Sleep and Breathing

, Volume 16, Issue 4, pp 1097–1103

Polysomnography reveals unexpectedly high rates of organic sleep disorders in patients with prediagnosed primary insomnia

  • Tatjana Crönlein
  • Peter Geisler
  • Berthold Langguth
  • Peter Eichhammer
  • Cecilia Jara
  • Christoph Pieh
  • Jürgen Zulley
  • Göran Hajak
Original Article

DOI: 10.1007/s11325-011-0608-8

Cite this article as:
Crönlein, T., Geisler, P., Langguth, B. et al. Sleep Breath (2012) 16: 1097. doi:10.1007/s11325-011-0608-8

Abstract

Objective

It is a matter of debate whether patients with primary insomnia require a polysomnographic examination in order to exclude specific sleep disorders such as sleep apnea syndrome (SAS) or periodic limb movements (PLM). Using a prospective design, we investigated the prevalence of organic sleep disorders by means of polysomnography (PSG) in a series of patients who were previously diagnosed with primary insomnia. This diagnosis was based on a clinical exam and an ambulatory monitoring device or previous PSG.

Methods

Seventy-seven women and 16 men (mean age 55.12 ± 13.21 years) who were admitted for cognitive behavioral therapy for insomnia were evaluated by PSG including cardiorespiratory parameters and tibialis EMG. Among them, 50 patients had undergone a clinical exam by a sleep specialist; in 18 patients, actigraphy or portable monitoring had been performed to exclude SAS or PLM; 25 patients had undergone PSG in another sleep lab previously.

Results

In 32 patients (34% of the sample), a PSG revealed a specific sleep disorder (SAS 16; PLMD 11; both 5), resulting in therapeutic consequences for 21 patients (SAS 10; PLMD 9; both 2). SAS and PLM patients were older and SAS patients had a higher body mass index than insomnia patients without additional findings.

Conclusion

Indications for a PSG should be handled less restrictively in the diagnostic workup of older insomnia patients since they have a higher risk of comorbid sleep disorders even in the absence of the clinical signs of SAS or PLM.

Keywords

PolysomnographySleep apneaPsychophysiological insomniaWomen

Abbreviations

AHI

Apnea–hypopnea index

BDI

Beck Depression Inventory

BMI

Body mass index

CBT-I

Cognitive behavior therapy for insomnia

CPAP

Continuous positive airway pressure

ESS

Epworth Sleepiness Scale

INS

Insomnia patients without any new findings in PSG

I-PLM

Insomnia patients with unexpected PLMs in PSG

I-SAS

Insomnia patients with unexpected SAS in PSG

I-SAS + PLM

Insomnia patients with unexpected SAS and PLMs in PSG

PLM

Periodic limb movements in sleep

PSG

Polysomnography

PSQI

Pittsburgh Sleep Quality Index

SAS

Sleep apnea syndrome

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Tatjana Crönlein
    • 1
  • Peter Geisler
    • 1
  • Berthold Langguth
    • 1
  • Peter Eichhammer
    • 1
  • Cecilia Jara
    • 1
  • Christoph Pieh
    • 1
  • Jürgen Zulley
    • 1
  • Göran Hajak
    • 1
  1. 1.Department of Psychiatry and PsychotherapyUniversity of RegensburgRegensburgGermany