The overall goal of this project is to determine the efficacy of a multidisciplinary treatment model for patients with Obstructive Sleep Apnea (OSA) and comorbid Insomnia. Specific Aim 1: To determine the efficacy of a treatment model combining Cognitive Behavioral Therapy (CBT) and Continued Positive Airway Pressure(CPAP) for individuals with OSA and comorbid insomnia. Specific Aim 2: To determine if there are relative benefits in the sequence of treatment initiation. Specific Aim 3: To examine the mechanisms between insomnia symptoms and CPAP adherence.
OSA is a sleep-related breathing disorder that is growing in prevalence and is associated with negative cardiovascular consequences and adverse events from excessive daytime sleepiness. Insomnia is a frequently co-occurring sleep disorder that adds significant morbidity and is a potential barrier to adherence of OSA treatment. It is currently unknown if direct treatment of insomnia will enhance outcomes of OSA treatment. The investigators at the Rush Sleep Disorders Center have developed an approach that combines CBT for insomnia delivered by a psychologist with CPAP therapy managed by a physician. Building upon preliminary data collected in the clinic, the investigators seek to test the efficacy and mechanisms of this multidisciplinary model against the standard practice of treating OSA using CPAP alone.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
121
Cognitive Behavior Therapy for Insomnia (CBT-I) consists of 4 weekly sessions delivered individually. The focus of these sessions is on modifying behaviors and cognitions related to sleep and insomnia.
CPAP is an FDA-approved medical device used to treat obstructive sleep apnea. This device consists of a mask, hose, and machine that blows continuous air which maintains a consistent pressure of airflow preventing the upper airway from collapsing during sleep.
Center for Circadian and Sleep Medicine, Northwestern University
Chicago, Illinois, United States
CPAP adherence
CPAP adherence is defined as % nights used and hrs per night and % of "good users" (≥ 4 hours on ≥ 70% of nights)
Time frame: 90 days after CPAP initiation
Pittsburgh Sleep Quality Index (PSQI)
Improvements in sleep quality is defined as change of PSQI score from baseline to 90 days after CPAP initiation.
Time frame: 90 days after CPAP initiation
Polysomnography (PSG)
Improvement in PSG sleep efficiency at the end of Phase I
Time frame: End of phase 1 (1 month after baseline assessment)
Insomnia Severity Index (ISI)
Improvement in ISI from baseline to 90 days after CPAP initiation
Time frame: 90 days after CPAP initiation
Functional Outcomes of Sleep Questionnaire (FOSQ)
Improvement in FOSQ from baseline to 90 days after CPAP initiation
Time frame: 90 days after CPAP initiation
Actigraphy
Improvement in sleep as measured by actigraphy from baseline to 90 days after CPAP initiation.
Time frame: 90 days after CPAP initiation
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