4.7 Article

Sleep Apnea and Insomnia Emerging Evidence for Effective Clinical Management

Journal

CHEST
Volume 159, Issue 5, Pages 2020-2028

Publisher

ELSEVIER
DOI: 10.1016/j.chest.2020.12.002

Keywords

cognitive-behavior therapy for insomnia; insomnia; patient-centered care; positive airway pressure; sleep apnea

Funding

  1. National Heart, Lung, and Blood Institute of the National Institutes of Health [R01HL114529]

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This review highlights the clinical challenges and recent advancements in the management of patients with comorbid insomnia and sleep apnea, emphasizing innovative approaches in evaluation and treatment of COMISA and discussing patient-centered care opportunities in integrating characteristics, preferences, and accessibility to optimize patient care.
Comorbid insomnia and sleep apnea (COMISA) are the most common co-occurring sleep disorders and present many challenges to clinicians. This review provides an overview of the clinical challenges in the management of patients with COMISA, with a focus on recent evidence regarding the evaluation and treatment of COMISA. Innovations in the assessment of COMISA have used profile analyses or dimensional approaches to examine symptom clusters or symptom severity that could be particularly useful in the assessment of COMISA. Recent randomized controlled trials have provided important evidence about the safety and effectiveness of a concomitant treatment approach to COMISA using cognitive-behavioral therapy for insomnia (CBT-I) with positive airway pressure (PAP). Furthermore, patient-centered considerations that integrate patient characteristics, treatment preferences, and accessibility to treatment in the context of COMISA are discussed as opportunities to improve patient care. Based on these recent advances and clinical perspectives, a model for using multidisciplinary, patient-centered care is recommended to optimize the clinical management of patients with COMISA.

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