SEATTLE – Many adults who have obstructive sleep apnea or insomnia also have attention-deficit disorder as well as neuromuscular and psychiatric conditions, results from a detailed analysis suggest.
“The sleep specialist isn't done when he says, 'It's sleep apnea. Use continuous positive airway pressure,' or 'It's insomnia; take a sleeping pill,'” Clifford G. Risk, M.D., said at a press briefing during the annual meeting of the American College of Chest Physicians. “He has to work out what the concurrent conditions are at the same time he's trying to improve the insomnia or sleep apnea. The assessment of patients with a sleep disorder and impaired daytime cognition may represent a complex interlay between the sleep disorder and comorbid dual diagnoses.”
He and his associates at a sleep disorder center in Marlborough, Mass., evaluated 58 patients who presented with sleep apnea or insomnia. Investigators administered a wide battery of standardized tests to assess the severity of obstructive sleep apnea, attention-deficit problems, depression, and insomnia.
All patients received treatment for their respective conditions, including continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea, cognitive behavior therapy and/or hypnotic medication for insomnia, and psychiatric evaluation and possible medication for primary ADD.
Of the 34 patients who were found to have sleep apnea, 16 had baseline Adult Self-Report Scale (ASRS) symptom checklist scores that suggested moderate or severe impairment of attention. After CPAP treatment, 60% of these patients substantially improved their attention scores. “However, 40% continued to report serious attention deficits following treatment, and required further neuropsychiatric evaluation and specific interventions,” said Dr. Risk, who directs the sleep disorder center.
Of the 24 patients who had insomnia, 54% had baseline ASRS scores that suggested moderate or severe impairment of attention. Nine patients suffered from a primary muscular disorder, including fibromyalgia, chronic fatigue, multiple sclerosis, peripheral neuropathy, and postpolio syndrome; 15 suffered from a primary psychological disorder, including depression, bipolar disorder, and anxiety.
There were serious rheumatologic and neurologic diseases causing sleep disturbances in patients with insomnia, Dr. Risk said. “If they slept through the night, we found that they were mostly in stage 1 or 2 sleep. They never got to restorative sleep stage 3 or 4. So they had a lack of restorative sleep due to a light or fragmented sleep.”
He and his associates have begun trying to identify reversible risk factors in each patient with insomnia to design specific interventions that may be of benefit.