Randomized controlled trial of an integrated approach to treating insomnia and improving the use of positive airway pressure therapy in veterans with comorbid insomnia disorder and obstructive sleep apnea
| Autor: | Stella Jouldjian, Constance H. Fung, Yeonsu Song, Juan Carlos Rodriguez Tapia, Michael N. Mitchell, Michelle Zeidler, Karen R. Josephson, Lavinia Fiorentino, Cathy A. Alessi, Jennifer L. Martin, Carl Stepnowsky, Joseph M. Dzierzewski |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Polysomnography Cognitive behavioral therapy for insomnia Sleep medicine Pittsburgh Sleep Quality Index 03 medical and health sciences 0302 clinical medicine Physiology (medical) Sleep Initiation and Maintenance Disorders Positive airway pressure medicine Humans Aged Veterans Sleep Apnea Obstructive Continuous Positive Airway Pressure business.industry Sleep apnea Middle Aged medicine.disease Obstructive sleep apnea Treatment Outcome 030228 respiratory system Insomnia and Psychiatric Disorders Physical therapy Sleep diary Female Neurology (clinical) Sleep onset latency business 030217 neurology & neurosurgery |
| Zdroj: | Sleep |
| ISSN: | 1550-9109 |
| Popis: | Study ObjectivesCognitive behavioral therapy for insomnia (CBTI) for comorbid insomnia and obstructive sleep apnea (OSA) has had mixed results. We integrated CBTI with a positive airway pressure (PAP) adherence program and tested effects on sleep and PAP use.Methods125 veterans (mean age 63.2, 96% men, 39% non-Hispanic white, 26% black/African American, 18% Hispanic/Latino) with comorbid insomnia and newly-diagnosed OSA (apnea-hypopnea index ≥ 15) were randomized to 5-weekly sessions integrating CBTI with a PAP adherence program provided by a “sleep coach” (with behavioral sleep medicine supervision), or 5-weekly sleep education control sessions. Participants and assessment staff were blinded to group assignment. Outcomes (baseline, 3 and 6 months) included Pittsburgh Sleep Quality Index (PSQI), 7-day sleep diary (sleep onset latency [SOL-D], wake after sleep onset [WASO-D], sleep efficiency [SE-D]), 7-day actigraphy (SE-A), and objective PAP use (hours/night and nights ≥ 4 h). Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and Functional Outcomes of Sleep Questionnaire-10 (FOSQ-10) were also collected.ResultsCompared to controls, intervention participants showed greater improvement (baseline to 3 and 6 months, respectively) in PSQI (−3.2 and −1.7), SOL-D (−16.2 and −15.5 minutes), SE-D (10.5% and 8.5%), SE-A (4.4% and 2.6%) and more 90-day PAP use (1.3 and 0.9 more hours/night, 17.4 and 11.3 more nights PAP ≥ 4 h). 90-day PAP use at 3 months was 3.2 and 1.9 h/night in intervention versus controls. Intervention participants also had greater improvements in ISI, ESS, and FOSQ-10 (all p < 0.05).ConclusionsAn intervention integrating CBTI with a PAP adherence program delivered by a supervised sleep coach improved sleep and PAP use in adults with comorbid insomnia and OSA.Trial RegistrationClinicalTrials.govStudy name: Novel Treatment of Comorbid Insomnia and Sleep Apnea in Older VeteransURL: https://clinicaltrials.gov/ct2/results?cond=&term=NCT02027558&cntry=&state=&city=&dist=Registration: NCT02027558 |
| Databáze: | OpenAIRE |
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