• Erla Björnsdóttir, Christer Janson, Jón F Sigurdsson, Philip Gehrman, Michael Perlis, Sigurdur Juliusson, Erna S Arnardottir, Samuel T Kuna, Allan I Pack, Thorarinn Gislason, and Bryndis Benediktsdóttir.
• Faculty of Medicine, University of Iceland, Reykjavík, Iceland ; Department of Respiratory Medicine and Sleep, Landspitali - The National University Hospital of Iceland.
• Sleep. 2013 Dec 1; 36 (12): 1901-9.

Study ObjectivesTo assess the changes of insomnia symptoms among patients with obstructive sleep apnea (OSA) from starting treatment with positive airway pressure (PAP) to a 2-y follow-up.DesignLongitudinal cohort study.SettingLandspitali--The National University Hospital of Iceland.ParticipantsThere were 705 adults with OSA who were assessed prior to and 2 y after starting PAP treatment.InterventionPAP treatment for OSA.Measurements And ResultsAll patients underwent a medical examination along with a type 3 sleep study and answered questionnaires on health and sleep before and 2 y after starting PAP treatment. The change in prevalence of insomnia symptoms by subtype was assessed by questionnaire and compared between individuals who were using or not using PAP at follow-up. Symptoms of middle insomnia were most common at baseline and improved significantly among patients using PAP (from 59.4% to 30.7%, P < 0.001). Symptoms of initial insomnia tended to persist regardless of PAP treatment, and symptoms of late insomnia were more likely to improve among patients not using PAP. Patients with symptoms of initial and late insomnia at baseline were less likely to adhere to PAP (odds ratio [OR] 0.56, P = 0.007, and OR 0.53, P < 0.001, respectively).ConclusionPositive airway pressure treatment significantly reduced symptoms of middle insomnia. Symptoms of initial and late insomnia, however, tended to persist regardless of positive airway pressure treatment and had a negative effect on adherence. Targeted treatment for insomnia may be beneficial for patients with obstructive sleep apnea comorbid with insomnia and has the potential to positively affect adherence to positive airway pressure.

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