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Nalaka S. Gooneratne, MD, MSCE; Philip R. Gehrman, PhD; J. Emeka Nkwuo, PhD; Scarlett L. Bellamy, ScD; Sharon Schutte-Rodin, MD; David F. Dinges, PhD; Allan I. Pack, MB, ChB, PhD

Arch Intern Med. 2006;166:1732-1738.

Background  The prevalence of sleep-related breathing disorder (SRBD) and insomnia symptoms increases considerably with advancing age, but little is known about their cooccurrence and their effects on daytime functioning when present together.

Methods  Older adults with (cases, n = 99) and without (controls, n = 100) symptoms of insomnia underwent 2 nights of in-laboratory polysomnography, daytime nap, and neurobehavioral testing and completed study questionnaires. Predictors of SRBD were identified (apnea-hypopnea index [indicating number of events per hour], 15). Participants were divided into 4 groups—with and without insomnia and with and without SRBD—and the groups were compared on measures of daytime functioning.

Results  Cases had a lower rate of SRBD (29.3%) than controls (38.0%). Body mass index (calculated as weight in kilograms divided by height in meters squared) of 30 or higher, neck circumference greater than 15.5 inches, and a history of "loud snoring" or "stops breathing, chokes, or struggles for breath" were independently predictive of SRBD in participants with insomnia symptoms. Having both insomnia symptoms and SRBD was associated with significantly lower daytime functioning and longer psychomotor reaction times compared with having neither condition.

Conclusion  Because insomnia comorbid with SRBD is associated with the greatest functional impairment, and SRBD is commonly found in the elderly population, health care providers should also consider SRBD in elderly patients with insomnia symptoms.

Author Affiliations: Division of Geriatric Medicine (Dr Gooneratne), Center for Sleep and Respiratory Neurobiology and Division of Sleep Medicine (Drs Gooneratne, Gehrman, Nkwuo, Schutte-Rodin, and Pack), Center for Clinical Epidemiology and Biostatistics (Dr Bellamy), and Department of Psychiatry (Dr Dinges), University of Pennsylvania School of Medicine, Philadelphia; and Department of Social Sciences, University of the Sciences, Philadelphia (Dr Gehrman).

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