Cited by 101Obstructive Sleep Apnea ResearchSleep and related disordersSleep and Wakefulness Research

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Prospective Randomized Study of Patients with Insomnia and Mild Sleep Disordered Breathing

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Guilleminault, Christian, Davis, Kala, Huynh, Nelly T.·2008·SLEEP

DOI 10.1093/sleep/31.11.1527PMC PMC2579981

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Abstract

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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Authors: Guilleminault, C., Davis, K., & Huynh, N. T.
Affiliations: Stanford Medicine (US)
Corresponding author: Guilleminault, Christian
ORCID: Guilleminault, Christian
Huynh, Nelly T.
Venue: SLEEP
Publisher: Oxford University Press (OUP)
Published: 2008-11
Volume: 31
Issue: 11
Pages: 1527-1533
ISSN: 0161-8105 (ISSN-L)
1550-9109
DOI: 10.1093/sleep/31.11.1527
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 (medical) › 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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Prospective Randomized Study of Patients with Insomnia and Mild Sleep Disordered Breathing

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