![]() In this regard, not only the severity of insomnia but also type of insomnia (sleep onset insomnia, sleep maintenance insomnia, and early morning awakening) should play a differential role in PAP adherence. A previous study revealed that although PAP therapy significantly reduced the symptoms of middle insomnia, initial insomnia tended to persist and had a negative effect on adherence. ![]() However, if insomnia occurs independently from OSA, it will interfere with PAP treatment. If insomnia occurs secondary to OSA, treatment of OSA may relieve disturbed sleep. These studies reported that the severity of insomnia was associated with poor adherence, except for one study found no such association. The relationships among comorbid insomnia, OSA, and PAP adherence have been evaluated by several studies. Insomnia, presenting either as a symptom of OSA or independently co-occurring with OSA, was associated with 68% of patients with OSA. Another study reported that distinct clinical OSA phenotypes differ in terms of comorbidities and the adherence to nasal PAP therapy. Recently, cluster analysis of the presentation of OSA revealed considerable variations in the presentation as well as different symptom profiles, including disturbed sleep or upper airway symptoms with sleepiness. OSA is associated with variable degrees of daytime sleepiness and insomnia, suggesting the presence of different clinical phenotypes of OSA. One of the reasons for the discrepancy between studies may be that OSA syndrome is not a uniform condition. Although several studies have focused on factors influencing adherence, no single factor has been consistently identified as predictive of adherence. ![]() However, the effectiveness of the treatment is limited by moderate-to-low adherence to PAP therapy. Positive airway pressure (PAP) therapy stabilizes the vulnerable upper airway during sleep, relieves symptoms, and may prevent or mitigate the adverse outcomes of this condition. Obstructive sleep apnea (OSA) is characterized by repetitive upper airway obstruction which leads to nocturnal hypoxia and sleep fragmentation. ![]()
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