0340 EFFECTIVENESS OF COGNITIVE BEHAVIORAL THERAPY FOR INSOMNIA IN PATIENTS WITH COMORBID OBSTRUCTIVE SLEEP APNEA

Abstract

Introduction: Co-morbid insomnia and Obstructive Sleep Apnea (OSA) is a prevalent and debilitating condition. The most recommended treatment for these co-morbid patients includes initial treatment with Cognitive Behavioral Therapy for Insomnia (CBTi), before managing the OSA with positive airway pressure (PAP) therapy. CBTi is an effective treatment for patients with insomnia, however less is known about its effectiveness in patients with co-morbid OSA. This randomized controlled trial compared the effectiveness of CBTi to a no-treatment control condition in patients with co-morbid insomnia and OSA. Methods: Participants included 77 adults (72% Male) with specialist diagnoses of both insomnia (ICSD-2) and OSA (AHI≥15). Participants were randomly allocated to either 4-weekly 45-minute sessions of CBTi or a no-treatment control condition. Insomnia symptoms including subjective sleep parameters, global insomnia severity, dysfunctional cognitions, anxiety, stress, and daytime impairments, were assessed at pre- and post-treatment with sleep diaries, and self-report questionnaires. Results: Among patients in the CBTi condition, significant changes were observed in subjective sleep onset latency (23 minute decrease), wake after sleep onset (46 minute decrease), sleep efficiency (16 percent increase), and Insomnia Severity Index (ISI; 6 points improvement) scores from pre- to post-treatment (all p≤.05). These improvements were significantly greater than those observed in the control condition (all p≤.05). Furthermore, CBTi was associated with significantly greater improvements in daytime symptoms including fatigue, dysfunctional beliefs and attitudes about sleep, and stress, compared to the control condition. Following CBTi, a significantly greater number of participants were categorised as 'improved', according to post-treatment ISI < 7, compared to participants in the control condition (CBTi = 19.5%; Control = 2.8%, p = .032, phi=.26). Conclusion: CBTi is an effective treatment for insomnia in the presence of co-morbid OSA. Clinicians should consider initial treatment with CBTi to treat insomnia symptoms, in patients with co-morbid insomnia and sleep apnea. Furthermore, future research should also trial CBTi with this co-morbid population before beginning PAP therapy.