Cathy A Alessi1,2, Constance H Fung1,2, Joseph M Dzierzewski3, Lavinia Fiorentino4, Carl Stepnowsky5,6, Juan C Rodriguez Tapia7, Yeonsu Song1,2,8, Michelle R Zeidler2,9, Karen Josephson1, Michael N Mitchell1, Stella Jouldjian1, Jennifer L Martin1,2. 1. Geriatric Research, Education and Clinical Center (GRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA. 2. Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA. 3. Department of Psychology, Virginia Commonwealth University, Richmond, VA. 4. Department of Psychiatry, University of California, San Diego, San Diego, CA. 5. Department of Medicine, University of California, San Diego, San Diego, CA. 6. VA San Diego Healthcare System, San Diego, CA. 7. Department of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile. 8. School of Nursing, University of California Los Angeles, Los Angeles, CA. 9. Pulmonary, Critical Care and Sleep Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA.
Abstract
STUDY OBJECTIVES:Cognitive behavioral therapy for insomnia (CBTI) for comorbid insomnia and obstructive sleep apnea (OSA) has had mixed results. We integrated CBTI with a positive airway pressure (PAP) adherence program and tested effects on sleep and PAP use. METHODS:125 veterans (mean age 63.2, 96% men, 39% non-Hispanic white, 26% black/African American, 18% Hispanic/Latino) with comorbid insomnia and newly-diagnosed OSA (apnea-hypopnea index ≥ 15) were randomized to 5-weekly sessions integrating CBTI with a PAP adherence program provided by a "sleep coach" (with behavioral sleep medicine supervision), or 5-weekly sleep education control sessions. Participants and assessment staff were blinded to group assignment. Outcomes (baseline, 3 and 6 months) included Pittsburgh Sleep Quality Index (PSQI), 7-day sleep diary (sleep onset latency [SOL-D], wake after sleep onset [WASO-D], sleep efficiency [SE-D]), 7-day actigraphy (SE-A), and objective PAP use (hours/night and nights ≥ 4 h). Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and Functional Outcomes of Sleep Questionnaire-10 (FOSQ-10) were also collected. RESULTS: Compared to controls, intervention participants showed greater improvement (baseline to 3 and 6 months, respectively) in PSQI (-3.2 and -1.7), SOL-D (-16.2 and -15.5 minutes), SE-D (10.5% and 8.5%), SE-A (4.4% and 2.6%) and more 90-day PAP use (1.3 and 0.9 more hours/night, 17.4 and 11.3 more nights PAP ≥ 4 h). 90-day PAP use at 3 months was 3.2 and 1.9 h/night in intervention versus controls. Intervention participants also had greater improvements in ISI, ESS, and FOSQ-10 (all p < 0.05). CONCLUSIONS: An intervention integrating CBTI with a PAP adherence program delivered by a supervised sleep coach improved sleep and PAP use in adults with comorbid insomnia and OSA. TRIAL REGISTRATION: ClinicalTrials.govStudy name: Novel Treatment of Comorbid Insomnia and Sleep Apnea in Older VeteransURL: https://clinicaltrials.gov/ct2/results?cond=&term=NCT02027558&cntry=&state=&city=&dist=Registration: NCT02027558. Published by Oxford University Press on behalf of Sleep Research Society (SRS) 2020.
RCT Entities:
STUDY OBJECTIVES: Cognitive behavioral therapy for insomnia (CBTI) for comorbid insomnia and obstructive sleep apnea (OSA) has had mixed results. We integrated CBTI with a positive airway pressure (PAP) adherence program and tested effects on sleep and PAP use. METHODS: 125 veterans (mean age 63.2, 96% men, 39% non-Hispanic white, 26% black/African American, 18% Hispanic/Latino) with comorbid insomnia and newly-diagnosed OSA (apnea-hypopnea index ≥ 15) were randomized to 5-weekly sessions integrating CBTI with a PAP adherence program provided by a "sleep coach" (with behavioral sleep medicine supervision), or 5-weekly sleep education control sessions. Participants and assessment staff were blinded to group assignment. Outcomes (baseline, 3 and 6 months) included Pittsburgh Sleep Quality Index (PSQI), 7-day sleep diary (sleep onset latency [SOL-D], wake after sleep onset [WASO-D], sleep efficiency [SE-D]), 7-day actigraphy (SE-A), and objective PAP use (hours/night and nights ≥ 4 h). Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and Functional Outcomes of Sleep Questionnaire-10 (FOSQ-10) were also collected. RESULTS: Compared to controls, intervention participants showed greater improvement (baseline to 3 and 6 months, respectively) in PSQI (-3.2 and -1.7), SOL-D (-16.2 and -15.5 minutes), SE-D (10.5% and 8.5%), SE-A (4.4% and 2.6%) and more 90-day PAP use (1.3 and 0.9 more hours/night, 17.4 and 11.3 more nights PAP ≥ 4 h). 90-day PAP use at 3 months was 3.2 and 1.9 h/night in intervention versus controls. Intervention participants also had greater improvements in ISI, ESS, and FOSQ-10 (all p < 0.05). CONCLUSIONS: An intervention integrating CBTI with a PAP adherence program delivered by a supervised sleep coach improved sleep and PAP use in adults with comorbid insomnia and OSA. TRIAL REGISTRATION: ClinicalTrials.govStudy name: Novel Treatment of Comorbid Insomnia and Sleep Apnea in Older VeteransURL: https://clinicaltrials.gov/ct2/results?cond=&term=NCT02027558&cntry=&state=&city=&dist=Registration: NCT02027558. Published by Oxford University Press on behalf of Sleep Research Society (SRS) 2020.
Authors: Susheel P Patil; Indu A Ayappa; Sean M Caples; R Joh Kimoff; Sanjay R Patel; Christopher G Harrod Journal: J Clin Sleep Med Date: 2019-02-15 Impact factor: 4.062
Authors: Francisco Campos-Rodriguez; Nicolas Peña-Griñan; Nuria Reyes-Nuñez; Ines De la Cruz-Moron; Jose Perez-Ronchel; Francisco De la Vega-Gallardo; Ana Fernandez-Palacin Journal: Chest Date: 2005-08 Impact factor: 9.410
Authors: Terri E Weaver; Greg Maislin; David F Dinges; Thomas Bloxham; Charles F P George; Harly Greenberg; Gihan Kader; Mark Mahowald; Joel Younger; Allan I Pack Journal: Sleep Date: 2007-06 Impact factor: 5.849
Authors: Camille P Vaughan; Alayne D Markland; Alison J Huang; Cathy A Alessi; Andrew Guzman; Jennifer L Martin; Donald L Bliwise; Theodore M Johnson Ii; Kathryn L Burgio; Constance H Fung Journal: Age Ageing Date: 2022-02-02 Impact factor: 10.668
Authors: Alice Y Tu; Megan R Crawford; Spencer C Dawson; Louis F Fogg; Arlener D Turner; James K Wyatt; Maria I Crisostomo; Bantu S Chhangani; Clete A Kushida; Jack D Edinger; Sabra M Abbott; Roneil G Malkani; Hrayr P Attarian; Phyllis C Zee; Jason C Ong Journal: J Clin Sleep Med Date: 2022-03-01 Impact factor: 4.062
Authors: Alexander Sweetman; Bastien Lechat; Peter G Catcheside; Simon Smith; Nick A Antic; Amanda O'Grady; Nicola Dunn; R Doug McEvoy; Leon Lack Journal: Front Psychol Date: 2021-05-04
Authors: Kelly Glazer Baron; Allyson Gilles; Krishna M Sundar; Brian R W Baucom; Kevin Duff; Wendy Troxel Journal: Pilot Feasibility Stud Date: 2022-08-06