Daytime impairment and depressive symptoms in patients with obstructive sleep apnea and coexisting insomnia symptoms: A cross-sectional study from a Caribbean sleep center

OBJECTIVES: This study aimed to examine the association between insomnia symptoms and daytime functioning, depressive symptoms, and cardiovascular comorbidities among patients evaluated for obstructive sleep apnea in Martinique. METHODS: This cross-sectional study included consecutive adults referred for suspected obstructive sleep apnea at the University Hospital of Martinique. Insomnia symptoms were self-reported. Daytime sleepiness, fatigue, and depressive symptoms were assessed using the Epworth Sleepiness Scale, the Pichot Fatigue Scale, and the Pichot Depression Scale. RESULTS: Among 189 patients with obstructive sleep apnea, insomnia symptom data were available for 178 patients and 61.2% reported insomnia symptoms. The mean age was 55.1 ± 15.8 years in the group without insomnia and 56.9 ± 15.7 years in the insomnia group (P =.47). The median apnea-hypopnea index did not differ significantly between patients with and without insomnia symptoms (18 [9.6-31.0] vs. 21 [12.2-33.3], P = .28). In contrast, patients with coexisting insomnia symptoms exhibited significantly higher daytime sleepiness (ESS: 10.4 ± 5.7 vs. 7.5 ± 4.7, P = .001), fatigue (13.6 ± 8.2 vs. 8.9 ± 6.5, P<.001), and depressive symptoms (4.1 ± 3.7 vs. 2.7 ± 2.9, P = .016). No significant interaction was observed between insomnia symptoms and OSA severity, indicating that the impact of insomnia on daytime functioning was consistent across levels of respiratory disease severity. In sex-stratified analyses, the association between insomnia symptoms and daytime impairment was more pronounced in women, whereas in men, fatigue appeared more strongly related to cardiovascular comorbidities. CONCLUSIONS: Insomnia symptoms were strongly associated with impaired daytime functioning and depressive symptoms, independent of obstructive sleep apnea severity, supporting systematic insomnia assessment in patients with obstructive sleep apnea.