0379 A Randomized Controlled Trial Of CBT-I and CPAP For Comorbid Insomnia and OSA: Initial Findings from the MATRICS Study

Abstract

Introduction: The purpose of this study was to compare the efficacy of three treatment sequences using CPAP with or without CBT‐I for the treatment of comorbid insomnia and obstructive sleep apnea (COMISA). Methods: One‐hundred and twenty‐one adults (52.50% female, mean age=50.00) with COMISA were randomized to receive one of three treatment models using a partial factorial design: CBT‐I followed by CPAP (Model A), CBT‐I concurrent with CPAP (Model B), and CPAP only (Model C). CPAP was delivered following standard procedures for in‐lab CPAP titration and home set‐up with a third‐party vendor. CBT‐I was delivered in four individual sessions. Primary outcomes were CPAP adherence across the first 90 days of use and global measures of insomnia (Insomnia Severity Index; ISI) and sleep quality (Pittsburgh Sleep Quality Index; PSQI). Planned comparisons were conducted on those who received CBT‐I+CPAP (Models A and B combined) versus CPAP only (Model C) using Wilcoxon signed ranks test and linear mixed models. Results: No significant differences were found between the CPAP+CBT‐I groups versus the CPAP only group on percent of nights used (Median=48.65% vs Median=71.10%, p=.29), minutes used per night (Median=232.87 vs Median=186.06, p=.21) or percentage of participants who were regular CPAP users (≥4 hours on ≥70% of nights during 30‐day period; 37.50% vs 36.59%, p=.92). For mild OSA (AHI≥5 and <15), the CPAP+CBT‐I groups used CPAP on a greater percentage of nights compared to the CPAP only group (Median=30.00% vs Median=5.00%), which approached significance (p=.05). A significant main effect was found for improvement in the ISI (p