Prospective randomized study of patients with insomnia and mild sleep disordered breathing
Open accessAbstract
BACKGROUND: Patients with insomnia may present with mild and often unrecognized obstructive sleep apnea (OSA). OBJECTIVE: To evaluate both subjective and objective outcomes of patients with complaints of insomnia and mild OSA who receive surgical treatment for OSA versus behavioral treatment with cognitive behavioral therapy for insomnia (CBT-I). METHODS: Prospective study with crossover design of 30 patients with complaints of insomnia and mild OSA. Thirty subjects, matched for age and gender, were randomized with stratification to receive either CBT-I or surgical treatment of OSA as primary treatment. Patients were reassessed after completing the initial intervention and reassigned if agreeable to the alternative treatment option and assessed again on completion of both treatment arms. Outcome measures included clinical impression, Epworth Sleepiness Scale (ESS) score, Fatigue Severity Scale (FSS) score, and polysomnography (PSG) results. RESULTS: Surgery resulted in greater improvements in total sleep time (TST), slow wave sleep and REM sleep duration, respiratory disturbance index, apnea-hypopnea index, minimum oxygen saturation, FSS, and ESS. CBT-I also improved TST and resulted in shorter sleep latency. CONCLUSION: Surgical intervention for the management of patients with complaints of insomnia and mild OSA demonstrated greater improvement in both subjective and objective outcome measures. Initial treatment of underlying OSA in patients with insomnia was more successful in improving insomnia than CBT-I alone. However CBT-I as initial treatment improved TST compared to baseline; following surgical intervention, it had the additional benefit of further increasing TST and helped to control sleep onset difficulties that may be related to conditioning due to unrecognized symptoms of mild OSA.
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Although several early pilot studies and a randomized controlled trial reported mixed findings, more recent quasi-experimental and RCT data support the effectiveness of CBTi in COMISA patients.
“Although several early pilot studies and a randomized controlled trial (RCT) reported mixed findings [69,75,76,77], more recent quasi-experimental and RCT data support the effectiveness of CBTi in COMISA patients [52,64,78,79].”
From Co-morbid insomnia and sleep apnea (COMISA): Prevalence, consequences, methodological considerations, and recent randomized controlled trials (2019) · cites this paper as [77]
Upper airway surgery significantly improved sleep parameters, sleep architecture, AHI, and daytime functioning in 30 patients with co-morbid insomnia and mild OSA.
“Guilleminault and colleagues [77] reported that upper airway surgery significantly improved sleep parameters, sleep architecture, AHI, and daytime functioning in 30 patients with co-morbid insomnia and mild OSA.”
From Co-morbid insomnia and sleep apnea (COMISA): Prevalence, consequences, methodological considerations, and recent randomized controlled trials (2019) · cites this paper as [77]
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Overview of Medication Treatment for Co-Morbid Insomnia and Sleep Apnea (COMISA)
Lowe, A. D., & Lowe, M. S. (2022) · Springer eBooks · doi:10.1007/978-3-030-93146-9_18 · Cited by 3 · see citing works
García‐Sierra, R., Feijoo-Cid, M., Font, R., Varoucha-Azcarate, A. C., Bernal-Balada, R., Parra, M. L., Saez, I. C., & Pérez-Bernal, M. (2015) · Enfermería Clínica · doi:10.1016/j.enfcli.2015.04.001 · Cited by 3 · see citing works
Strategies to Enhance Adherence to PAP Therapy for OSA
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Psicoeducación en el síndrome de apnea-hipopnea obstructiva del sueño (SAHOS)
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Relationship between obstructive sleep apnea and morning headache
Sadeghniiat‐Haghighi, K., Yazdi, Z., & Firoozeh, M. (2011) · The Journal of Qazvin University of Medical Sciences · Cited by 2 · see citing works
Sleep Disorders Documented by Night Polysomnography in Patients with Chronic Insomnia Disorder
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New definition, diagnostic criteria, and diagnostic workflows for patients with suspected COMISA
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Schlafbruxismus und schlafbezogene Atmungsstörungen
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Insomnie et syndrome d’apnée obstructive du sommeil : une liaison dangereuse
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- Authors
- Guilleminault, C., Davis, K., & Huynh, N. T.
- Affiliations
- Stanford Medicine (US)
- Corresponding author
- Guilleminault, Christian
- Venue
- SLEEP
- Publisher
- Oxford University Press (OUP)
- Published
- 2008-11
- Volume
- 31
- Issue
- 11
- Pages
- 1527-1533
- ISSN
- 0161-8105 (ISSN-L)
- 1550-9109
- PMC
- PMC2579981
- OpenAlex
- W172918800
- Cited by
- 100
- References
- 22
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 1 · 2023: 4 · 2022: 6 · 2021: 6 · 2020: 2 · 2019: 8 · 2018: 7 · 2017: 6 · 2016: 3 · 2015: 8 · 2014: 8 · 2013: 12 · 2012: 7
- FWCI
- 3.39
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- SLEEP (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
- Keywords
- insomnia, mild obstructive sleep apnea, cognitive behavioral therapy for insomnia, sleep apnea surgery, crossover design, total sleep time, sleep latency, daytime sleepiness, fatigue, polysomnography outcomes, Epworth Sleepiness Scale, Fatigue Severity Scale
- MeSH terms
- Adult, Fatigue, Female, Humans, Disorders of Excessive Somnolence, Sleep Initiation and Maintenance Disorders, Male, Prospective Studies, Severity of Illness Index, Sleep Apnea Syndromes, Sleep Stages, Cognitive Behavioral Therapy, Polysomnography, Cross-Over Studies, Sleep Apnea, Obstructive
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