A randomized controlled trial of CBT-I and PAP for obstructive sleep apnea and comorbid insomnia: main outcomes from the MATRICS study
Open accessAbstract
Study Objectives: To investigate treatment models using cognitive behavioral therapy for insomnia (CBT-I) and positive airway pressure (PAP) for people with obstructive sleep apnea (OSA) and comorbid insomnia. Methods: 121 adults with OSA and comorbid insomnia were randomized to receive CBT-I followed by PAP, CBT-I concurrent with PAP, or PAP only. PAP was delivered following standard clinical procedures for in-lab titration and home setup and CBT-I was delivered in four individual sessions. The primary outcome measure was PAP adherence across the first 90 days, with regular PAP use (≥4 h on ≥70% of nights during a 30-day period) serving as the clinical endpoint. The secondary outcome measures were the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) with good sleeper (PSQI <5), remission (ISI <8), and response (ISI reduction from baseline >7) serving as the clinical endpoints. Results: No significant differences were found between the concomitant treatment arms and PAP only on PAP adherence measures, including the percentage of participants who met the clinical endpoint. Compared to PAP alone, the concomitant treatment arms reported a significantly greater reduction from baseline on the ISI (p = .0009) and had a greater percentage of participants who were good sleepers (p = .044) and remitters (p = .008). No significant differences were found between the sequential and concurrent treatment models on any outcome measure. Conclusions: The findings from this study indicate that combining CBT-I with PAP is superior to PAP alone on insomnia outcomes but does not significantly improve adherence to PAP.
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Two RCTs found no between-group differences in average CPAP use.
“Two RCTs found no between-group differences in average CPAP use.1188,1192”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [1188]
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- Authors
- Ong, J. C., Crawford, M. R., Dawson, S. C., Fogg, L. F., Turner, A. D., Wyatt, J. K., Crisostomo, M. I., Chhangani, B. S., Kushida, C. A., Edinger, J. D., Abbott, S. M., Malkani, R. G., Attarian, H. P., & Zee, P. C.
- Affiliations
- Northwestern University (US)
- University of Strathclyde (GB)
- Rush University Medical Center (US)
- New York University (US)
- Stanford Medicine (US)
- National Jewish Health (US)
- Corresponding author
- Ong, Jason C
- ORCID
- Venue
- Sleep
- Publisher
- Oxford University Press (OUP)
- Published
- 2020-03-14
- Volume
- 43
- Issue
- 9
- ISSN
- 0161-8105 (ISSN-L)
- 1550-9109
- PMC
- PMC7487869
- OpenAlex
- W3011555365
- Semantic Scholar
- 6dcea71a399e65fd358dfa21a492dfa93a0d3bba
- Cited by
- 74
- References
- 54
- Citations by year
- 2026: 9 · 2025: 11 · 2024: 9 · 2023: 13 · 2022: 17 · 2021: 12 · 2020: 3
- FWCI
- 6.77
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- SLEEP (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Strathprints: The University of Strathclyde institutional repository (University of Strathclyde) (submittedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01HL114529)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Health Professions › Complementary and Manual Therapy › Temporomandibular Joint Disorders
- Keywords
- cognitive behavioral therapy for insomnia, positive airway pressure, obstructive sleep apnea, comorbid insomnia, PAP adherence, insomnia severity, sleep quality, treatment remission
- MeSH terms
- Adult, Humans, Sleep Initiation and Maintenance Disorders, Cognitive Behavioral Therapy, Treatment Outcome, Outcome Assessment, Health Care, Sleep Apnea, Obstructive
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