0407 Randomized Controlled Trial of an Integrated Behavioral Treatment in Veterans with Obstructive Sleep Apnea and Coexisting Insomnia

Abstract

Introduction: Insomnia disorder commonly occurs with obstructive sleep apnea (OSA), and may predict lower positive airway pressure (PAP) adherence. We tested a behavioral treatment integrating behavioral insomnia therapy with a PAP adherence program, in a 4‐year randomized controlled trial among veterans with both disorders, to determine effects on sleep and objective PAP adherence. Methods: 125 veterans aged ≥ 50 (mean 63 years, 96% male, 42% non‐Hispanic white), with OSA (apnea‐hypopnea index ≥ 15) and insomnia (ICSD3 criteria) were randomized to 5 sessions of intervention (behavioral insomnia therapy integrated with a PAP adherence program, provided by nonclinicians supervised by behavioral sleep medicine specialists) or control (general sleep education). Outcomes (baseline, 3 and 6 months) included sleep onset latency (SOL‐d), wake after sleep onset (WASO‐d) and sleep efficiency (SE‐d) by sleep diary; Pittsburgh Sleep Quality Index (PSQI); sleep efficiency by 7‐day actigraphy (SE‐a); and modem mean hours PAP use/night (PAPhrs) and number of nights used ≥ 4hrs (PAPnts), over the last 90 days. Analyses were intent‐to‐treat; mixed models with random intercepts (sleep) or t‐tests (PAP adherence). Results: Intervention participants had greater improvement than controls, between baseline and 3‐months, and between baseline and 6‐months, in SOL‐d (17 and 16 min greater improvement at 3 and 6 months, respectively), SE‐d (10.7% and 8.6%), SE‐a (4.3% and 2.7%), and PSQI (3.2 and 1.7); all p