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.
Level 2 - randomized trial
Individual randomized controlled trial
PubMed 31403168 · doi:10.1093/sleep/zsz178
What was done
One hundred and forty-five participants with obstructive sleep apnea (apnea-hypopnea index ≥ 15) and comorbid insomnia were randomized to either four sessions of cognitive and behavioral therapy for insomnia (CBT-i) or treatment as usual (TAU) before starting CPAP therapy. Participants were followed through 6 months post-randomization. Primary outcomes were objective average CPAP adherence and changes in objective sleep efficiency at 6 months. Secondary outcomes included immediate CPAP acceptance, sleep parameters, insomnia severity, and daytime impairments.
What was found
Compared to TAU, the CBT-i group had 61 minutes greater average nightly CPAP adherence (95% CI: 9 to 113; p = 0.023, d = 0.38) and higher initial CPAP acceptance (99% vs. 89%; p = 0.034). CBT-i also led to greater improvements in global insomnia severity and dysfunctional sleep-related cognitions at 6 months (both p < 0.001). There were no between-group differences in objective sleep outcomes or daytime impairments at 6 months.
Why it matters
Co-occurring insomnia frequently undermines CPAP adherence in patients with obstructive sleep apnea; brief pre-treatment with CBT-i significantly improves device use and insomnia severity.
Limits
The abstract does not report baseline demographics, masking procedures, or dropout rates at 6 months. Improvements in CPAP use did not translate into statistically significant between-group differences in objective sleep outcomes or daytime impairments at 6 months.
Cited by
- supports CBT-I is effective for improving insomnia in patients with sleep apnea before their sleep apnea is treated.