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Sleep Breath 2004; 8(1): 15-29
DOI: 10.1055/s-2004-822850
ORIGINAL ARTICLE

Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Refractory Insomnia and Sleep-Disordered Breathing: A Pilot Study

Barry Krakow1 , 2 , 3 , 4 , Dominic Melendrez1 , Samuel A. Lee1 , Teddy D. Warner2 , 3 , 5 , Jimmy O. Clark1 , David Sklar2 , 4
  • 1Sleep and Human Health Institute, Albuquerque, New Mexico
  • 2University of New Mexico Health Sciences Center, Albuquerque, New Mexico
  • 3Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico
  • 4Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
  • 5Institute of Ethics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
Further Information

Publication History

Publication Date:
17 March 2004 (online)

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Objective: To assess an uncontrolled, open-label trial of sleep-disordered breathing (SDB) treatment on two different samples of chronic insomnia patients. Method: In Study 1 (Retrospective), data from one diagnostic and one continuous positive airway pressure (CPAP) titration polysomnogram were compiled from 19 chronic insomnia patients with SDB. Objective polysomnogram indicators of sleep and arousal activity and self-reported sleep quality were measured. In Study 2 (Prospective), clinical outcomes were assessed after sequential cognitive-behavioral therapy (CBT) and SDB therapy (CPAP, oral appliances, or bilateral turbinectomy) were provided to 17 chronic insomnia patients with SDB. Repeat measures included the Insomnia Severity Index, Functional Outcomes of Sleep Questionnaire, Pittsburgh Sleep Quality Index, and self-reported insomnia indices and CPAP use. Results: In Study 1, seven objective measures of sleep and arousal demonstrated or approached significant improvement during one night of CPAP titration. Sixteen of 19 patients reported improvement in sleep quality. In Study 2, Insomnia Severity Index, Functional Outcomes of Sleep Questionnaire, and Pittsburgh Sleep Quality Index improved markedly with CBT followed by SDB treatment and achieved an average outcome equivalent to curative status. Improvements were large for each treatment phase; however, of 17 patients, only 8 attained a nonclinical level of insomnia after CBT compared with 15 patients after SDB therapy was added. Self-reported insomnia indices also improved markedly, and self-reported SDB therapy compliance was high. Conclusions: In one small sample of chronic insomnia patients with SDB, objective measures of insomnia, arousal, and sleep improved during one night of CPAP titration. In a second small sample, validated measures of insomnia, sleep quality, and sleep impairment demonstrated clinical cures or near-cures after combined CBT and SDB therapies. These pilot results suggest a potential value in researching the pathophysiological relationships between SDB and chronic insomnia, which may be particularly relevant to patients with refractory insomnia.

KEYWORDS

Insomnia - sleep-disordered breathing - sleep fragmentation - obstructive sleep apnea - upper airway resistance syndrome - polysomnography - continuous positive airway pressure - oral appliance therapy

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Barry KrakowM.D. 

Sleep and Human Health Institute

6739 Academy NE, Ste. 380

Albuquerque, NM 87109

Email: bkrakow@sleeptreatment.com