SEATTLE — Many adults with obstructive sleep apnea or insomnia also have attention-deficit disorder as well as neuromuscular and psychiatric conditions, results from a detailed analysis suggest.
“The assessment of patients with a sleep disorder and impaired daytime cognition may represent a complex interplay between the sleep disorder and comorbid dual diagnoses,” Clifford G. Risk, M.D., said at a press briefing during the annual meeting of the American College of Chest Physicians.
He and his associates at a sleep disorder center in Marlborough, Mass., evaluated 58 patients who presented with sleep apnea or insomnia. They assessed the severity of obstructive sleep apnea, attention deficit problems, depression, and insomnia with a battery of standardized tests.
All patients had treatment, including continuous positive airway pressure (CPAP) 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.
Thus there were serious neurologic or rheumatologic diseases causing their 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.”