0413 Impact of Insomnia on Obstructive Sleep Apnea in a General Sleep Medicine Clinic

Abstract Introduction Among patients diagnosed with obstructive sleep apnea (OSA), 20-30% have comorbid insomnia. OSA can result in patients waking up gasping/choking. Once awake, patients with comorbid insomnia may have difficulty falling back asleep. Continuous positive airway pressure (CPAP) is the gold standard treatment of OSA. With effective treatment of OSA, patients may be less likely to wake up and therefore may have decreased symptoms of insomnia and daytime sleepiness. The purpose of the current quality improvement (QI) project is to determine the prevalence of excessive daytime sleepiness (EDS) and comorbid insomnia symptoms among patients with OSA in a sleep disorders clinic within an academic health center. Determining these prevalence rates will establish a foundation for future QI projects to optimize treatment for OSA and comorbid insomnia. Methods Participants (N = 47) with a diagnosis of or suspected OSA completed the Insomnia Severity Index (ISI) for insomnia symptoms and the Epworth Sleepiness Scale (ESS) to assess EDS at their sleep medicine visit. When available, PAP usage data was evaluated via smartcard downloads from the computer-based platform and patient device for the same medical visit. Results Participants were more likely to have severe OSA (38.3%), identify as White (63.8%), and be male (58.3%). Twenty-five participants (53.2%) scored within the Clinical Insomnia (Moderate or Severe) category on the ISI, and 19 scored within the Excessively Sleepy or May Be Excessively Sleepy category on the ESS (47.5% of the 40 patients who completed the scale). Fourteen patients (51.9% of the 27 whose PAP usage data was available) wore their PAP at least 90% of the days and 8 (29.6%) wore their PAP for at least 4 hours per night at least 90% of the time. Conclusion This initial phase of our ongoing QI project identifies insomnia as a potential comorbid condition that could negatively impact treatment of OSA. Further QI evaluations should include the bidirectional impact of insomnia treatment with CPAP therapy of OSA. Support (if any)