TABLE VII.I.1.

Prevalence of insomnia in patients with OSA

Study	Year	LOE	Study design	Study groups	Clinical endpoint	Conclusion
Zhang et al.956	2019	4	Systematic review and meta-analysis	31 studies assessing the prevalence of insomnia symptoms in OSA; four studies assessing the prevalence of OSA in patients with insomnia; two studies assessing prevalence of both insomnia in OSA and OSA in insomnia	Presence of insomnia symptoms or diagnosis, PSG	38% of patients with OSA had comorbid insomnia. In patients with insomnia, the pooled prevalence rates of OSA were 35% for AHI ≥ 5 events/h and 29% for AHI ≥ 15 events/h.
Luyster et al.588	2010	4	Systematic review	4 studies assessing the prevalence of insomnia symptoms in OSA; three studies assessing the prevalence of OSA in patients with insomnia	Presence of insomnia symptoms or diagnosis, PSG	39%–58% of patients with OSA had comorbid insomnia symptoms. 29%–67% of patients with insomnia had an AHI of >5 events/h.
Gupta and Knapp946	2014	2c	Retrospective, cross-sectional, case–control study of epidemiologic databases	62,253,910 ± 5,274,747 (unweighted count = 7234) patient visits with diagnosis of OSA from 1995–2010	ICD-9 coded diagnosis of sleep apnea or insomnia	6.4% ± 0.9% of patient visits for OSA also contained a diagnosis of insomnia. Visits with both OSA and insomnia were significantly more likely to also list essential hypertension (OR = 1.83, 95% CI 1.27–2.65).
Sivertsen et al.951	2013	2c	Historical cohort case–control design	6892 participants aged40–45 years	Karolinska Sleep Questionnaire, Norwegian official registry data, Health information from the Hordaland Health Study in western Norway (1997–1999)	8.4% of the population had OSA and 0.6% had comorbid insomnia.
Lang et al.948	2017	2b	Prospective, general population, cohort study	837 randomly selected men without prior diagnosis of OSA	At-home unattended PSG; 36-item Short Form (SF-36) vitality scale, Beck Depression Inventory	46% of the population had OSA; of these, 14.5% had comorbid insomnia.
Stelzer et al.953	2020	4	Prospective, cross-sectional case series	238 patients with OSA	ICSD-3, PSG-3, Beck Depression, and Anxiety Inventories	29% of patients diagnosed with OSA had comorbid insomnia. Depression and anxiety were higher in the group with insomnia.
Wallace and Wohlgemuth955	2019	4	Prospective, cross-sectional, case series	630 veterans with a new diagnosis of OSA	Insomnia Severity Index (ISI), PSG	74% of patients with OSA had moderate or severe insomnia.
Cho et al.945	2018	4	Prospective, cross-sectional case series	476 patients with OSA seen at two tertiary hospital sleep centers	ISI, PSG, SF-36, PSQI, Beck Depression Inventory	29.2% of patients with OSA had significant insomnia. Patients with both OSA and insomnia had higher rates of heart disease, lower quality of life, and worse depression than those with OSA only. No significant differences in CPAP adherence between those with vs. without insomnia.
Taskaban et al.954	2018	4	Prospective, cross-sectional case series	197 consecutive patients with OSA seen in a sleep laboratory	PSG, WHO Quality of Life form	18.8% of patients with OSA had comorbid insomnia. Patients with both OSA and insomnia had lower physical and social scores than those with OSA only.
Bjorvatn et al.944	2014	4	Prospective, cross-sectional, general population sample case series	1502 randomly selected participants from the general population	Bergen Insomnia Scale. Self- or spouse-reported OSA symptoms	6.2% of participants were diagnosed with OSA; of these, 57.6% reported comorbid insomnia.
Mysliwiec et al.949	2013	4	Prospective cross-sectional case series	110 military personnel who returned from combat with sleep disturbances	ICSD-2, PSG	24.5% diagnosed with OSA alone and 38.2% with comorbid OSA and insomnia. Patients with both OSA and insomnia were significantly more likely to meet criteria for depression.
Bjornsdottir et al.943	2013	4	Prospective cross-sectional case series	705 adults with OSA	Basic Nordic Sleep Questionnaire, HSAT	68.3% had comorbid insomnia, 15.5% exhibited symptoms of initial insomnia, 59.3% had symptoms of middle insomnia, and 27.7% exhibited symptoms of late insomnia, with overlap between groups.
Nguyen et al.950	2010	4	Prospective, cross-sectional, case series	148 consecutive patients with OSA treated in a sleep clinic	ISI, PSG	50% of patients had moderate to severe comorbid insomnia. Presence of insomnia did not significantly affect CPAP adherence.
Smith et al.952	2004	4	Prospective, cross-sectional, case series	105 patients with OSA	ISI, PSG, sleep diary, reported daytime consequences of insomnia, Depression Anxiety Scale-21	35% of patients had comorbid insomnia. Patients with both OSA and insomnia had increased levels of depression, anxiety, and stress.
Krakow et al.947	2001	4	Retrospective cross-sectional case series	231 patients with OSA	Reported insomnia symptoms, sleep diary; reported psychiatric disorders; reported use of sedative and psychotropic medications	50% reported insomnia complaints. OSA + insomina had significantly more psychiatric disorders and physical/mental symptoms that disrupted sleep. OSA + insomnia also reported greater use of sedative and psychotropic medications.