AUTHOR=Sweetman Alexander , Reynolds Chelsea , Lack Leon , Vakulin Andrew , Chai-Coetzer Ching Li , Wallace Douglas M. , Crawford Megan , Richardson Cele 

TITLE=Effect of high-risk sleep apnea on treatment-response to a tailored digital cognitive behavioral therapy for insomnia program: a quasi-experimental trial

JOURNAL=Frontiers in Sleep

VOLUME=3

YEAR=2024

URL=https://www.frontiersin.org/journals/sleep/articles/10.3389/frsle.2024.1355468

DOI=10.3389/frsle.2024.1355468

ISSN=2813-2890

ABSTRACT=<sec><title>Introduction</title><p>Therapist-delivered Cognitive Behavioral Therapy for Insomnia (CBTi) is an effective but largely inaccessible treatment for people with Co-Morbid Insomnia and Sleep Apnea (COMISA). To increase CBTi access for COMISA, we aimed to develop a self-guided interactive 5-session digital CBTi program that is appropriate for people with insomnia-alone and COMISA, and compare its effectiveness between people with insomnia-alone, vs. comorbid insomnia and high-risk sleep apnea.</p></sec><sec><title>Methods</title><p>Data from 62 adults with insomnia symptoms were used. High-risk sleep apnea was defined as a score of ≥5 on the OSA50. Participants self-reported symptoms of insomnia (ISI), depression, anxiety, sleepiness (ESS), fatigue, and maladaptive sleep-related beliefs (DBAS-16) at baseline, 8-week, and 16-week follow-up. ESS scores were additionally assessed during each CBTi session. Intent-to-treat mixed models and complete-case chi<sup>2</sup> analyses were used.</p></sec><sec><title>Results</title><p>There were more participants with insomnia-alone [<italic>n</italic> = 43, age <italic>M</italic> (sd) = 51.8 (17.0), 86.1% female] than suspected COMISA [<italic>n</italic> = 19, age = 54.0 (14.8), 73.7% female]. There were no between-group differences in baseline questionnaire data, or rates of missing follow-up data. There were no significant group by time interactions on any outcomes. Main effects of time indicated moderate-to-large and sustained improvements in insomnia (<italic>d</italic> = 3.3), depression (<italic>d</italic> = 1.2), anxiety (<italic>d</italic> = 0.6), ESS (<italic>d</italic> = 0.5), fatigue (<italic>d</italic> = 1.2), and DBAS-16 symptoms (<italic>d</italic> = 1.2) at 16-weeks. ESS scores did not increase significantly during any CBTi session.</p></sec><sec><title>Conclusion</title><p>This interactive digital CBTi program is effective in people with insomnia-alone, and people with co-morbid insomnia and high-risk sleep apnea. Further research is required to determine the effectiveness, safety and acceptability of digital CBTi in people with insomnia and confirmed sleep apnea.</p></sec><sec><title>Clinical Trial Registration</title><p>This trial was prospectively registered on the Australian and New Zealand Clinical Trials Registry (ANZCTR, ACTRN12621001395820).</p></sec>