tional study of a large cohort of sleep apnea patients (n = 403), snorers, and healthy controls who had been followed for an average of 10 years, found a threefold higher risk of fatal cardiovascular events with severe OSA (Marin et al., 2005). An observational follow-up study of the long-term effects of CPAP therapy on mortality found that compared to individuals that began receiving CPAP therapy for at least 5 years (n = 107), individuals that were untreated with CPAP (n = 61) were more likely to die from cardiovascular disease (14.8 percent versus 1.9 percent, log rank test, P = .009) (Yaggi et al., 2005; Doherty et al., 2005).

Treatment

In adults, OSA is most effectively treated with CPAP and weight loss (Strollo et al., 2005; Grunstein, 2005a). Evidence of CPAP’s efficacy for alleviating daytime sleepiness comes from randomized controlled trials and meta-analysis (Patel et al., 2003). The problem is that many patients are noncompliant with CPAP (see Chapter 6). Other options, although less effective, include a variety of dental appliances (Ferguson and Lowe, 2005) or surgery (e.g., uvulopalatopharyngoplasty) (Powell et al., 2005). In children, the first-line treatment for most cases of OSA is adenotonsillectomy, according to clinical practice guidelines developed by the American Academy of Pediatrics (Marcus et al., 2002). Children who are not good candidates for this procedure can benefit from CPAP. Central apnea treatment is tailored to the cause of the ventilatory instability. Commonly used treatments include oxygen, CPAP, and acetazolamide, a drug that acts as a respiratory stimulant (White, 2005).

INSOMNIA

Manifestations and Prevalence

Insomnia is the most commonly reported sleep problem (Ohayon, 2002). It is a highly prevalent disorder that often goes unrecognized and untreated despite its adverse impact on health and quality of life (Benca, 2005a) (see also Chapter 4). Insomnia is defined by having difficulty falling asleep, maintaining sleep, or by short sleep duration, despite adequate opportunity for a full night’s sleep. Other insomnia symptoms include daytime consequences, such as tiredness, lack of energy, difficulty concentrating, and/or irritability (Simon and VonKorff, 1997). The diagnostic criteria for primary insomnia include:

  • Difficulty initiating or maintaining sleep or nonrestorative sleep.



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