Sleep Disorders

High-Risk Sleep Apnea and Insomnia

High-Risk Sleep Apnea and Insomnia Across Neurological Centers

2023

Treating sleep disorders can lead to improvements in some neurological and psychiatric populations. However, there is limited prevalence data on obstructive sleep apnea (OSA) and insomnia in neurological conditions.

Data was collected between March, 2015 and October, 2016 from patients at Cleveland Clinic Neurological Institute Centers: Brain Tumor (BT), Movement Disorders (MD), Cerebrovascular (CV), Epilepsy (EPI) and Psychiatry (PSYC). High-risk OSA (HR_OSA) was defined as STOP (Snoring, feeling Tired/sleepy during the day, Observed apneas, and high blood Pressure) score ≥2. High-risk insomnia (HR-Insomnia) was defined as Insomnia Severity Index ≥15. Disease severity was determined with: Karnofsky Performance Scales (KPS) and Eastern Cooperative Oncology Group (ECOG) for BT, Unified Parkinson's Disease Rating Scale II (UPDRII) for MD, Modified Rankin Scale (mRS) for CV, Liverpool Seizure Severity Scale 2.0 (LSSS2.0) for EPI, and Patient Health Questionnaire 9 (PHQ-9) for PSYC. Models were adjusted.

N=6224 patients were included who were 50.3±18.4 years of age, and 58.7% were female. Sample constitution was: BT 11.6%, MD 23.3%, CV 16.5%, EPI 16.2%, and PSYC 32.4%. Overall prevalence of HR-OSA and HR-Insomnia was 36.5% (95% CI=35.3-37.7) and 24.6% ((%% CI=23.6-25.7), respectively. The highest HR-OSA was in CV (48.1%, 95% CI=45-51.2) and the highest HR-Insomnia in PSYC (33.6%, 95% CI=31.6-35.8).

  • In BT, KPS≤60 and ECOG≥2 were associated with 2.67 and 1.73 times the odds of HR-OSA (OR=2.67, 95% CI=1.22-5.86, and OR=1.73, 95% CI=1.11-2.70), respectively, and 3.87 and 4.17 times the odds of HR-Insomnia (OR=3.87, 95% CI=1.4-10.66 and OR=4.17, 95% CI-2.43-7.17), respectively.
  • In MD, each unit increase in UPDRSII score was associated with 1.04 times the odds of HR-OSA (OR=1.04, 95% CI=1.02-1.05) and 1.10 times the odds of HR-Insomnia (OR=1.10, 95% CI=1.06-1.13).
  • In CV, mRS≥2 was associated with 2.11 times the odds of HR-OSA (OR=2.11, 95% CI=1.38-3.22) and 3.90 times the odds of HR-Insomnia (OR=3.90, 95% CI=2.29-6.66), compared to those with mRS=0.
  • In EPI, compared to zero, LSSS2.0≥41 was associated with HR-OSA and HR-Insomnia (for LSSS2.0 41-60 and 41-60, OR=1.78, 95% CI=1.2-2.65 and OR 2.59, 95% CI=1.68-4.01, respectively). Furthermore, patients with 6-10 seizures in the past 4 weeks had 1.87 times the odds of HR-OSA (OR=1.87, 95% CI=1.11-3.14) and 4.44 times the odds of HR-Insomnia (OR=4.44, 95% CI=2.60-7.57), compared to patients with fewer seizures.
  • In PSYC, each 5-point increase in PHQ-9 score was associated with 1.28 times the odds of HR-OSA (OR=1.28, 95% CI=1.19-1.38) and 2.54 times the odds of HR-Insomnia (OR=2.54, 95% CI=2.31-2.79).

HR-OSA and HR-Insomnia are highly prevalent in neurological and psychiatric populations and are associated with worsening disease. The findings support the routine screening and treatment of common sleep disorders in these populations.