Internal medicine

Sleep (system call)

Continuous positive airway pressure

Apnea

Refining (metallurgy)

Operating system

Psychiatry

Intensive care medicine

Physical chemistry

Physical therapy

Obstructive sleep apnea

Chemistry

Sleep apnea

Polysomnography

Computer science

Insomnia

Medicine

Journal of Clinical Sleep Medicine

Comorbid insomnia and sleep apnea (COMISA) is a common condition which results in additive impairments to patients' sleep and quality of life, difficult diagnostic decisions for treating clinicians, and problems with treatment adherence and effectiveness. 1 Although the co-occurrence of insomnia and obstructive sleep apnea (OSA) was first reported by Guilleminaut and colleagues in 1973, 2 there was a lack of research interest in the field until two articles were published in 1999 3 and 2001, 4 reporting that 50% of patients with OSA report clinically significant insomnia symptoms, and 43% of those with insomnia fulfill minimum diagnostic criteria for OSA.][7] Despite this increased interest in COMISA, there has a been a surprising lack of research investigating the validity of current measures of insomnia in the presence of co-occurring OSA.Insomnia and OSA result in many shared symptoms that can complicate the measurement and diagnosis of each disorder in the presence of the other. 5For example, a diagnosis of insomnia is indicated according to the frequency, severity, timing, and chronicity of trouble falling asleep or night time awakenings, and associated daytime functional impairments. 8However, OSA commonly manifests in similar symptoms; including perceptions of nonrestorative sleep, frequent (postapneic) night time awakenings, and daytime sleepiness, fatigue, and depressive symptoms.Additionally, the International Classification of Sleep Disorders lists "insomnia" among criteria to indicate a diagnosis of OSA in the presence of an apnea-hypopnea index of 5-15 events/h. 8These shared symptoms therefore complicate the measurement and diagnosis of COMISA, and highlight the need for research investigating the validity of current insomnia measures in patients with OSA.The Insomnia Severity Index (ISI) 9 is a concise and useful self-report measure of insomnia, which has been used in several hundred cross-sectional and treatment studies.However, there has previously been a lack of data examining the validity of the

Refining the Measurement of Insomnia in Patients With Obstructive Sleep Apnea