Prevalence of Obstructive Sleep Apnea and Insomnia in Neurological Populations
Christian Mouchati1, Irene Katzan2, Laura Mora Munoz1, Maeve Pascoe3, Harneet Walia1, Nancy Foldvary-Schaefer1
1Sleep Disorders Center, Neurological Institute, 2Cerebrovascular Center, Cleveland Clinic, 3Cleveland Clinic Lerner College of Medicine
Objective:
Determine the prevalence and effect of Obstructive Sleep Apnea (OSA) and Insomnia in patients with neurological disorders.
Background:
Limited data exists on OSA and Insomnia prevalence in neurological disorders.
Design/Methods:
Data was collected from 03/2015-10/2016 from five specialized Centers. High-risk OSA (HR-OSA) was defined as STOP≥2, and high-risk Insomnia (HR-Insomnia) as ISI≥15. We used the following health status scales to determine disease severity: Karnofsky Performance Scales (KPS) for Brain Tumors (BT), Modified Rankin Scale (mRankin) for Stroke and other neurological disabilities (CV), Unified Parkinson’s Disease Rating Scale II (UPDRS-II) for Parkinson’s and related movement disorders (MD), Liverpool Seizure Severity Scale 2.0 (LSSS) for Epilepsy (EPI), and Patient Health Questionnaire 9 (PHQ-9) for Psychology & Psychiatry (PSYC). Models were adjusted for pre-specified covariates.
Results:
We included 6224 patients; mean age was 50.29 (18.36), and 58.69% were female. Sample constitution included: BT 11.6%, CV 16.5%, MD 23.3%, EPI 16.2%, and PSYC 32.4%. Overall, HR-OSA and HR-Insomnia were 36.5% (95%CI=35.3-37.7) and 24.6% (95%CI=23.6-25.7), with the highest HR-OSA in CV 48.1% (95%CI=45-51.2), and the highest HR-Insomnia in PSYC 33.6% (95% CI, 31.6-35.8). KPS score <60 was associated with higher HR-OSA (OR=2.67, 95%CI=1.3-6.4) and HR-Insomnia (OR=3.87, 95%CI=1.495-11.50). For each unit increase in UPDRS II score, odds of HR-OSA increased by 3.6% (OR=1.036, 95%CI=1.018-1.054), and HR-Insomnia increased by 9.7% (OR=1.097, 95%CI=1.061-1.134). mRankin >2 had higher odds of HR-OSA (OR=2.11, 95% CI=1.384-3.22) and HR-Insomnia (OR=3.9, 95%CI=2.28-6.6). When compared to EPI patients with zero seizures, those with 6-10 seizures in the prior 4 weeks had higher odds of HR-OSA (OR=1.87, 95%CI=1.11-3.14) and HR-Insomnia (OR=4.44, 95%CI=2.6-7.57). With each 5-point increase in PHQ-9 score in PSYC patients, the odds of HR-OSA increased by 28% (OR=1.28, 95%CI=1.185-1.383), and HR-Insomnia increased by 154% (OR=2.54, 95%CI=2.305-2.79).
Conclusions:
HR-OSA and HR-Insomnia are highly prevalent in neurological populations and associated with worsening disease.