A randomized controlled trial of cognitive behavioral therapy for insomnia and PAP for obstructive sleep apnea and co-morbid insomnia: effects on nocturnal sleep and daytime performance
- S-Med
- 2 days ago
- 2 min read
The goal of this study was to provide further insights into the clinical impact of using CBT-I and PAP on nocturnal sleep and daytime functioning for individuals with COMISA. In general, the findings indicate that using PAP, alone or concomitant with CBT-I, resulted in significant improvements from baseline to 90 days of PAP use on several measures of sleep and daytime functioning. However, the addition of CBT-I to PAP therapy accelerated the improvements on several clinical measures, regardless of when it was initiated relative to PAP. Collectively, these findings reinforce the benefits of PAP use for COMISA but also indicate that adding CBT-I to PAP as part of a concomitant approach can achieve more rapid improvements in nocturnal sleep and daytime functioning.
Significant improvements were observed on self-reported and objective measures of sleep across all treatment arms. Self-reported sleep efficiencies increased by about 10–12% from baseline to end of treatment (Arm A [CBT-I, followed by PAP]: 12.2%; Arm B [CBT-I concurrent with PAP]: 11.0%; Arm C [PAP only]: 10.1%), reaching a SE around 87% at the end of treatment in all arms. This level of SE is considered within the normal range. All treatment approaches also significantly reduced SOL and WASO in sleep diary with all three treatment arms reporting SOL and WASO < 30 minutes at the end of treatment, which is a common clinical cut-off for insomnia. Planned comparisons of CBT-I, PAP, and self-monitoring found that CBT-I was superior to self-monitoring and PAP on improving self-reported SOL, WASO, TIB, and SE, consistent with expectations of sleep restriction and stimulus control delivered during CBT-I. A significant reduction was also found across all treatment arms on actigraphy-measured WASO, TIB, and SE. Importantly, the significant reduction in actigraphy-measured TIB was most prominent during the period when participants received CBT-I, which provides objective evidence of adherence to the sleep restriction component of CBT-I in people with COMISA. Consistent with previous findings on global insomnia symptoms, these findings underscore the benefits of CBT-I on sleep parameters and further support the use of CBT-I for improving sleep in COMISA population. It is notable that even participants in Arm C, who received PAP with no CBT-I, reported significant improvements in several sleep parameters, indicating that PAP can be an effective singular treatment in improving sleep in people with COMISA.
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