| Summary: | Introduction: Patients with obstructive sleep apnea (OSA) often sleep poorly, have a high co-morbidity of insomnia and evidence suggests elevated levels of depression among this patient population. All of these conditions affect quality of life and accordingly it can be difficult to identify the most important contributors for poor health and life qualities among these patients. It is important to look at all of these factors in combination and figure out whether some subgroups of OSA patients require additional interventions prior to or simultaneously with positive airway pressure (PAP) treatment to maximize treatment effects Objectives: The overall aim of this study was to investigate insomnia, depression and quality of life among patients with OSA: firstly, their prevalence among untreated OSA patients and the relationship with OSA severity, secondly, how these factors change with long term PAP treatment of OSA and thirdly if they have some impact on treatment outcome and adherence. Methods: The relationship between insomnia, quality of life and OSA was assessed by comparing 822 untreated OSA patients from the Icelandic sleep apnea cohort (ISAC, 666 males, 156 females) to 762 controls from the general population in Iceland (404 males, 358 females). Changes in both insomnia and quality of life were subsequently assessed among ISAC subjects 2 years after initiating PAP treatment. Furthermore, depression was assessed among 284 untreated OSA patients (223 males, 61 females) waiting to initiate PAP treatment. All OSA patients underwent a sleep study and answered standardized questionnaires about their sleep and health. Insomnia was assessed with the Basic Nordic Sleep Questionnaire and those who reported insomnia symptoms ≥3x week were considered to have insomnia. Three subtypes of insomnia were defined: difficulty initiating sleep (initial insomnia), difficulty maintaining sleep (middle insomnia) and early morning awakenings (late insomnia). The Short Form 12 (SF-12) questionnaire was used to assess quality of ...
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