Interesting articles

@article{Brendan2018,
title = {Recognizable clinical subtypes of obstructive sleep apnea across international sleep centers: a cluster analysis},
author = {Brendan, T Keenan and Jinyoung, Kim and Bhajan, Singh and Lia, Bittencourt and Ning-Hung, Chen and Peter, A Cistulli and Ulysses, J Magalang and Nigel, McArdle and Jesse, W Mindel and Bryndís, Benediktsdóttir and Erna, Sif Arnardóttir and Lisa, Kristin Prochnow and Thomas, Penzel and Bernd, Sanner and Richard, J Schwab and Chol, Shin and Kate, Sutherland and Sergio, Tufik and Greg, Maislin and Þórarinn, Gíslason and Allan, I Pack},
url = {https://academic.oup.com/sleep/article/41/3/zsx214/4791307},
year = {2018},
date = {2018-01-05},
abstract = {Study Objectives
A recent study of patients with moderate–severe obstructive sleep apnea (OSA) in Iceland identified three clinical clusters based on symptoms and comorbidities. We sought to verify this finding in a new cohort in Iceland and examine the generalizability of OSA clusters in an international ethnically diverse cohort.

Methods
Using data on 972 patients with moderate–severe OSA (apnea–hypopnea index [AHI] ≥ 15 events per hour) recruited from the Sleep Apnea Global Interdisciplinary Consortium (SAGIC), we performed a latent class analysis of 18 self-reported symptom variables, hypertension, cardiovascular disease, and diabetes.

Results
The original OSA clusters of disturbed sleep, minimally symptomatic, and excessively sleepy replicated among 215 SAGIC patients from Iceland. These clusters also generalized to 757 patients from five other countries. The three clusters had similar average AHI values in both Iceland and the international samples, suggesting clusters are not driven by OSA severity; differences in age, gender, and body mass index were also generally small. Within the international sample, the three original clusters were expanded to five optimal clusters: three were similar to those in Iceland (labeled disturbed sleep, minimal symptoms, and upper airway symptoms with sleepiness) and two were new, less symptomatic clusters (labeled upper airway symptoms dominant and sleepiness dominant). The five clusters showed differences in demographics and AHI, although all were middle-aged (44.6–54.5 years), obese (30.6–35.9 kg/m2), and had severe OSA (42.0–51.4 events per hour) on average.

Conclusions
Results confirm and extend previously identified clinical clusters in OSA. These clusters provide an opportunity for a more personalized approach to the management of OSA.},
keywords = {Daytime sleepiness, Insomnia, Sleep Apnea},
pubstate = {published},
tppubtype = {article}
}

@article{Dieter2017,
title = {European guideline for the diagnosis and treatment of insomnia.},
author = {Dieter, Riemann and Chiara, Baglioni and Claudio, Bassetti and Bjørn, Bjorvatn and Leja, Dolenc Groselj and Jason, G Ellis and Colin, A Espie and Diego, Garcia‐Borreguero and Michaela, Gjerstad and Marta, Gonçalves and Elisabeth, Hertenstein and Markus, Jansson, Fröjmark and Poul, J Jennum and Damien, Leger and Christoph, Nissen and Liborio, Parrino and Tiina, Paunio and Dirk, Pevernagie and Johan, Verbraecken and Hans, Günter Weeß and Adam, Wichniak and Irina, Zavalko and Erna, Sif Arnardottir and Oana, Claudia Deleanu and Barbara, Strazisar and Marielle, Zoetmulder and Kai, Spiegelhalder},
url = {https://onlinelibrary.wiley.com/doi/full/10.1111/jsr.12594},
year = {2017},
date = {2017-09-05},
abstract = {This European guideline for the diagnosis and treatment of insomnia was developed by a task force of the European Sleep Research Society, with the aim of providing clinical recommendations for the management of adult patients with insomnia. The guideline is based on a systematic review of relevant meta‐analyses published till June 2016. The target audience for this guideline includes all clinicians involved in the management of insomnia, and the target patient population includes adults with chronic insomnia disorder. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to grade the evidence and guide recommendations. The diagnostic procedure for insomnia, and its co‐morbidities, should include a clinical interview consisting of a sleep history (sleep habits, sleep environment, work schedules, circadian factors), the use of sleep questionnaires and sleep diaries, questions about somatic and mental health, a physical examination and additional measures if indicated (i.e. blood tests, electrocardiogram, electroencephalogram; strong recommendation, moderate‐ to high‐quality evidence). Polysomnography can be used to evaluate other sleep disorders if suspected (i.e. periodic limb movement disorder, sleep‐related breathing disorders), in treatment‐resistant insomnia, for professional at‐risk populations and when substantial sleep state misperception is suspected (strong recommendation, high‐quality evidence). Cognitive behavioural therapy for insomnia is recommended as the first‐line treatment for chronic insomnia in adults of any age (strong recommendation, high‐quality evidence). A pharmacological intervention can be offered if cognitive behavioural therapy for insomnia is not sufficiently effective or not available. Benzodiazepines, benzodiazepine receptor agonists and some antidepressants are effective in the short‐term treatment of insomnia (≤4 weeks; weak recommendation, moderate‐quality evidence). Antihistamines, antipsychotics, melatonin and phytotherapeutics are not recommended for insomnia treatment (strong to weak recommendations, low‐ to very‐low‐quality evidence). Light therapy and exercise need to be further evaluated to judge their usefulness in the treatment of insomnia (weak recommendation, low‐quality evidence). Complementary and alternative treatments (e.g. homeopathy, acupuncture) are not recommended for insomnia treatment (weak recommendation, very‐low‐quality evidence).},
keywords = {Insomnia},
pubstate = {published},
tppubtype = {article}
}

@article{Erla2013,
title = {Symptoms of Insomnia among Patients with Obstructive Sleep Apnea Before and After Two Years of Positive Airway Pressure Treatment.},
author = {Erla, Björnsdóttir and Christer, Janson and Jón, F Sigurðsson and Philip, Gehrman and Michael, Perlis and Sigurður, Júlíusson and Erna, Sif Arnardóttir and Samuel, T Kuna and Allan, I Pack and Þórarinn, Gíslason and Bryndís, Benediktsdóttir},
url = {https://academic.oup.com/sleep/article/36/12/1901/2709415},
year = {2013},
date = {2013-12-01},
abstract = {Study Objectives:
To assess the changes of insomnia symptoms among patients with obstructive sleep apnea (OSA) from starting treatment with positive airway pressure (PAP) to a 2-y follow-up.

Design:
Longitudinal cohort study.

Setting:
Landspitali—The National University Hospital of Iceland.

Participants:
There were 705 adults with OSA who were assessed prior to and 2 y after starting PAP treatment.

Intervention:
PAP treatment for OSA.

Measurements and Results:
All patients underwent a medical examination along with a type 3 sleep study and answered questionnaires on health and sleep before and 2 y after starting PAP treatment. The change in prevalence of insomnia symptoms by subtype was assessed by questionnaire and compared between individuals who were using or not using PAP at follow-up. Symptoms of middle insomnia were most common at baseline and improved signifcantly among patients using PAP (from 59.4% to 30.7%, P < 0.001). Symptoms of initial insomnia tended to persist regardless of PAP treatment, and symptoms of late insomnia were more likely to improve among patients not using PAP. Patients with symptoms of initial and late insomnia at baseline were less likely to adhere to PAP (odds ratio [OR] 0.56, P = 0.007, and OR 0.53, P < 0.001, respectively).

Conclusion:
Positive airway pressure treatment significantly reduced symptoms of middle insomnia. Symptoms of initial and late insomnia, however, tended to persist regardless of positive airway pressure treatment and had a negative effect on adherence. Targeted treatment for insomnia may be beneficial for patients with obstructive sleep apnea comorbid with insomnia and has the potential to positively affect adherence to positive airway pressure.},
keywords = {Insomnia, Positive airway pressure, Sleep Apnea},
pubstate = {published},
tppubtype = {article}
}

@article{Erla2011,
title = {Insomnia in untreated sleep apnea patients compared to controls.},
author = {Erla, Björnsdóttir and Christer, Janson and Þórarinn, Gíslason and Jón, F Sigurðsson and Allan, I Pack and Philip, Gehrman and Bryndís, Benediktsdóttir},
url = {https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2869.2011.00972.x},
year = {2011},
date = {2011-10-12},
abstract = {Insomnia and obstructive sleep apnea (OSA) often coexist, but the nature of their relationship is unclear. The aims of this study were to compare the prevalence of initial and middle insomnia between OSA patients and controls from the general population as well as to study the influence of insomnia on sleepiness and quality of life in OSA patients. Two groups were compared, untreated OSA patients (n = 824) and controls ≥ 40 years from the general population in Iceland (n = 762). All subjects answered the same questionnaires on health and sleep and OSA patients underwent a sleep study. Altogether, 53% of controls were males compared to 81% of OSA patients. Difficulties maintaining sleep (DMS) were more common among men and women with OSA compared to the general population (52 versus 31% and 62 versus 31%, respectively, P < 0.0001). Difficulties initiating sleep (DIS) and DIS + DMS were more common among women with OSA compared to women without OSA. OSA patients with DMS were sleepier than patients without DMS (Epworth Sleepiness Scale: 12.2 versus 10.9, P < 0.001), while both DMS and DIS were related to lower quality of life in OSA patients as measured by the Short Form 12 (physical score 39 versus 42 and mental score 36 versus 41, P < 0.001). DIS and DMS were not related to OSA severity. Insomnia is common among OSA patients and has a negative influence on quality of life and sleepiness in this patient group. It is relevant to screen for insomnia among OSA patients and treat both conditions when they co‐occur.},
keywords = {Insomnia, Risk factors, Sleep Apnea},
pubstate = {published},
tppubtype = {article}
}