Negar Almassi MPS[/caption]
Dr Brian Chia MPS[/caption]
COPD is significantly underdiagnosed
Associate Professor Debbie Rigby FPS[/caption]
Nicolette Ellis MPS[/caption]
A national education program for pharmacists funded by the Australian Government under the Quality Use of Diagnostics, Therapeutics and Pathology program.[/caption]
Both these disorders can occur separately, but if they co-occur, this is termed COMISA. Approximately 30–50% of people with OSA have comorbid insomnia, and 30–40% of people with chronic insomnia have comorbid OSA.9,12 A recent population-based study reported that 11% of Australian adults report symptoms of COMISA.13
The ‘gold standard’ measure of OSA presence and severity is an overnight sleep study (Table 1).25 The most common single metric to determine OSA presence and severity is the apnoea-hypopnoea index (AHI), representing the average number of airway narrowing and closure events occurring per hour of sleep.24 Identifying the most appropriate management approaches for OSA also requires consideration of lifestyle factors, symptoms and consequences, occupation, chronic conditions, and other sleep conditions. Self-report questionnaires may be used to screen for a high-risk of OSA and identify patients suitable for referral and consideration of overnight sleep study assessment (Table 1).24
Although evidence-based guidelines unanimously recommend avoiding long-term use of hypnotics, they are indicated for a minority of patients that present with severe acute insomnia that is causing significant psychological distress or functional impairment.29 Most people who experience short-term insomnia symptoms (1–2 weeks) can be reassured that sleep will return to ‘normal’ after the underlying precipitant has subsided, without targeted treatment (i.e. hypnotic medicines).29,33 For those who experience persistent insomnia, cognitive behavioural therapy for insomnia (CBTi) is the first-line treatment. Pharmacotherapy may be considered in patients with severe insomnia that is causing significant impairment or distress (e.g. times of acute work/exam stress, bereavement).34
Tailored recommendations for non-CPAP therapies may also be provided to patients with different levels of OSA severity and presenting features.17 For example, weight management advice where indicated, positional devices (in the presence of supine-predominant OSA), mandibular advancement splints (in patients with mild-to-moderate OSA), and upper airway surgery are effective treatments that may be tailored to each individual patient.24
Dr Alexander Sweetman (he/him) PhD
Senior Program Manager, and chair of the psychologist education subcommittee at the Australasian Sleep Association.
Associate Professor Sutapa Mukherjee (she/her) MBBS, FRACP, PhD
Respiratory and sleep physician, Associate Professor of Respiratory and Sleep Medicine at Flinders University and past President of the Australasian Sleep Association.
Professor Garun Hamilton (he/him) MBBS, FRACP, PhD
Respiratory and sleep physician, clinical professor at Monash Health and Monash University and President of the Australasian Sleep Association.
Professor John Turnidge AO[/caption]
References
1. Hillman D, Mitchell S, Streatfeild J, et al. The economic cost of inadequate sleep. Sleep 2018;41(8). Epub 2018 Jun 4.
2. Claughton D. Farmers cite daylight saving’s work and health impacts, vote for it to be cut back. ABC Rural. 2924. At: www.abc.net.au/news/rural/2024-07-25/farmers-want-daylight-saving-months-shortened/104125708
3. Shi T, Min M, Sun C, et al. Does insomnia predict a high risk of cancer? A systematic review and meta-analysis of cohort studies. J Sleep Res 2020;29(1):e12876.
4. Perlis, ML, Smith MT, Pigeon W. Etiology and Pathophysiology of insomnia. In Principals and practice of sleep medicine. Elsevier, 2005. p.714–25. At: www.med.upenn.edu/cbti/assets/user-content/documents/PPSMChapter6.pdf
5. Steedman E. Why do I keep waking up during the night? Here’s how to improve your winter sleep. 2024. At: www.abc.net.au/news/2024-07-06/how-to-improve-your-winter-sleep/103991558
6. Logan T. Record-breaking autumn heatwave over south-east Australia hints at growing trend. 2024. At: www.abc.net.au/news/2024-03-12/heatwave-over-south-east-australia/103572236
7. Sleep Health Foundation. Insomnia. 2024. At: www.sleephealthfoundation.org.au/sleep-disorders/insomnia-2#:~:text=How%20common%20is%20insomnia%3F,have%20at%20least%20mild%20insomnia.
8. Australasian Sleep Association. Health professionals information. Shift work. On-the-spot management information for health professionals – shift work sleep disorder. 2020. At: https://sleep.org.au/common/Uploaded%20files/Public%20Files/Professional%20resources/Adult%20resources/Shiftwork%20Disorder_0617.pdf
9. Sleep Health Foundation. Common sleep disorders. 2023. At: www.sleephealthfoundation.org.au/sleep-disorders/common-sleep-disorders
10. Hale L, Guan S. Screen time and sleep among school-aged children and adolescents: a systematic literature review. Sleep Med Rev 2015;21:50–8.
11. Reynolds A, Appleton S, Gill T, et al. Chronic insomnia disorder in Australia: a report to the Sleep Health Foundation. Sleep Health Foundation Special Report. 2019. At: www.sleephealthfoundation.org.au/special-sleep-reports/chronic-insomnia-disorder-in-australia
12. Ree M, Junge M, Cunnington D. Australasian Sleep Association position statement regarding the use of psychological/behavioral treatments in the management of insomnia in adults. Sleep Medicine 2017;36(Suppl 1):S43–7. At: https://pubmed.ncbi.nlm.nih.gov/28648226/
13. Sweetman A, Lovato N, Haycock J, et al. Insomnia treatment. Improved access to effective nondrug options. Medicine Today 2020;21(11)14–20.
14. Royal Australian College of General Practitioners. Guidelines for preventive activities in general practice. 10th edn. East Melbourne, Vic: RACGP, 2024. At:
www.racgp.org.au/getattachment/8f57912d-11bd-47c9-9d24-81a2301e9fe2/Guidelines-for-preventive-activities-in-general-practice.aspx
15. Australian Government Australian Institute of Family Studies. Are children and adolescents getting enough sleep? In: The longitudinal study of Australian children. 2019. At: https://growingupinaustralia.gov.au/research-findings/annual-statistical-reports-2018/are-children-and-adolescents-getting-enough-sleep?_ga=2.168509095.78394973.1648428449-1794046761.1648162847
16–18, 20, 21. Adams RJ, Appleton SL, Taylor AW, et al. Sleep health of Australian adults in 2016: results of the 2016 Sleep Health Foundation national survey. Sleep Health 2017;3(1):35–42.
19. Australian Institute for Health and Welfare. Sleep problems as a risk factor for chronic conditions. 2021. At: www.aihw.gov.au/reports/risk-factors/sleep-problems-as-a-risk-factor/data
22. Sweetman A, Putland S, Lack L, et al. The effect of cognitive behavioural therapy for insomnia on sedative-hypnotic use: a narrative review. Sleep Med Rev 2021;56:101404. At: https://pubmed.ncbi.nlm.nih.gov/33370637/
23. Treatment guidelines for pharmacists: insomnia. In: Sansom LN, ed. Australian pharmaceutical formulary and handbook. 2024. At: https://apf.psa.org.au
24. Australian Sleep Association. Insomnia – Chronic insomnia / insomnia disorder: pathogenesis, risk factors & development. 2024. At: www.sleepprimarycareresources.org.au/insomnia/risk-factors-and-development
25. Sweetman A, Andronis C, Hancock K, et al. General practitioner assessment and management of insomnia in adults. Aust J Gen Pract 2023;52(10). At: www1.racgp.org.au/ajgp/2023/october/general-practitioner-assessment-and-management-of
