![]() ![]() We hypothesized that a low AT is more common among COMISA than among OSA patients without insomnia. The purpose of the present study is to assess the AT among participants with COMISA and those with OSA only. Hypnotics aiming to increase the arousal threshold have also been tried as a treatment for OSA, resulting in OSA improvement for some individuals 10, 11, 12. For instance, hypnotics are commonly used to treat insomnia 9. Understanding the relationship between respiratory AT and arousability can shed light to the understanding of the pathophysiology implicated in COMISA and allow targeting more specific treatments. The arousal threshold has not been studied according to the different insomnia subtypes. ![]() Middle insomnia is the most prevalent subtype in COMISA subjects, possibly due to frequent arousals at the end of respiratory events 1, 8. Insomnia subtypes are associated with co-existing disorders such as depression, anxiety and sleep apnea 7. Arousability in these patients can be defined as the physiological, cognitive, emotional, and behavioral responsiveness of individuals to particular variations in environmental stressful conditions 6 and is associated with insomnia severity as measured by the Insomnia Severity Index (ISI) 6. Arousability may describe a particular phenotypical trait of insomnia patients 5. Patients with a low AT typically have respiratory events that terminate early, preventing the opportunity for ventilatory drive to build up and restore pharyngeal patency during sleep and promoting sleep fragmentation. A low AT has been implicated in the pathogenesis of OSA and may affect one-third of moderate to severe OSA patients 4. The respiratory arousal threshold (AT) is defined as the level of ventilatory drive that triggers an arousal from sleep at the termination of a respiratory event 3. Arousals from sleep are common in both insomnia and OSA and may be a common link explaining the frequent comorbidity of both disorders. The comorbidity of insomnia and sleep apnea (COMISA) is associated to poorer health outcomes 2. Obstructive sleep apnea and insomnia are highly prevalent sleep disorders that are associated with impaired daytime functioning and reduced quality of life 1. The similar proportion of low AT among COMISA and patients with OSA suggests that the respiratory arousal threshold may not be related to the increased arousability of insomnia. The proportion of participants with a low AT among OSA-only and COMISA groups was similar (29 vs 33%, p = NS). OSA-only group had significantly more males than the COMISA group (58% vs 33%, p = 0.013. OSA-only (n = 51) and COMISA (n = 52) participants had similar age (61 vs 60 years), body-mass index (31.3 vs 32.2 kg/m 2) and OSA severity (40.2 vs 37.55 events/h): all p = NS. ![]() Low AT was determined using a previously validated score based on 3 polysomnography variables (AHI, nadir SpO 2 and the frequency of hypopneas). Sleep apnea was defined as an apnea hypopnea index (AHI) ≥ 15 events/h. Participants with an ISI score ≥ 15 were defined as having insomnia. Participants referred for OSA diagnosis underwent a type 3 sleep study and answered the insomnia severity index (ISI) questionnaire and the Epworth sleepiness scale. We hypothesized that a low AT is more common among COMISA than among patients with OSA without insomnia. Respiratory arousal threshold (AT) is a physiologic measurement of the level of respiratory effort to trigger an arousal from sleep. Arousals from sleep may be a common link explaining the frequent comorbidity of both disorders. Exercising in then evenings sometimes helps, I find knowing there is no pressure to wake up for something by a certain the next morning can set me up for a better sleep (maybe 4-5 hrs) as well.Insomnia and obstructive sleep apnea (OSA) are common sleep disorders and frequently coexist (COMISA). I have found that some things work on some days though. But nothing keeps me asleep for long, and my MD is reluctant to prescribe heavier sleeping pills because he thinks I would be foggy or unable to function the next day □. I currently take the usual melatonin and sometimes benedryl, and them I'm prescribed a bunch of gabapentin and trazadone to take at night as well. Usually I will get tired and be able to fall asleep for a couple hours, but after that something wakes me up and I'm up until I have to go to work, etc. I've been dealing with this type of sleep problem for a few years now. Wow I didn't know there was a name for this. ![]()
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