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Jeon B, Chasens ER, Luyster FS, Callan JA, DiNardo MM, Sereika SM. Is insomnia severity a moderator of the associations between obstructive sleep apnea severity with mood and diabetes-related distress? Sleep Breath 2023; 27:1081-1089. [PMID: 37009968 DOI: 10.1007/s11325-023-02819-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/24/2023] [Accepted: 03/20/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE This study examined insomnia severity as a moderator of the associations between obstructive sleep apnea (OSA) severity with impaired mood and diabetes-related distress in adults with OSA and type 2 diabetes (T2D). METHODS This secondary analysis used pooled baseline data from two randomized controlled trials that evaluated the efficacy of treatment of OSA or insomnia in adults with T2D. Participants for this analysis had OSA (Apnea Hypopnea Index [AHI] ≥ five events/hour obtained from an in-home sleep apnea testing device) and completed questionnaires on insomnia, mood, and diabetes-related distress. Hierarchical multiple linear regression and multivariate linear regression analyses were used controlling for demographic characteristics and restless leg syndrome. RESULTS Of 240 participants, mean age was 57.8 ± 10.17, 50% were female, and 35% were non-White. Participants had poorly controlled diabetes (Mean HbA1C = 7.93 ± 1.62), and moderate OSA (Mean AHI = 19.3 ± 16.2). Insomnia severity significantly moderated the association between OSA severity and mood (b = -0.048, p = .017). Although insomnia severity did not moderate the relationship between OSA severity and diabetes-related distress (b = -0.009, p = .458), insomnia severity was independently associated with greater diabetes-related distress (b = 1.133, p < .001). CONCLUSIONS In adults with T2D and OSA, as insomnia severity increased, increasing OSA severity was associated with lower level of mood disturbances. Insomnia independently increased the level of diabetes-related distress. These findings suggest that comorbid insomnia may be more impactful than OSA on increasing mood disturbances and diabetes-related distress in adults with T2D.
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Affiliation(s)
- Bomin Jeon
- University of Iowa College of Nursing, 50 Newton Road, Iowa City, IA, 52242, USA.
| | | | - Faith S Luyster
- University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Judith A Callan
- University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | | | - Susan M Sereika
- University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
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Watson NF, Benca RM, Krystal AD, McCall WV, Neubauer DN. Alliance for Sleep Clinical Practice Guideline on Switching or Deprescribing Hypnotic Medications for Insomnia. J Clin Med 2023; 12:jcm12072493. [PMID: 37048577 PMCID: PMC10095217 DOI: 10.3390/jcm12072493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
Determining the most effective insomnia medication for patients may require therapeutic trials of different medications. In addition, medication side effects, interactions with co-administered medications, and declining therapeutic efficacy can necessitate switching between different insomnia medications or deprescribing altogether. Currently, little guidance exists regarding the safest and most effective way to transition from one medication to another. Thus, we developed evidence-based guidelines to inform clinicians regarding best practices when deprescribing or transitioning between insomnia medications. Five U.S.-based sleep experts reviewed the literature involving insomnia medication deprescribing, tapering, and switching and rated the quality of evidence. They used this evidence to generate recommendations through discussion and consensus. When switching or discontinuing insomnia medications, we recommend benzodiazepine hypnotic drugs be tapered while additional CBT-I is provided. For Z-drugs zolpidem and eszopiclone (and not zaleplon), especially when prescribed at supratherapeutic doses, tapering is recommended with a 1–2-day delay in administration of the next insomnia therapy when applicable. There is no need to taper DORAs, doxepin, and ramelteon. Lastly, off-label antidepressants and antipsychotics used to treat insomnia should be gradually reduced when discontinuing. In general, offering individuals a rationale for deprescribing or switching and involving them in the decision-making process can facilitate the change and enhance treatment success.
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Lechat B, Loffler KA, Wallace DM, Reynolds A, Appleton SL, Scott H, Vakulin A, Lovato N, Adams R, Eckert DJ, Catcheside PG, Sweetman A. All-Cause Mortality in People with Co-Occurring Insomnia Symptoms and Sleep Apnea: Analysis of the Wisconsin Sleep Cohort. Nat Sci Sleep 2022; 14:1817-1828. [PMID: 36263373 PMCID: PMC9576322 DOI: 10.2147/nss.s379252] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/30/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Insomnia symptoms and sleep apnea frequently co-occur and are associated with worse sleep, daytime function, mental health and quality of life, compared to either insomnia or obstructive sleep apnea (OSA) alone. This study aimed to investigate the association of symptoms of co-morbid insomnia and sleep apnea (COMISA) with all-cause mortality. PATIENTS AND METHODS Wisconsin Sleep Cohort data were analysed to assess potential associations between COMISA symptoms and all-cause mortality. Nocturnal insomnia symptoms were defined as difficulties initiating sleep, maintaining sleep, and/or early morning awakenings "often" or "almost always", and/or regular sedative-hypnotic medicine use. OSA was defined as an apnea-hypopnea index ≥5/hr sleep. Participants were classified as having neither insomnia symptoms nor OSA, insomnia symptoms alone, OSA alone, or COMISA symptoms. Associations between the four groups and all-cause mortality over 20 years of follow-up were examined via multivariable adjusted Cox regression models. RESULTS Among 1115 adult participants (mean ± SD age 55 ± 8 years, 53% males), 19.1% had COMISA symptoms. After controlling for sociodemographic and behavioral factors, COMISA symptoms were associated with an increased risk of all-cause mortality compared to no insomnia symptoms or OSA (HR [95% CI]; 1.71 [1.00-2.93]). OSA alone (0.91 [0.53, 1.57]) and insomnia symptoms alone (1.04 [0.55, 1.97]) were not associated with increased mortality risk. CONCLUSION Co-morbid insomnia symptoms and sleep apnea is associated with increased all-cause mortality risk. Future research should investigate mechanisms underpinning COMISA and the effectiveness of different treatment approaches to reduce mortality risk for this common condition.
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Affiliation(s)
- Bastien Lechat
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Kelly A Loffler
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Douglas M Wallace
- Department of Neurology, Sleep Medicine Division, University of Miami Miller School of Medicine, Miami, FL, USA.,Neurology Service, Bruce W. Carter Department of Veterans Affairs Medical Centre, Miami, FL, USA
| | - Amy Reynolds
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Sarah L Appleton
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Hannah Scott
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Andrew Vakulin
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, Flinders University, Adelaide, South Australia, Australia.,National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
| | - Nicole Lovato
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, Flinders University, Adelaide, South Australia, Australia.,National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
| | - Robert Adams
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, Flinders University, Adelaide, South Australia, Australia.,National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
| | - Danny J Eckert
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Peter G Catcheside
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Alexander Sweetman
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, Flinders University, Adelaide, South Australia, Australia.,National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
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