Association between age and comorbid insomnia and sleep apnea.
Level 4 - case-series / case-control
Cross-sectional observational study
PubMed 39531785 · doi:10.1016/j.sleep.2024.11.011
What was done
A single-night polysomnography with video monitoring was conducted in 2,176 Chinese adults (ages 18–102) undergoing screening for obstructive sleep apnea (OSA). Insomnia was defined as difficulty initiating or maintaining sleep, or early morning awakening at least three times per week for more than three months with daytime symptoms. Comorbid insomnia and sleep apnea (COMISA) was defined as an apnea-hypopnea index (AHI) ≥5 with insomnia. Characteristics were compared between COMISA and OSA-only groups, and sex-adjusted logistic regression evaluated the association between age and COMISA.
What was found
Of the participants, 981 had COMISA and 433 had OSA only. Compared to OSA-only patients, COMISA patients were more often female (48% vs. 24%), had longer sleep onset latency (+5.8 min), shorter total sleep time (-14.0 min), lower AHI (-14.4 points), and higher mean peripheral oxygen saturation (+0.6%; all p < 0.05). The COMISA vs. OSA-only proportion was 51.9% vs. 48.1% in participants under 50 years, compared to 78.1% vs. 21.9% in those aged 70 or older. Logistic regression adjusted for sex showed a 3% increase in the odds of COMISA per additional year of age (OR 1.03, 95% CI: 1.02–1.04).
Why it matters
The study shows that insomnia frequently co-occurs with OSA, particularly in older adults where it comprises the vast majority of sleep apnea presentations, highlighting the need for dual screening and tailored management.
Limits
The study is cross-sectional, precluding causal or temporal inferences. Data relied on a single-night polysomnography subject to first-night effect. Statistical adjustment was limited to sex, leaving potential confounding by body mass index, medical and psychiatric comorbidities, and medication use unmeasured.
Cited by
- supports Chronic insomnia disorder is clinically defined as persistent difficulty initiating or maintaining sleep or waking up too early occurring at least three nights per week for at least three months, with daytime impairment.