Abstract
Insomnia and obstructive sleep apnoea (OSA) frequently co-occur and may be causally related through sleep fragmentation and/or hyperarousal mechanisms. Previous studies suggest that OSA treatment can improve insomnia severity. However, the effect of insomnia treatment on OSA severity has not been investigated. We performed a randomised controlled trial to investigate the effect of cognitive behavioural therapy for insomnia (CBTi) on OSA severity, controlling for potential sleep-stage and posture effects.
145 patients with comorbid insomnia (International Classification of Sleep Disorders, 3rd Edn) and untreated OSA (apnoea–hypopnoea index (AHI) ≥15 events·h−1 sleep) were randomised to a four-session CBTi programme or to a no-treatment control. Overnight sleep studies were completed pre- and post-treatment to measure AHI, arousal index and sleep architecture, to investigate the effect of intervention group, time, sleep stage (N1–3 or REM) and posture (supine or nonsupine) on OSA severity.
The CBTi group showed a 7.5 event·h−1 greater AHI difference (mean (95% CI) decrease 5.5 (1.3–9.7) events·h−1, Cohen's d=0.2, from 36.4 events·h−1 pre-treatment) across sleep-stages and postures, compared to control (mean increase 2.0 (−2.0–6.1) events·h−1, d=0.01, from 37.5 events·h−1 at pre-treatment; interaction p=0.012). Compared to control, the CBTi group also had a greater reduction in total number (mean difference 5.6 (0.6–10.6) greater overall reduction; p=0.029) and duration of nocturnal awakenings (mean difference 21.1 (2.0–40.3) min greater reduction; p=0.031) but showed no difference in the arousal index, or sleep architecture.
CBTi consolidates sleep periods and promotes a 15% decrease in OSA severity in patients with comorbid insomnia and OSA. This suggests that insomnia disorder may exacerbate OSA and provides further support for treating insomnia in the presence of comorbid OSA.
Abstract
Cognitive behavioural therapy for insomnia consolidates sleep periods and promotes a 15% decrease in obstructive sleep apnoea severity in patients with comorbid insomnia and sleep apnoea https://bit.ly/3e4iPgB
Footnotes
This study is registered at https://www.anzctr.org.au/ with identifier number 12613001178730. No data from this trial will be made publicly available due to exclusion from ethics approval and participant consent.
Conflict of interest: A. Sweetman reports grants from the National Health and Medical Research Council, and a Collaborative Research Centre (CRC) Consortium Grant between the Australian Government, academia and industry, during the conduct of the study.
Conflict of interest: L. Lack reports grants from National Health and Medical Research Council, during the conduct of the study; and grants and personal fees from Re-time Pty. Ltd. outside the submitted work.
Conflict of interest: R.D. McEvoy reports grants from the National Health and Medical Research Council during the conduct of the study.
Conflict of interest: S. Smith reports grants from the National Health and Medical Research Council during the conduct of the study.
Conflict of interest: C.L. Chai-Coetzer reports grants from National Health and Medical Research Council during the conduct of the study.
Conflict of interest: J. Douglas reports grants from National Health and Medical Research Council, during the conduct of the study.
Conflict of interest: A. O'Grady reports grants from the National Health and Medical Research Council during the conduct of the study.
Conflict of interest: N. Dunn reports grants from the National Health and Medical Research Council during the conduct of the study.
Conflict of interest: J. Robinson reports grants from the National Health and Medical Research Council during the conduct of the study.
Conflict of interest: D. Paul reports grants from the National Health and Medical Research Council during the conduct of the study, and personal fees from Philips Australia and New Zealand outside the submitted work.
Conflict of interest: D. Eckert reports grants from the National Health and Medical Research Council during the conduct of the study; grants and personal fees from Bayer and Apnimed, and a Collaborative Research Centre (CRC) Consortium Grant between the Australian Government, academia and industry (industry partner: Oventus Medical), outside the submitted work.
Conflict of interest: P.G. Catcheside reports grants from the National Health and Medical Research Council (NHMRC) during the conduct of the study; grants from the Australian Research Council, the Cooperative Research Centre (CRC) for Alertness, Safety and Productivity, and the NHMRC, equipment loan from Philips Respironics, and CPAP equipment provision from Air Liquide, outside the submitted work.
Support statement: This research was funded by a National Health and Medical Research Council grant (1049591; Treating insomnia comorbid with obstructive sleep apnoea: a randomised controlled clinical effectiveness trial). Funding information for this article has been deposited with the Crossref Funder Registry.
- Received April 1, 2020.
- Accepted April 3, 2020.
- Copyright ©ERS 2020
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