Case study: Hypertension during pregnancy
There are three different components to be related in this case: Sleep apnea and hypertension, pregnancy and snoring or sleep apnea, and then pregnancy and hypertension. There is a very strong relationship between sleep apnea and hypertension. All clinical questionnaires related to prediction of apnea indicate the importance – both the Berlin and the STOPBANG include hypertension as a key feature. Up to 80% of patients with resistant hypertension and 40% of patients with any type of hypertension have OSA. The surges in sympathetic activity occurring with the arousals from sleep cause repetitive and brief surges in blood pressure. These surges can eliminate the usual nocturnal dipping of blood pressure during sleep increasing the risk of cardiovascular disease. CPAP treatment causes reduction in both systolic and diastolic blood pressure.
Case study: Comorbid Insomnia and sleep apnea (COMISA) and night-eating syndrome
While the traditional presentation of obstructive sleep apnea (OSA) is normal sleep with excessive daytime sleepiness, a clear relationship between OSA and insomnia has been researched since first described in 1973. The most recent review shows that 35% of patients with insomnia have an AHI>5 while 38% of patients with OSA meet insomnia criteria. The insomnia criteria used are usually those of the DSM-V which require nightly disturbances in sleep (difficulty falling asleep or maintaining sleep) plus daytime dysfunction. Thus, they commonly occur with each other and may present with very similar daytime consequences.
Case study: Prolonged unescapable stress ahead with insomnia
In the natural history of insomnia (Figure1) a precipitating cause, often a psychological stress, initiates acute insomnia. As the stress resolves, up to 75% of patients return to normal sleeping patterns. In the other quarter of patients, the severity or long duration of the stress creates a cognitive dysfunction and also poor sleep behaviours. The cognitive dysfunction takes the form of anxiety around sleep, dysfunctional beliefs about the impact of no sleep and constant thinking about sleep (creating an event). The poor sleep behaviours present as spending too much time in bed (in excess of the sleep needed), and then staying lying in bed if awake – often for hours. Together these factors are called perpetuating factors (Figure 1).
Health Professions Councils of South Africa
Attempts allowed: 2
70% pass rate
Sleep Matters - 2022 Vol 13 No 2