title: Polysomnography reveals unexpectedly high rates of organic sleep disorders in patients with prediagnosed primary insomnia.
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.
  
  
  CONCLUSIONS
  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.
authors: Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93042, Regensburg, Germany. tatjana.croenlein@medbo.de
authors: Tatjana
authors: T
authors: Crönlein
authors: Peter
authors: P
authors: Geisler
authors: Berthold
authors: B
authors: Langguth
authors: Peter
authors: P
authors: Eichhammer
authors: Cecilia
authors: C
authors: Jara
authors: Christoph
authors: C
authors: Pieh
authors: Jürgen
authors: J
authors: Zulley
authors: Göran
authors: G
authors: Hajak
mesh_terms: D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D020189:Nocturnal Myoclonus Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D017286:Polysomnography; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D012893:Sleep Wake Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy