleep onset (46.07 to 27.30 minutes), total sleep time (6.23 to 6.33 hours), and sleep efficiency (75.56% to 84.95%). OSA was present by testing in 73.9% of the population (147 subjects). Recommended testing based on clinical suspicion was deferred in 16.1% (32 subjects). Only 10.1% (20 subjects) had a negative sleep study. Compared to successful controls, CBTI failure was associated with a stable sleep efficiency (71.3% to 72.3% compared to 75.3% to 89.0%) and a higher overall incidence of sleep apnea (80% vs. 71.5%). Conclusion: Obstructive sleep apnea is extremely common among patients presenting for CBTI, many of whom take sleeping pills that may mask the symptoms. Though CBTI may be effective, treatment failure is associated with an even higher incidence of sleep apnea. Resolution of insomnia may depend on identification and treatment of comorbid sleep apnea, which could have further impacts on long-term health.