![]() ![]() ![]() OSA may therefore cause, exacerbate, or contribute to symptoms of insomnia ( Krakow et al., 2001 Sweetman A.M. For instance, OSA may disturb sleep and increase the number of nightly awakenings ( Krakow et al., 2001 Smith et al., 2004). The relation between OSA and insomnia is likely bidirectional ( Sweetman A.M. In line with this, we recently reported that the prevalence of chronic insomnia disorder among OSA patients was reduced from 74–79% (depending on OSA severity) using the DSM-IV/ICSD-2 criteria to 44–55% using the DSM-5/ICSD-3 criteria ( Bjorvatn et al., 2015). As non-restorative sleep is commonly reported by OSA patients, these revised criteria will reduce the prevalence of insomnia among OSA patients. Non-restorative sleep (poor sleep quality) was previously a diagnostic criterion for chronic insomnia, but is no longer part of the diagnostic criteria according to the fifth and latest version of the Diagnostic and Statistical Manual for Mental disorders (DSM-5) ( American Psychiatric Association, 2013) and the International Classification of Sleep Disorders-3 (ICSD-3) ( American Academy of Sleep Medicine, 2014). Chronic insomnia is characterized by difficulties initiating or maintaining sleep to such a degree that it causes daytime impairments for a period of 3 months or more ( American Academy of Sleep Medicine, 2014). The disorder typically co-occurs with other sleep related problems, such as insomnia symptoms ( Luyster et al., 2010 Bjorvatn et al., 2015). The severity of OSA is usually characterized with the apnea-hypopnea-index (AHI), in which a higher AHI indicates more severe OSA. Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder characterized by breathing pauses, oxygen desaturation, and arousals during sleep ( American Academy of Sleep Medicine, 2014). The statistically significant improved sleep at follow-up in both groups is most likely explained by the CPAP treatment. No time × condition interaction effects were detected, suggesting that the self-help book did not improve insomnia symptoms more than the sleep hygiene advice.Ĭonclusion: In this randomized controlled trial among patients with OSA and comorbid insomnia who were initiating CPAP treatment, concurrently treating their insomnia with a self-help book did not improve sleep more than sleep hygiene advice. Similarly, the ISI scores were significantly improved in both conditions (sleep hygiene: 17.0 vs. 21.8) and in the self-help book group (26.3 vs. Results: The scores on the BIS improved significantly from pre-treatment to follow-up in the sleep hygiene advice group (26.8 vs. The main outcome measure was insomnia severity assessed with the Bergen Insomnia Scale (BIS) and the Insomnia Severity Index (ISI). The self-help book focused on cognitive behavioral therapy for insomnia. OSA was diagnosed and categorized based on a standard respiratory polygraphic sleep study using a type 3 portable monitor. Methods: In all, 164 patients were included. Objective: To compare the effects of a self-help book for insomnia to that of sleep hygiene advice in a randomized controlled trial with follow-up after about 3 months among patients who were diagnosed with obstructive sleep apnea (OSA) and comorbid chronic insomnia, and who were concurrently initiating treatment with continuous positive airway pressure (CPAP). 5Department of Psychosocial Science, University of Bergen, Bergen, Norway.4Section of Thoracic Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway.3Centre of Sleep Medicine, Haukeland University Hospital, Bergen, Norway.2Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.1Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway.Bjørn Bjorvatn 1,2,3* Thomas Berge 3 Sverre Lehmann 1,3,4 Ståle Pallesen 1,5 Ingvild W. ![]()
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