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Psychiatry Investig. 2010 Mar;7(1):75-8. doi: 10.4306/pi.2010.7.1.75. Epub 2010 Feb 8.

A case of obstructive sleep apnea syndrome presenting as paradoxical insomnia.

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  • 1Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.


A 63-year-old female with obstructive sleep apnea syndrome (OSAS) presented with clinical features indistinguishable from paradoxical insomnia (PI). Her main complaint was chronic insomnia. Her subjective sleep latency was 2-3 h, subjective sleep time was less than 3 h, despite spending 8 h in bed, and she reported near constant awareness of her surroundings while lying in bed. Her body mass index (BMI) was 22.67 kg/m(2), and her neck circumference was 34.5 cm. Nocturnal polysomnography (NPSG) findings indicated severe OSAS. Her total sleep time (TST) was 359 min, sleep latency 13 min, and her apnea/hypopnea index (AHI) was 74.6/h. The aim of this report is to evaluate the association between PI and OSAS cases confirmed by NPSG.


Nocturnal polysomnography; Paradoxical insomnia; Sleep apnea syndrome; Sleep state misperception

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