Skip to main content
SpringerLink
Log in

Prevalence of excessive sleepiness is higher whereas insomnia is lower with greater severity of obstructive sleep apnea

  • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Purpose

The objective of the present study was to investigate the prevalence of insomnia and excessive sleepiness in relation to the presence and severity of obstructive sleep apnea (OSA).

Methods

The sample consisted of patients referred to a university hospital on suspicion of OSA. In total, 1115 patients with mean age of 48 years were studied. Insomnia (Bergen Insomnia Scale) and excessive sleepiness (Epworth Sleepiness Scale) were diagnosed using validated questionnaires. The insomnia scale permits diagnosing insomnia using both old and new (from 2014) criteria. OSA was diagnosed and categorized based on a standard respiratory polygraphic sleep study using a type 3 portable monitor.

Results

OSA was diagnosed in 59.4 % of the referred patients. The prevalence of excessive sleepiness was higher with greater severity of OSA: 40.5 % in the patients without OSA (apnea-hypopnea index (AHI) <5), 46.5 % in mild OSA (AHI 5–14.9), 52.0 % in moderate OSA (AHI 15–29.9), and 58.0 % in severe OSA (AHI 30 or above). In contrast, the prevalence of insomnia using the 2014 diagnostic criteria showed an opposing prevalence: 54.2 % no OSA, 54.9 % mild OSA, 48.5 % moderate OSA, and 44.6 % severe OSA. Logistic and linear regression analyses showed that sleepiness was positively associated whereas insomnia was negatively associated with OSA severity and AHI.

Conclusions

Both excessive sleepiness and insomnia were seen in high proportions of the patients referred on suspicion of OSA. Excessive sleepiness was higher whereas insomnia was lower with greater OSA severity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Hrubos-Strom H, Randby A, Namtvedt SK, Kristiansen HA, Einvik G, Benth J, Somers VK, Nordhus IH, Russell MB, Dammen T, Omland T, Kvaerner KJ (2010) A Norwegian population-based study on the risk and prevalence of obstructive sleep apnea. The Akershus Sleep Apnea Project (ASAP). J Sleep Res 20(1 Pt 2):162–170. doi:10.1111/j.1365-2869.2010.00861.x

    Google Scholar 

  2. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328(17):1230–1235. doi:10.1056/NEJM199304293281704

    Article  CAS  PubMed  Google Scholar 

  3. Young T, Peppard PE, Gottlieb DJ (2002) Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 165(9):1217–1239

    Article  PubMed  Google Scholar 

  4. Bjornsdottir E, Janson C, Gislason T, Sigurdsson JF, Pack AI, Gehrman P, Benediktsdottir B (2012) Insomnia in untreated sleep apnea patients compared to controls. J Sleep Res 21(2):131–138. doi:10.1111/j.1365-2869.2011.00972.x

    Article  PubMed Central  PubMed  Google Scholar 

  5. Berg S (2008) Obstructive sleep apnoea syndrome: current status. Clin Respir J 2(4):197–201. doi:10.1111/j.1752-699X.2008.00076.x

    Article  CAS  PubMed  Google Scholar 

  6. Beneto A, Gomez-Siurana E, Rubio-Sanchez P (2009) Comorbidity between sleep apnea and insomnia. Sleep Med Rev 13(4):287–293. doi:10.1016/j.smrv.2008.09.006

    Article  PubMed  Google Scholar 

  7. Engleman HM, Douglas NJ (2004) Sleep. 4: sleepiness, cognitive function, and quality of life in obstructive sleep apnoea/hypopnoea syndrome. Thorax 59(7):618–622

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  8. Gold AR, Gold MS, Harris KW, Espeleta VJ, Amin MM, Broderick JE (2008) Hypersomnolence, insomnia and the pathophysiology of upper airway resistance syndrome. Sleep Med 9(6):675–683. doi:10.1016/j.sleep.2007.08.013

    Article  PubMed  Google Scholar 

  9. Doghramji PP (2008) Recognition of obstructive sleep apnea and associated excessive sleepiness in primary care. J Fam Pract 57(8 Suppl):S17–S23

    PubMed  Google Scholar 

  10. Johns MW (1993) Daytime sleepiness, snoring, and obstructive sleep apnea. The Epworth Sleepiness Scale. Chest 103(1):30–36

    Article  CAS  PubMed  Google Scholar 

  11. Kapur VK, Baldwin CM, Resnick HE, Gottlieb DJ, Nieto FJ (2005) Sleepiness in patients with moderate to severe sleep-disordered breathing. Sleep 28(4):472–477

    PubMed  Google Scholar 

  12. Bixler EO, Vgontzas AN, Lin HM, Calhoun SL, Vela-Bueno A, Kales A (2005) Excessive daytime sleepiness in a general population sample: the role of sleep apnea, age, obesity, diabetes, and depression. J Clin Endocrinol Metab 90(8):4510–4515. doi:10.1210/jc.2005-0035

    Article  CAS  PubMed  Google Scholar 

  13. Bjorvatn B, Pallesen S, Gronli J, Sivertsen B, Lehmann S (2014) Prevalence and correlates of insomnia and excessive sleepiness in adults with obstructive sleep apnea symptoms. Percept Mot Skills 118(2):571–586

    Article  PubMed  Google Scholar 

  14. 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(2):196–204

    PubMed Central  PubMed  Google Scholar 

  15. Krakow B, Melendrez D, Ferreira E, Clark J, Warner TD, Sisley B, Sklar D (2001) Prevalence of insomnia symptoms in patients with sleep-disordered breathing. Chest 120(6):1923–1929

    Article  CAS  PubMed  Google Scholar 

  16. Smith S, Sullivan K, Hopkins W, Douglas J (2004) Frequency of insomnia report in patients with obstructive sleep apnoea hypopnea syndrome (OSAHS). Sleep Med 5(5):449–456. doi:10.1016/j.sleep.2004.03.005

    Article  PubMed  Google Scholar 

  17. Bjornsdottir E, Janson C, Sigurdsson JF, Gehrman P, Perlis M, Juliusson S, Arnardottir ES, Kuna ST, Pack AI, Gislason T, Benediktsdottir B (2013) Symptoms of insomnia among patients with obstructive sleep apnea before and after two years of positive airway pressure treatment. Sleep 36(12):1901–1909. doi:10.5665/sleep.3226

    PubMed Central  PubMed  Google Scholar 

  18. Association. AP (2013) Diagnostic and statistical manual of mental disorders (DSM-V). American Psychiatric Association, Washington, DC

    Google Scholar 

  19. Medicine AAoS (2014) The international classification of sleep disorders, 3nd ed.: diagnostic and coding manual. American Academy of Sleep Medicine, Darien

    Google Scholar 

  20. Iber C, Ancoli-Israel S, Chesson A, Quan SF, Medicine. ftAAoS (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, 1st edn. American Academy of Sleep Medicine, Westchester

    Google Scholar 

  21. Pallesen S, Bjorvatn B, Nordhus IH, Sivertsen B, Hjørnevik M, Morin CM (2008) A new scale for measuring insomnia: the Bergen Insomnia Scale. Percept Mot Skills 107:691–706

    PubMed  Google Scholar 

  22. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14(6):540–545

    CAS  PubMed  Google Scholar 

  23. Pallesen S, Nordhus IH, Omvik S, Sivertsen B, Tell GS, Bjorvatn B (2007) Prevalence and risk factors of subjective sleepiness in the general adult population. Sleep 30(5):619–624

    PubMed  Google Scholar 

  24. Beiske KK, Kjelsberg FN, Ruud EA, Stavem K (2009) Reliability and validity of a Norwegian version of the Epworth sleepiness scale. Sleep Breath 13(1):65–72. doi:10.1007/s11325-008-0202-x

    Article  PubMed  Google Scholar 

  25. Bonnet MH, Arand DL (2010) Hyperarousal and insomnia: state of the science. Sleep Med Rev 14(1):9–15. doi:10.1016/j.smrv.2009.05.002

    Article  PubMed  Google Scholar 

  26. Weaver TE, George CFP (2011) Cognition and perfomrance in patients with obstructive sleep apnea. In: Kryger MH, Roth T, Dement WC (eds) Principles and practice of sleep medicine. Elsevier Saunders, St. Louis, pp 1194–1205

    Chapter  Google Scholar 

  27. Verma A, Radtke RA, VanLandingham KE, King JH, Husain AM (2001) Slow wave sleep rebound and REM rebound following the first night of treatment with CPAP for sleep apnea: correlation with subjective improvement in sleep quality. Sleep Med 2(3):215–223

    Article  PubMed  Google Scholar 

  28. Sivertsen B, Overland S, Glozier N, Bjorvatn B, Maeland JG, Mykletun A (2008) The effect of OSAS on sick leave and work disability. Eur Respir J 32(6):1497–1503. doi:10.1183/09031936.00044908

    Article  CAS  PubMed  Google Scholar 

  29. Morin CM, Belanger L, LeBlanc M, Ivers H, Savard J, Espie CA, Merette C, Baillargeon L, Gregoire JP (2009) The natural history of insomnia: a population-based 3-year longitudinal study. Arch Intern Med 169(5):447–453. doi:10.1001/archinternmed.2008.610

    Article  PubMed  Google Scholar 

  30. Masa JF, Corral J, Pereira R, Duran-Cantolla J, Cabello M, Hernandez-Blasco L, Monasterio C, Alonso A, Chiner E, Rubio M, Garcia-Ledesma E, Cacelo L, Carpizo R, Sacristan L, Salord N, Carrera M, Sancho-Chust JN, Embid C, Vazquez-Polo FJ, Negrin MA, Montserrat JM (2011) Effectiveness of home respiratory polygraphy for the diagnosis of sleep apnoea and hypopnoea syndrome. Thorax 66(7):567–573. doi:10.1136/thx.2010.152272

    Article  PubMed  Google Scholar 

  31. Nerfeldt P, Aoki F, Friberg D (2014) Polygraphy vs. polysomnography: missing osas in symptomatic snorers—a reminder for clinicians. Sleep Breath 18(2):297–303. doi:10.1007/s11325-013-0884-6

    Article  CAS  PubMed  Google Scholar 

  32. Littner MR (2007) Mild obstructive sleep apnea syndrome should not be treated. Con J Clin Sleep Med 3(3):263–264

    PubMed  Google Scholar 

Download references

Conflict of interest

Author Harald Aurlien is shareholder of and CEO in Holberg EEG AS. The other authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway

    Bjørn Bjorvatn, Sverre Lehmann, Shashi Gulati, Ståle Pallesen & Ingvild W. Saxvig

  2. Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, 5018, Bergen, Norway

    Bjørn Bjorvatn

  3. Section of Thoracic Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway

    Sverre Lehmann

  4. Department of Otolaryngology, Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway

    Shashi Gulati

  5. Section of Clinical Neurophysiology, Department of Neurology, Haukeland University Hospital, Bergen, Norway

    Harald Aurlien

  6. Department of Clinical Medicine, University of Bergen, Bergen, Norway

    Harald Aurlien

  7. Department of Psychosocial Science, University of Bergen, Bergen, Norway

    Ståle Pallesen

Authors
  1. Bjørn Bjorvatn
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sverre Lehmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shashi Gulati
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Harald Aurlien
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ståle Pallesen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ingvild W. Saxvig
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bjørn Bjorvatn.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bjorvatn, B., Lehmann, S., Gulati, S. et al. Prevalence of excessive sleepiness is higher whereas insomnia is lower with greater severity of obstructive sleep apnea. Sleep Breath 19, 1387–1393 (2015). https://doi.org/10.1007/s11325-015-1155-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-015-1155-5

Keywords

Search

Navigation