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Association of adherence to the Mediterranean diet and physical activity habits with the presence of insomnia in patients with obstructive sleep apnea

  • Sleep Breathing Physiology and Disorders • Original Article
  • Published:
  • volume 26pages 89–97 (2022)
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Insomnia and obstructive sleep apnea (OSA) are among the most prevalent sleep disorders and frequently co-occur, defining the sleep apnea-insomnia syndrome. However, data exploring associations between insomnia and lifestyle habits in patients with OSA are lacking. Therefore, the aim of the present study was to investigate potential associations between insomnia presence and individual lifestyle parameters in patients with mild/moderate-to-severe OSA evaluated by attended polysomnography.


These are secondary analyses, using data from a cross-sectional study among 269 Greek patients with OSA. Clinical, anthropometric, socioeconomic, and lifestyle data were collected for all participants. Insomnia presence was evaluated through the validated psychometric instrument “Athens Insomnia Scale” (AIS). Adherence to the Mediterranean diet was estimated with the MedDietScale index and physical activity habits were assessed through a validated questionnaire. Backward stepwise multiple logistic regression analysis was used to estimate the association between lifestyle habits (i.e., adherence to the Mediterranean diet and physical activity) and the likelihood of having insomnia, while adjusting for potential confounders.


Of 269 patients newly diagnosed with OSA (aged 21–70 years; 73% men), 146 (54%) were categorized as having insomnia. In multivariable models, higher adherence to the Mediterranean diet and engagement in physical activity for ≥ 30 min/day were both associated with a lower likelihood of having insomnia (odds ratio (95% confidence intervals): 0.40 (0.18–0.91) and 0.49 (0.28–0.86), respectively).


Results add to the limited data on the role of lifestyle in insomnia and should be further explored both in epidemiological and clinical studies.

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Fig. 1

Data availability

The data is available on request from the corresponding author.


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The authors would like to thank the staff of the Centre of Sleep Disorders of “Evangelismos” Hospital for their valuable help in data collection.


This work was partially supported by a grant from the Hellenic Atherosclerosis Society.

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Authors and Affiliations



NY, MDK, and EV conceived the study’s research hypothesis. NY and MDK designed the study. IK, MG, and KL were involved in participant recruitment and assessments. IK analyzed the data and drafted the manuscript. EC supervised the statistical analysis. MDK and NY critically revised the manuscript. NY had the primary responsibility for the final content. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Ioanna Kechribari or Nikos Yiannakouris.

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Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Evangelismos Hospital and by the Bioethics Committee of Harokopio University.

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Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Kechribari, I., Kontogianni, M.D., Georgoulis, M. et al. Association of adherence to the Mediterranean diet and physical activity habits with the presence of insomnia in patients with obstructive sleep apnea. Sleep Breath 26, 89–97 (2022).

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