![]() The purpose of this review is to provide an overview of the clinical challenges associated with the management of patients with COMISA. This shift includes utilization of symptom profiles or phenotypes that transcend diagnostic categories, treatment combinations using various specialties and sequences, and consideration of patient characteristics and preferences throughout the process of clinical care. Traditional approaches based on clinical lore and older diagnostic nomenclature are being challenged by recent innovations and emerging data that support multidisciplinary approaches with considerations based on patient-centered care. 10, 11, 12, 13, 14, 15, 16, 17, 18 As a result, clinical management of COMISA is often very challenging.Ĭurrently, no definitive guidelines exist for evaluating and treating patients with COMISA. ![]() COMISA is associated with increased medical (eg, cardiometabolic conditions) and psychiatric morbidity (eg, mood disorders, posttraumatic stress disorder), and worse daytime functioning relative to each condition alone. Given that chronic insomnia is considered a distinct disorder, 7, 8 comorbid insomnia and sleep apnea (COMISA) are the most common co-occurring sleep disorders, with a global prevalence between 18% and 42%, 9 and a prevalence between 29% and 67% among patients presenting for treatment. It is also common for people with OSA to have difficulty falling or staying asleep. 2, 3, 4, 5, 6 Respiratory events result in sleep fragmentation and poor sleep quality. ![]() OSA is a sleep-related breathing disorder that affects approximately 10% to 20% of middle- to older-aged adults 1 and is associated with excessive daytime sleepiness, cardiovascular sequelae, neurocognitive deficits, and depression. Based on these recent advances and clinical perspectives, a model for using multidisciplinary, patient-centered care is recommended to optimize the clinical management of patients with COMISA. ![]() Furthermore, patient-centered considerations that integrate patient characteristics, treatment preferences, and accessibility to treatment in the context of COMISA are discussed as opportunities to improve patient care. Recent randomized controlled trials have provided important evidence about the safety and effectiveness of a concomitant treatment approach to COMISA using cognitive-behavioral therapy for insomnia (CBT-I) with positive airway pressure (PAP). Innovations in the assessment of COMISA have used profile analyses or dimensional approaches to examine symptom clusters or symptom severity that could be particularly useful in the assessment of COMISA. This review provides an overview of the clinical challenges in the management of patients with COMISA, with a focus on recent evidence regarding the evaluation and treatment of COMISA. ![]() The treatment program used in the current study has demonstrated potential for a brief, inexpensive, and effective treatment of sleep maintenance insomnia in the older adult population.Comorbid insomnia and sleep apnea (COMISA) are the most common co-occurring sleep disorders and present many challenges to clinicians. Participants also reported a reduction of the Insomnia Severity Index, Flinders Fatigue Scale, Epworth Sleepiness Scale, Daytime Feeling and Functioning Scale, Sleep Anticipatory Anxiety Questionnaire, the Dysfunctional Beliefs and Attitudes Scale, and increased Sleep Self-Efficacy Scale. The brief group-administered CBT-I program produced improvements in the timing and quality of sleep including later bedtimes, earlier out-of-bed times, reduced wake after sleep onset, and improved sleep efficiency. Seven-day sleep diaries, actigraphy, and several self-report measures to assess perceived insomnia severity, daytime functioning, and confidence in and beliefs about sleep. One-hundred eighteen adults with sleep maintenance insomnia (mean age = 63.76 y, standard deviation = 6.45 y, male = 55).Ī 4-w, group-based treatment program of CBT-I including bedtime restriction therapy, sleep education, and cognitive restructuring. Randomized controlled trial of CBT-I compared to waitlist control with comparisons at pretreatment, posttreatment, and 3-mo follow-up.įlinders University Sleep and Circadian Rhythm Research Laboratory, Adelaide, South Australia. To evaluate the efficacy of a brief 4-w group-administered treatment program of cognitive behavior therapy for insomnia (CBT-I) for older adults with sleep maintenance insomnia. ![]()
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