title: Sleep apnea-plus: prevalence, risk factors, and association with cardiovascular diseases using United States population-level data.
abstract: OBJECTIVE
  The purpose of this study was to estimate the prevalence of, to identify sociodemographic risk factors for, and to examine the association of cardiovascular diseases with sleep apnea-plus (i.e., comorbid insomnia and sleep apnea) in the general United States population.
  
  
  METHODS
  A population-based multi-year cross-sectional study design was used with data from the 2005-2008 United States National Health and Nutrition Examination Surveys (NHANES) (n=12,593).
  
  
  RESULTS
  The prevalence of insomnia among individuals with sleep apnea (n=236/546 or 43%) was higher compared to individuals without sleep apnea (n=3550/12,047 or 30%). Among individuals with sleep apnea, women (OR 2.19, 95% CI 1.07-4.48) and individuals with symptoms of depression (OR 3.53, 95% CI 1.49-8.35) were significantly more likely, and individuals ages 60+ years (OR 0.43, 95% CI 0.20-0.94) and individuals with morbid obesity (OR 0.27, 95% CI 0.09-0.75) were significantly less likely, to have sleep apnea-plus. After controlling for confounders, the odds of health professional-diagnosed self-reported hypertension (OR 0.64, 95% CI 0.29-1.44), diabetes (OR 1.02, 95% CI 0.33-3.11), congestive heart failure (OR 0.67, 95% CI 0.19-2.44), myocardial infarction (OR 1.80, 95% CI 0.49-6.67), and stroke (OR 0.82, 95% CI 0.18-3.77), as well as objectively measured risk factors for these conditions, were not significantly different between individuals with sleep apnea-plus and individuals with sleep apnea-alone.
  
  
  CONCLUSIONS
  The prevalence of insomnia in sleep apnea is high, and substantially greater than in the general population, and this has important implications for the management of sleep apnea patients. Similar to sleep apnea-alone, individuals with sleep apnea-plus have elevated rates of cardiovascular diseases compared to the general population. Given the elevated rates of cardiovascular diseases among individuals with sleep apnea-plus, along with their known poor CPAP compliance, identification of individuals with sleep apnea-plus and treatment of their concomitant insomnia is important.
authors.affiliation: Division of Respirology, Department of Medicine, St. Michael's Hospital, Canada. nick.vozoris@utoronto.ca
authors.forename: Nicholas T
authors.initials: NT
authors.lastname: Vozoris
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D009749:Nutrition Surveys / Q000706:statistics & numerical data*; D009767:Obesity, Morbid / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000453:epidemiology*; D020521:Stroke / Q000453:epidemiology; D014481:United States / Q000453:epidemiology