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Polysomnography reveals unexpectedly high rates of organic sleep disorders in patients with prediagnosed primary insomnia

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Abstract

Objective

It is a matter of debate whether patients with primary insomnia require a polysomnographic examination in order to exclude specific sleep disorders such as sleep apnea syndrome (SAS) or periodic limb movements (PLM). Using a prospective design, we investigated the prevalence of organic sleep disorders by means of polysomnography (PSG) in a series of patients who were previously diagnosed with primary insomnia. This diagnosis was based on a clinical exam and an ambulatory monitoring device or previous PSG.

Methods

Seventy-seven women and 16 men (mean age 55.12 ± 13.21 years) who were admitted for cognitive behavioral therapy for insomnia were evaluated by PSG including cardiorespiratory parameters and tibialis EMG. Among them, 50 patients had undergone a clinical exam by a sleep specialist; in 18 patients, actigraphy or portable monitoring had been performed to exclude SAS or PLM; 25 patients had undergone PSG in another sleep lab previously.

Results

In 32 patients (34% of the sample), a PSG revealed a specific sleep disorder (SAS 16; PLMD 11; both 5), resulting in therapeutic consequences for 21 patients (SAS 10; PLMD 9; both 2). SAS and PLM patients were older and SAS patients had a higher body mass index than insomnia patients without additional findings.

Conclusion

Indications for a PSG should be handled less restrictively in the diagnostic workup of older insomnia patients since they have a higher risk of comorbid sleep disorders even in the absence of the clinical signs of SAS or PLM.

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Abbreviations

AHI:

Apnea–hypopnea index

BDI:

Beck Depression Inventory

BMI:

Body mass index

CBT-I:

Cognitive behavior therapy for insomnia

CPAP:

Continuous positive airway pressure

ESS:

Epworth Sleepiness Scale

INS:

Insomnia patients without any new findings in PSG

I-PLM:

Insomnia patients with unexpected PLMs in PSG

I-SAS:

Insomnia patients with unexpected SAS in PSG

I-SAS + PLM:

Insomnia patients with unexpected SAS and PLMs in PSG

PLM:

Periodic limb movements in sleep

PSG:

Polysomnography

PSQI:

Pittsburgh Sleep Quality Index

SAS:

Sleep apnea syndrome

References

  1. Littner M, Hirshkowitz M, Kramer M, Kapen S, Anderson WM, Bailey D, Berry RB, Davila D, Johnson S, Kushida C, Loube DI, Wise M, Woodson BT (2003) Practice parameters for using polysomnography to evaluate insomnia: an update. Sleep 26:754–760

    PubMed  Google Scholar 

  2. Reite M, Buysse D, Reynolds C, Mendelson W (1995) The use of polysomnography in the evaluation of insomnia. Sleep 18:58–70

    PubMed  CAS  Google Scholar 

  3. Kushida CA, Littner MR, Morgenthaler T, Alessi CA, Bailey D, Coleman J Jr, Friedman L, Hirshkowitz M, Kapen S, Kramer M, Lee-Chiong T, Loube DL, Owens J, Pancer JP, Wise M (2005) Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep 28:499–521

    PubMed  Google Scholar 

  4. Spielman AJ, Saskin P, Thorpy MJ (1987) Treatment of chronic insomnia by restriction of time in bed. Sleep 10:45–56

    PubMed  CAS  Google Scholar 

  5. Sivertsen B, Nordhus IH, Bjorvatn B, Pallesen S (2010) Sleep problems in general practice: a national survey of assessment and treatment routines of general practitioners in Norway. J Sleep Res 19:36–41

    Article  PubMed  Google Scholar 

  6. Collop NA (2004) Portable monitoring for diagnosing obstructive sleep apnea: not yet ready for primetime. Chest 125:809–811

    Article  PubMed  Google Scholar 

  7. Collop NA, Anderson WM, Boehlecke B, Claman D, Goldberg R, Gottlieb DJ, Hudgel D, Sateia M, Schwab R (2007) Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 3:737–747

    PubMed  Google Scholar 

  8. McCall WV, Kimball J, Boggs N, Lasater B, D'Agostino RB Jr, Rosenquist PB (2009) Prevalence and prediction of primary sleep disorders in a clinical trial of depressed patients with insomnia. J Clin Sleep Med 5:454–458

    PubMed  Google Scholar 

  9. Edinger JD, Hoelscher TJ, Webb MD, Marsh GR, Radtke RA, Erwin CW (1989) Polysomnographic assessment of DIMS: empirical evaluation of its diagnostic value. Sleep 12:315–322

    PubMed  CAS  Google Scholar 

  10. Jacobs EA, Reynolds CF III, Kupfer DJ, Lovin PA, Ehrenpreis AB (1988) The role of polysomnography in the differential diagnosis of chronic insomnia. Am J Psychiatry 145:346–349

    PubMed  CAS  Google Scholar 

  11. Luyster FS, Buysse DJ, Strollo PJ Jr (2010) Comorbid insomnia and obstructive sleep apnea: challenges for clinical practice and research. J Clin Sleep Med 6:196–204

    PubMed  Google Scholar 

  12. American Academy of Sleep Medicine (2005) ICSD-2—international classification of sleep disorders: diagnostic and coding manual, 2nd edn. American Academy of Sleep Medicine, Westchester

    Google Scholar 

  13. Penzel T, Hajak G, Hofmann RM, Lund R, Podszus T, Pollmächer T, Schäfer T, Schulz H, Sonnenschein W, Spieweg I (1993) Empfehlungen zur Durchführung und Auswertung polygraphischer Ableitungen im diagnostischen Schlaflabor. Z EEG-EMG 24:65–70

    Google Scholar 

  14. Rechtschaffen A, Kales A (1968) A manual of standardized terminology techniques and scoring system for sleep stages of human subjects. US Government Printing Office, Washington

    Google Scholar 

  15. Danker-Hopfe H, Schafer M, Dorn H, Anderer P, Saletu B, Gruber G, Zeitlhofer J, Kunz D, Barbanoj MJ, Himanen SL, Kemp B, Penzel T, Roschke J, Dorffner G (2005) Percentile reference charts for selected sleep parameters for 20- to 80-year-old healthy subjects from the SIESTA Database. Referenzkurven fur ausgewahlte Schlafparameter 20- bis 80-jahriger gesunder Personen aus der SIESTA-Datenbank. Somnologie 9:3–14

    Article  Google Scholar 

  16. Carskadon MA, Dement WC, Mitler MM, Guilleminault C, Zarcone VP, Spiegel R (1976) Self-reports versus sleep laboratory findings in 122 drug-free subjects with complaints of chronic insomnia. Am J Psychiatry 133:1382–1388

    PubMed  CAS  Google Scholar 

  17. Frankel BL, Coursey RD, Buchbinder R, Snyder F (1976) Recorded and reported sleep in chronic primary insomnia. Arch Gen Psychiatry 33:615–623

    Article  PubMed  CAS  Google Scholar 

  18. Krystal AD (2003) Insomnia in women. Clin Cornerstone 5:41–50

    Article  PubMed  Google Scholar 

  19. Larsson LG, Lindberg A, Franklin KA, Lundback B (2003) Gender differences in symptoms related to sleep apnea in a general population and in relation to referral to sleep clinic. Chest 124:204–211

    Article  PubMed  Google Scholar 

  20. Valipour A, Lothaller H, Rauscher H, Zwick H, Burghuber OC, Lavie P (2007) Gender-related differences in symptoms of patients with suspected breathing disorders in sleep: a clinical population study using the sleep disorders questionnaire. Sleep 30:312–319

    PubMed  Google Scholar 

  21. Bailes S, Baltzan M, Alapin I, Fichten CS, Libman E (2005) Diagnostic indicators of sleep apnea in older women and men: a prospective study. J Psychosom Res 59:365–373

    Article  PubMed  Google Scholar 

  22. Roth T (2009) Comorbid insomnia: current directions and future challenges. Am J Manag Care 15(Suppl):S6–S13

    PubMed  Google Scholar 

  23. Hornyak M, Riemann D, Voderholzer U (2004) Do periodic leg movements influence patients' perception of sleep quality? Sleep Med 5:597–600

    Article  PubMed  Google Scholar 

  24. Karadeniz D, Ondze B, Besset A, Billiard M (2000) Are periodic leg movements during sleep (PLMS) responsible for sleep disruption in insomnia patients? Eur J Neurol 7:331–336

    Article  PubMed  CAS  Google Scholar 

  25. Littner MR, Kushida C, Anderson WM, Bailey D, Berry RB, Hirshkowitz M, Kapen S, Kramer M, Lee-Chiong T, Li KK, Loube DL, Morgenthaler T, Wise M (2004) Practice parameters for the dopaminergic treatment of restless legs syndrome and periodic limb movement disorder. Sleep 27:557–559

    PubMed  Google Scholar 

  26. Pigeon WR, Yurcheshen M (2009) Behavioral sleep medicine interventions for restless legs syndrome and periodic limb movement disorder. Sleep Med Clin 4:487–494

    Article  PubMed  Google Scholar 

  27. Levendowski DJ, Zack N, Rao S, Wong K, Gendreau M, Kranzler J, Zavora T, Westbrook PR (2009) Assessment of the test-retest reliability of laboratory polysomnography. Sleep Breath 13:163–167

    Article  PubMed  Google Scholar 

  28. Mosko SS, Dickel MJ, Ashurst J (1988) Night-to-night variability in sleep apnea and sleep-related periodic leg movements in the elderly. Sleep 11:340–348

    PubMed  CAS  Google Scholar 

  29. Ahmadi N, Shapiro GK, Chung SA, Shapiro CM (2009) Clinical diagnosis of sleep apnea based on single night of polysomnography vs. two nights of polysomnography. Sleep Breath 13:221–226

    Article  PubMed  Google Scholar 

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Competing interests

None of the authors have a conflict of interest with respect to this study.

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Authors and Affiliations

  1. Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93042, Regensburg, Germany

    Tatjana Crönlein, Peter Geisler, Berthold Langguth, Peter Eichhammer, Cecilia Jara, Christoph Pieh, Jürgen Zulley & Göran Hajak

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  1. Tatjana Crönlein
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  2. Peter Geisler
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  3. Berthold Langguth
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  4. Peter Eichhammer
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  8. Göran Hajak
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Correspondence to Tatjana Crönlein.

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Crönlein, T., Geisler, P., Langguth, B. et al. Polysomnography reveals unexpectedly high rates of organic sleep disorders in patients with prediagnosed primary insomnia. Sleep Breath 16, 1097–1103 (2012). https://doi.org/10.1007/s11325-011-0608-8

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  • DOI: https://doi.org/10.1007/s11325-011-0608-8

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