Sleep

Screen and treat OSA patients for insomnia before starting CPAP


People with obstructive sleep apnoea should be evaluated for co-occurring insomnia and considered for cognitive and behavioural therapy before starting CPAP therapy, Australian sleep physicians have advised.

Professor Doug McEvoy and co-researchers from the Adelaide Institute for Sleep Health at Flinders University, South Australia, have shown that  in people with co-occurring OSA and insomnia the use of cognitive and behavioural therapy for insomnia  prior to CPAP treatment improved CPAP use and insomnia symptoms compared to when CPAP was started without CBT.

In their study, 145 participants with OSA (apnea-hypopnea index ≥ 15) and co-morbid insomnia were randomised to either four sessions of CBT, or treatment as usual, before starting CPAP therapy.

After six months, participants who received CBT had an average of 60 minutes additional adherence per night to CPAP compared to non-CBT users. They also had higher initial CPAP treatment acceptance (99 vs 89%).

The CBT group showed greater improvement of global insomnia severity (52% vs 35%) and night-time insomnia complaints (48% vs 34%)as well as improvement in dysfunctional sleep-related cognitions (30% vs 10%) and greater improvement in sleep impairment measures immediately following CBT-i.

However, while more time spent using CPAP led to greater improvement in secondary manifestations of OSA such as sleepiness and quality of life, the incremental improvements achieved with one extra hour of CPAP treatment did not translate into  better daytime impairments by six months.

“It is possible that these participants’ daytime symptoms were largely a manifestation of their OSA, and therefore showed little additional improvement as the insomnia was treated with CBT-i,” the researchers said

Professor McEvoy said that long-term cardio-metabolic benefits for patients with Co-Morbid Insomnia and Sleep Apnoea (COMISA) would be an important consideration, independent of the effect of CBT-I on other debilitating symptoms.

“This latest study suggests that sleep physicians and clinics should screen for insomnia symptoms and, if present, treat the insomnia with CBTi to improve subsequent acceptance and use of CPAP therapy. This will improve outcomes for both disorders,” he said.

The results are published in the journal Sleep.

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