Abstract
This study examines the impact of cognitive-behavioral therapy for insomnia (CBT-I) and positive airway pressure (PAP) therapy for comorbid insomnia and sleep apnea (COMISA) on nocturnal sleep and daytime functioning. A partial factorial design was used to examine treatment pathways with CBT-I and PAP and the relative benefits of each treatment. 118 individuals with COMISA were randomized to receive CBT-I followed by PAP, self-monitoring followed by CBT-I concurrent with PAP, or self-monitoring followed by PAP only. Participants were assessed at baseline, PAP titration, and 30- and 90-days after PAP initiation. Outcome measures included sleep diary- and actigraphy-measured sleep, Flinders Fatigue Scale(FFS), Epworth Sleepiness Scale(ESS), Functional Outcome of Sleep Questionnaire(FOSQ), and cognitive-emotional measures. A main effect of time was found on diary-measured sleep parameter (decreased sleep onset latency[SOL] and wake after sleep onset[WASO]; increased total sleep time[TST] and sleep efficiency[SE]) and actigraphy-measured sleep parameter (decreased WASO; increased SE) and daytime functioning (reduced ESS, FFS; increased FOSQ) across all arms (all p< 0.05). Significant interactions and planned contrast comparisons revealed that CBT-I was superior to PAP and self-monitoring on reducing diary-measured SOL and WASO and increasing SE; as well as improving FOSQ and FFS compared to self-monitoring. Improvements in sleep and daytime functioning were found with PAP alone or concomitant with CBT-I. However, more rapid effects were observed on subjective sleep and daytime performance when receiving CBT-I regardless of when it was initiated. Therefore, concomitant treatment appears to be a favorable approach to accelerate treatment outcomes. Registry: ClinicalTtrials.gov; Identifier: NCT01785303.
Original language | English |
---|---|
Pages (from-to) | 789-800 |
Number of pages | 12 |
Journal | Journal of Clinical Sleep Medicine |
Volume | 18 |
Issue number | 3 |
Early online date | 15 Oct 2021 |
DOIs | |
Publication status | Published - 1 Mar 2022 |
Keywords
- clinical neurology
- neurology
- pulmonary and respiratory medicine
- comorbid insomnia
- sleep apnea
- cognitive behavior therapy
- CBT
- positive airway pressure therapy
- sleep
- daytime functioning