In this large-scale, population-based study, we found that a combination of self-reported snoring and insomnia symptoms has an effect on co-morbid hypertension, asthma, and COPD compared with those with only snoring or insomnia symptoms alone. In addition, excessive daytime sleepiness and the use of hypnotics were more common in the group with both insomnia symptoms and snoring.
The interaction between SDB and insomnia is thought to take place via various routes, and it has not yet been established whether 1 condition has a causal effect on the other or whether they are merely mutually potentiating. Patients with insomnia, in their hype-arousal state, have a lower respiratory arousal threshold, which may cause an earlier response to the increased respiratory resistance in SDB than in those without insomnia, leading to increased fragmentation of sleep and ventilation stability, which, in turn, increases the risk of upper airway obstruction. Sleep fragmentation and arousals caused by SDB may more often be perceived as wakefulness in those with insomnia than in those without insomnia. Then, due to hyper-arousal, they have more difficulty falling back into a deep sleep, leading to the further re-enforcement of hyper-arousal. Other symptoms of SDB, such as nocturia and excessive daytime sleepiness, may cause sleep disruption and lead to compensatory daytime behaviors (increased caffeine intake, daytime napping), which, in turn, may lead to increased difficulty inducing and maintaining sleep and even more daytime sleepiness. The increased insomnia symptoms may also lead to increased use of hypnotics in an attempt to improve sleep quality. Finally, hypnotics can cause daytime sleepiness due to a residual sedative effect.
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