Sleep maintenance insomnia complaints predict poor CPAP adherence: A clinical case series

Wickwire, Emerson M.; Smith, Michael T.; Birnbaum, Sandra; Collop, Nancy A.

doi:10.1016/j.sleep.2010.03.012

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Volume 11, Issue 8 , Pages 772-776, September 2010

Sleep maintenance insomnia complaints predict poor CPAP adherence: A clinical case series

Emerson M. Wickwire
- Center for Sleep Disorders, Pulmonary Disease and Critical Care Associates, Columbia, MD, USA
- Behavioral Sleep Medicine Program, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Corresponding author. Address: Center for Sleep Disorders, Pulmonary Disease and Critical Care Associates, 10710 Charter Drive, Suite 310, Columbia, MD 21044, USA. Tel.: +1 (410) 997 5944; fax: +1 (410) 997 1720.
Michael T. Smith
- Behavioral Sleep Medicine Program, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Sandra Birnbaum
- Behavioral Sleep Medicine Program, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Nancy A. Collop
- Johns Hopkins Hospital Sleep Disorders Center, Division of Pulmonary and Critical Care, Johns Hopkins School of Medicine, Baltimore, MD, USA

Received 2 September 2009; received in revised form 10 March 2010; accepted 31 March 2010.

Abstract

Background

Although CPAP is a highly efficacious treatment for obstructive sleep apnea (OSA), low adherence presents a significant challenge for sleep medicine clinicians. The present study aimed to evaluate the relationship between insomnia symptoms and CPAP use. We hypothesized that pre-treatment insomnia complaints would be associated with poorer CPAP adherence at clinical follow-up.

Methods

This was a retrospective chart review of 232 patients (56.5% men, mean age=53.6±12.4years) newly diagnosed with OSA (mean AHI=41.8±27.7) and prescribed CPAP in the Johns Hopkins Sleep Disorder Center. Difficulty initiating sleep, difficulty maintaining sleep, and early morning awakening were measured via three self-report items. CPAP use was measured via objective electronic monitoring cards.

Results

Thirty-seven percent of the sample reported at least one frequent insomnia complaint, with 23.7% reporting difficulty maintaining sleep, 20.6% reporting early morning awakening and 16.6% reporting difficulty initiating sleep. After controlling for age and gender, sleep maintenance insomnia displayed a statistically significant negative relationship with average nightly minutes of CPAP use (p<.05) as well as adherence status as defined by the Centers for Medicaid and Medicare Services (p<.02).

Conclusions

To our knowledge, these are the first empirical data to document that insomnia can be a risk factor for poorer CPAP adherence. Identifying and reducing insomnia complaints among patients prescribed CPAP may be a straightforward and cost-effective way to increase CPAP adherence.

Keywords: Sleep, Insomnia, Apnea, CPAP, Adherence, Interdisciplinary, Comprehensive sleep medicine