0361 A Novel Longitudinal Approach to Evaluating Comorbid Insomnia and Sleep Apnea in Individuals Tested for Sleep Apnea

Abstract Introduction Comorbid insomnia and sleep apnea (COMISA) is a debilitating disorder marked by a bi-directional relationship between obstructive sleep apnea (OSA) and insomnia. To explore this relationship, we employed a novel approach to evaluate metrics associated with comorbid-insomnia (sleep maintenance) in individuals who tested for OSA with a longitudinal (multi-night) home sleep test. Methods 3,370 tests were evaluated (1,358 participants; mean age 49.73 years, SD 15.0; mean tests/participant 3.1, SD 4.5). OSA was measured by apnea/hypopnea index (AHI) and hypoxic burden (HB). ANOVA and PCC (99% CI) were used to evaluate the relationship between SA severity and measures of comorbid-insomnia (total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO), #awakenings (#W), %light sleep (%L), %REM sleep (%REM)). Results TST (F[3,3357]=5.21; p< 0.001), SE (F[3,3357]=16,12; p< 0.001), and %REM (F[3,3357]=2.84; p=0.014) decreased, and #W (F[3, 3357]=3.20; p< 0.001), WASO (F[3, 3357]=15.22; p< 0.0001) and %Light (F[3,3357]=3.40; p< 0.0001) increased with AHI severity. Between normal (AHI 0-4.99) and mild (AHI 5-14.99) tests, SE (-2%; p=0.005) decreased, and #W (+1.05; p=0.01) and WASO (+10.3 min; p< 0.0001) increased. The largest change occurred between normal and severe (AHI >30) tests (TST -28.65 min; WASO +27.15 min). AHI and HB were positively correlated (r=0.67; p< 0.0001). AHI was weakly, but significantly, correlated with TST (p< 0.0001), SE (p< 0.0001), #W (p< 0.0001), and WASO (p< 0.0001). HB was correlated with SE (p< 0.0001), #W (p< 0.0001), and WASO (p< 0.0001). Conclusion Comorbid-insomnia measures increased with SA severity at all levels, suggesting that the presence of OSA at any severity is a risk factor for COMISA. Further analysis is required to determine if the presence of SA and the impact of HB are the primary factors driving COMISA. Contextual issues surrounding the sleep period need to be addressed. Support (if any)