Cognitive and behavioral therapy for insomnia increases the use of continuous positive airway pressure therapy in obstructive sleep apnea participants with comorbid insomnia: a randomized clinical trial

Abstract Study Objectives Insomnia and obstructive sleep apnea (OSA) commonly co-occur which makes OSA difficult to treat with continuous positive airway pressure (CPAP). We conducted a randomized controlled trial in participants with OSA and co-occurring insomnia to test the hypothesis that initial...

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Published in:	Sleep (New York, N.Y.) N.Y.), 2019-12, Vol.42 (12), p.1
Main Authors:	Sweetman, Alexander, Lack, Leon, Catcheside, Peter G, Antic, Nick A, Smith, Simon, Chai-Coetzer, Ching Li, Douglas, James, O’grady, Amanda, Dunn, Nicola, Robinson, Jan, Paul, Denzil, Williamson, Paul, McEvoy, R Doug
Format:	Article
Language:	eng
Subjects:	Adult Aged Australia - epidemiology Behavior modification Behavior therapy Behavioral medicine Clinical trials Cognitive Behavioral Therapy - methods Comorbidity Continuous positive airway pressure Continuous Positive Airway Pressure - methods Female Follow-Up Studies Humans Insomnia Male Middle Aged Sleep - physiology Sleep apnea Sleep Apnea, Obstructive - epidemiology Sleep Apnea, Obstructive - physiopathology Sleep Apnea, Obstructive - therapy Sleep Initiation and Maintenance Disorders - epidemiology Sleep Initiation and Maintenance Disorders - physiopathology Sleep Initiation and Maintenance Disorders - therapy Young Adult
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Summary:	Abstract Study Objectives Insomnia and obstructive sleep apnea (OSA) commonly co-occur which makes OSA difficult to treat with continuous positive airway pressure (CPAP). We conducted a randomized controlled trial in participants with OSA and co-occurring insomnia to test the hypothesis that initial treatment with cognitive and behavioral therapy for insomnia (CBT-i), versus treatment as usual (TAU) would improve insomnia symptoms and increase subsequent acceptance and use of CPAP. Methods One hundred and forty-five participants with OSA (apnea-hypopnea index ≥ 15) and comorbid insomnia were randomized to either four sessions of CBT-i, or TAU, before commencing CPAP therapy until 6 months post-randomization. Primary between-group outcomes included objective average CPAP adherence and changes in objective sleep efficiency by 6 months. Secondary between-group outcomes included rates of immediate CPAP acceptance/rejection, and changes in; sleep parameters, insomnia severity, and daytime impairments by 6 months. Results Compared to TAU, participants in the CBT-i group had 61 min greater average nightly adherence to CPAP (95% confidence interval [CI] = 9 to 113; p = 0.023, d = 0.38) and higher initial CPAP treatment acceptance (99% vs. 89%; p = 0.034). The CBT-i group showed greater improvement of global insomnia severity, and dysfunctional sleep-related cognitions by 6 months (both: p < 0.001), and greater improvement in sleep impairment measures immediately following CBT-i. There were no between-group differences in sleep outcomes, or daytime impairments by 6 months. Conclusions In OSA participants with comorbid insomnia, CBT-i prior to initiating CPAP treatment improves CPAP use and insomnia symptoms compared to commencing CPAP without CBT-i. OSA patients should be evaluated for co-occurring insomnia and considered for CBT-i before commencing CPAP therapy. Clinical Trial Treating comorbid insomnia with obstructive sleep apnea (COMSIA) study: A new treatment strategy for patients with combined insomnia and sleep apnea, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365184 Australian New Zealand Clinical Trials Registry: ACTRN12613001178730. Universal Trial Number: U1111-1149-4230.
ISSN:	0161-8105 1550-9109