O2 Does obstructive sleep apnoea surgery improve perceived insomnia severity in patients suffering from co-morbid insomnia and sleep apnoea (COMISA)?

Abstract

Introduction 'COMISA' (Co-Morbid Insomnia and Sleep Apnea) is a medical term used to describe patients suffering from both obstructive sleep apnea and insomnia. OSA and insomnia are both common sleep disorders that frequently coexist and together, increase the overall severity of illness (1). Treatment is naturally difficult because COMISA is brought on by a complex combination of health variables that contribute to both insomnia and sleep apnea.

Objective To evaluate the effect of obstructive sleep apnoea (OSA) surgery on insomnia in patients with co-morbid insomnia and sleep apnoea (COMISA).

Methods A retrospective interventional study was conducted on fifty consecutive adult patients with OSA who underwent surgery for OSA. Outcome measures included the Insomnia Severity Index (ISI) and the following polysomnography (PSG) indices: apnoea-hypopnea index (AHI), oxygen saturation index (ODI), lowest oxygen saturation (LOS) and Epworth Sleepiness Score (ESS) before treatment and at 4 months post-operatively.

Results In our study, 36% of the patients had clinical insomnia (ISI score > 15) prior to surgery. Following OSA surgery, there was an average improvement in the total ISI scores from 19.82 to 5.65 (p < 0.05). One patient continued to have moderate to severe clinical insomnia.

Overall OSA parameters following surgery showed AHI decreased from 33.38 ± 23.76 to 18.37 ± 22.94 (p < 0.05); ODI reduced from 30.85 ± 22.37 to 16.77 ± 21.73 (p < 0.05); LOS significantly increased from 74.42 ± 11.93 to 87.70 ± 7.59 (p < 0.05); ESS showed significant reduction from 10 ± 5.9 to 6.55 ± 5.18 (p < 0.05).

Discussion Our results showed a reduction in the insomnia scores of our COMISA subgroup and a significant post-operative improvement in ambulatory polysomograph variables. OSA and insomnia are strongly correlated and surgical treatment of OSA appears to be effective in reducing the insomnia burden in COMISA patients.