Evaluating the treatment of obstructive sleep apnea comorbid with insomnia disorder using an incomplete factorial design

Megan R. Crawford, Arlener D. Turner, James K. Wyatt, Louis F. Fogg, Jason C. Ong

Research output: Contribution to journalArticlepeer-review

24 Citations (Scopus)


Chronic insomnia disorder is a prevalent condition and a significant proportion of these individuals also have obstructive sleep apnea (OSA). These two sleep disorders have distinct pathophysiology and are managed with different treatment approaches. High comorbidity rates have been a catalyst for emerging studies examining multidisciplinary treatment for OSA comorbid with insomnia disorder. In this article, we describe a randomized clinical trial of cognitive behavioral treatment for insomnia (CBT-I) and positive airway pressure (PAP) for OSA. Participants are randomized to receive one of three treatment combinations. Individuals randomized to treatment Arm A receive sequential treatment beginning with CBT-I followed by PAP, in treatment Arm B CBT-I and PAP are administered concurrently. These treatment arms are compared to a control condition, treatment Arm C, where individuals receive PAP alone. Adopting an incomplete factorial study design will allow us to evaluate the efficacy of multidisciplinary treatment (Arms A & B) versus standard treatment alone (Arm C). In addition, the random allocation of individuals to the two different combined treatment sequences (Arm A and Arm B) will allow us to understand the benefits of the sequential administration of CBT-I and PAP relative to concurrent treatment of PAP and CBT-I. These findings will provide evidence of the clinical benefits of treating insomnia disorder in the context of OSA.

Original languageEnglish
Pages (from-to)146-152
Number of pages7
JournalContemporary Clinical Trials
Early online date28 Dec 2015
Publication statusPublished - 31 Mar 2016


  • incomplete factorial design
  • insomnia disorder
  • obstructive sleep apnea
  • randomized clinical trial


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