Integrated CBTI and PAP Adherence Program Improves Sleep and PAP Use in Veterans with Comorbid Insomnia and OSA

Introduction

Insomnia and obstructive sleep apnea (OSA) often coexist, particularly among older adults and US veterans, leading to worse health outcomes. This study aimed to evaluate the effectiveness of an integrated treatment approach addressing both conditions early in the course of OSA diagnosis and treatment.

Methods

Participants were randomized to either the intervention group, receiving a 5-session program combining CBTI with PAP adherence strategies, or a control group. The intervention was delivered by a sleep coach with weekly telephone supervision by a behavioral sleep medicine specialist.

Results

At 3 months, the intervention group showed significant improvements in sleep quality, sleep onset latency, wake after sleep onset, and sleep efficiency compared to controls. PAP use was also significantly greater in the intervention group, with improvements maintained at 6 months.

Discussion

The study highlights the potential of an integrated approach to improve both sleep and PAP adherence in patients with comorbid insomnia and OSA. The intervention's structured format and use of supervised sleep coaches may facilitate its implementation in various clinical settings, offering a promising option for managing these coexisting conditions.

Conclusion

This integrated treatment approach significantly improves sleep outcomes and PAP use among veterans with comorbid insomnia and OSA, with benefits sustained for up to 6 months. The findings suggest that addressing insomnia at the initiation of PAP treatment can enhance treatment success and adherence.