Association of adherence to the Mediterranean diet and physical activity habits with the presence of insomnia in patients with obstructive sleep apnea

Sleep Breath. 2022 Mar;26(1):89-97. doi: 10.1007/s11325-021-02351-x. Epub 2021 Apr 4.


Purpose: Insomnia and obstructive sleep apnea (OSA) are among the most prevalent sleep disorders and frequently co-occur, defining the sleep apnea-insomnia syndrome. However, data exploring associations between insomnia and lifestyle habits in patients with OSA are lacking. Therefore, the aim of the present study was to investigate potential associations between insomnia presence and individual lifestyle parameters in patients with mild/moderate-to-severe OSA evaluated by attended polysomnography.

Methods: These are secondary analyses, using data from a cross-sectional study among 269 Greek patients with OSA. Clinical, anthropometric, socioeconomic, and lifestyle data were collected for all participants. Insomnia presence was evaluated through the validated psychometric instrument "Athens Insomnia Scale" (AIS). Adherence to the Mediterranean diet was estimated with the MedDietScale index and physical activity habits were assessed through a validated questionnaire. Backward stepwise multiple logistic regression analysis was used to estimate the association between lifestyle habits (i.e., adherence to the Mediterranean diet and physical activity) and the likelihood of having insomnia, while adjusting for potential confounders.

Results: Of 269 patients newly diagnosed with OSA (aged 21-70 years; 73% men), 146 (54%) were categorized as having insomnia. In multivariable models, higher adherence to the Mediterranean diet and engagement in physical activity for ≥ 30 min/day were both associated with a lower likelihood of having insomnia (odds ratio (95% confidence intervals): 0.40 (0.18-0.91) and 0.49 (0.28-0.86), respectively).

Conclusions: Results add to the limited data on the role of lifestyle in insomnia and should be further explored both in epidemiological and clinical studies.

Keywords: Comorbid insomnia and obstructive sleep apnea; Mediterranean diet; Physical activity.

MeSH terms

  • Adult
  • Aged
  • Cross-Sectional Studies
  • Diet, Mediterranean / statistics & numerical data*
  • Exercise*
  • Female
  • Healthy Lifestyle*
  • Humans
  • Male
  • Middle Aged
  • Risk Factors
  • Severity of Illness Index
  • Sleep Apnea, Obstructive / diet therapy
  • Sleep Apnea, Obstructive / prevention & control
  • Sleep Initiation and Maintenance Disorders / diet therapy*
  • Sleep Initiation and Maintenance Disorders / prevention & control*
  • Young Adult