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https://hdl.handle.net/2440/132111
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Type: | Journal article |
Title: | 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 |
Author: | Sweetman, A. Lack, L. Catcheside, P.G. Antic, N.A. Smith, S. Chai-Coetzer, C.L. Douglas, J. O'grady, A. Dunn, N. Robinson, J. Paul, D. Williamson, P. McEvoy, R.D. |
Citation: | Sleep, 2019; 42(12):1-12 |
Publisher: | Oxford University Press |
Issue Date: | 2019 |
ISSN: | 0161-8105 1550-9109 |
Statement of Responsibility: | Alexander Sweetman, , Leon Lack, Peter G. Catcheside, Nick A. Antic, Simon Smith, Ching Li Chai-Coetzer ... et al. |
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. |
Keywords: | COMISA adherence cognitive and behavioral therapy for insomnia comorbid insomnia continuous positive airway pressure therapy insomnia obstructive sleep apnea |
Rights: | © Sleep Research Society 2019. Published by Oxford University Press on behalf of the Sleep Research Society. |
DOI: | 10.1093/sleep/zsz178 |
Grant ID: | http://purl.org/au-research/grants/arc/FT120100510 http://purl.org/au-research/grants/arc/FT120100510 |
Published version: | http://dx.doi.org/10.1093/sleep/zsz178 |
Appears in Collections: | Psychology publications |
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