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Cited by 47Sleep and related disordersObstructive Sleep Apnea ResearchAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Efficacy of cognitive behavioral therapy for insomnia in older adults with occult sleep-disordered breathing

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Fung, Constance H., Martin, Jennifer L., Josephson, Karen, Fiorentino, Lavinia, Dzierzewski, Joseph M., Jouldjian, Stella, Tapia, Juan Carlos Rodriguez, Mitchell, Michael N. +1 more·2016·Psychosomatic Medicine
DOI 10.1097/psy.0000000000000314PMC PMC4891271
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Abstract

Objectives: The aims of the study were to determine whether mild, occult sleep-disordered breathing (SDB) moderates the efficacy of cognitive behavioral therapy for insomnia (CBTI) in older adults and to explore whether CBTI reduces the number of patients eligible for positive airway pressure (PAP) therapy. Methods: Data were analyzed for 134 adults 60 years or older with insomnia and apnea-hypopnea index (AHI) of less than 15 who were randomized to a larger study of CBTI versus a sleep education control. Sleep outcomes (sleep onset latency, total wake time, wake after sleep onset, sleep efficiency, Pittsburgh Sleep Quality Index) were compared between CBTI and control at 6 months using repeated-measures analysis of variance adjusted for baseline values. AHI of 5 or greater versus less than 5 was included as an interaction term to evaluate changes in sleep outcomes. The number of participants at baseline and 6 months with mild SDB for whom insomnia was their only other indication for PAP was also compared between CBTI and control. Results: AHI status (AHI ≥ 5 [75.5% of participants] versus AHI < 5) did not moderate improvements in sleep associated with CBTI (all p values ≥ .12). Nine (45.0%) of 20 participants with mild SDB for whom insomnia was their only other indication for PAP therapy at baseline no longer had another indication for PAP at 6 months, with no significant difference between CBTI and control. Conclusions: CBTI improves sleep in older veterans with insomnia and untreated mild SDB. Larger trials are needed to assess whether CBTI reduces the number of patients with mild SDB eligible for PAP.

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  • Preliminary evidence suggests that CBT-i is an effective treatment for insomnia in the presence of comorbid OSA.

    “Preliminary evidence suggests that CBT-i is an effective treatment for insomnia in the presence of comorbid OSA [32,33].”

    From Cognitive and behavioral therapy for insomnia increases the use of continuous positive airway pressure therapy in obstructive sleep apnea participants with comorbid insomnia: A randomized clinical trial (2019) · cites this paper as [32]

    The Discussion reports that CBT-I improved sleep in older veterans with insomnia and untreated mild, occult sleep-disordered breathing. This supports preliminary efficacy in that group, but the claim extends it to comorbid OSA generally, without the study’s limits on severity and population. The indexed passages provide section labels but no page numbers. (LLM, conf=0.84)

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  • In participants receiving CBT-i, there was a large improvement in diary-measured sleep parameters, global insomnia severity, and dysfunctional sleep-related cognitions from baseline to 6 weeks.

    “As observed previously in other COMISA populations [32,33], we found a large improvement in diary-measured sleep parameters, global insomnia severity, and dysfunctional sleep-related cognitions from baseline to 6 weeks in participants receiving CBT-i.”

    From Cognitive and behavioral therapy for insomnia increases the use of continuous positive airway pressure therapy in obstructive sleep apnea participants with comorbid insomnia: A randomized clinical trial (2019) · cites this paper as [32]

    The Discussion reports substantial reductions in sleep-onset latency and improved sleep quality with CBT-I in participants with mild sleep-disordered breathing, supporting the general comparison with another COMISA population. The Results’ Primary Endpoints section reports outcomes at six months; the Secondary Endpoints section does not establish a large baseline-to-six-week improvement across the claimed measures. The paper does not report improvement in dysfunctional sleep-related cognitions. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • When delivered in a face-to-face setting, CBTi is an effective insomnia treatment in the presence of co-morbid OSA.

    “Alternatively, the recent RCTs [64,79,88] and previous studies [52,78] investigating therapist-delivered CBTi, indicate that when delivered in a face-to-face setting, CBTi is an effective insomnia treatment in the presence of co-morbid OSA.”

    From Co-morbid insomnia and sleep apnea (COMISA): Prevalence, consequences, methodological considerations, and recent randomized controlled trials (2019) · cites this paper as [78]

    The Methods describe individual or group CBTI delivered by health educators, and the Discussion reports improved sleep onset latency and sleep quality among participants with mild, occult sleep-disordered breathing. The claim extends that finding to co-morbid OSA generally, whereas this analysis was limited to older veterans with untreated mild, occult sleep-disordered breathing; the copy does not establish the same result for all OSA severities. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Fung and colleagues compared the effectiveness of a five session CBTi intervention with a sleep-education control among 134 adult veterans with insomnia alone (n = 39) and co-morbid insomnia and mild OSA (n = 95), and found no differences in insomnia improvements during CBTi between patients with insomnia alone and COMISA patients.

    “Fung and colleagues, also recently compared the effectiveness of a five session CBTi intervention with a sleep-education control, among 134 adult veterans with insomnia alone (n = 39), and co-morbid insomnia and mild OSA (n = 95), and also found no differences in insomnia improvements during CBTi between patients with insomnia alone, and COMISA patients [78].”

    From Co-morbid insomnia and sleep apnea (COMISA): Prevalence, consequences, methodological considerations, and recent randomized controlled trials (2019) · cites this paper as [78]

  • 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 [78]

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Research works printed but not linked: 1

  1. [11]Buysse DJ Germain A Moul DE Franzen PL Brar LK Fletcher ME Begley A Houck PR Mazumdar S Reynolds CF III Monk TH Efficacy of brief behavioral treatment for chronic insomnia in older adults Arch Intern Med 2011 171 10 887 95 21263078 PMC3101289

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Authors
Fung, C. H., Martin, J. L., Josephson, K., Fiorentino, L., Dzierzewski, J. M., Jouldjian, S., Tapia, J. C. R., Mitchell, M. N., & Alessi, C.
Affiliations
University of California, Los Angeles (US)
Corresponding author
Fung, Constance H.
ORCID
Venue
Psychosomatic Medicine
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2016-06
Volume
78
Issue
5
Pages
629-639
ISSN
  • 0033-3174 (ISSN-L)
  • 1534-7796
DOI
10.1097/psy.0000000000000314
PMC
PMC4891271
OpenAlex
W2344963125
Cited by
47
References
27
Citations by year
2026: 3 · 2025: 3 · 2024: 3 · 2023: 5 · 2022: 6 · 2021: 8 · 2020: 3 · 2019: 6 · 2018: 6 · 2017: 3 · 2016: 1
FWCI
7.57
Type
journal article
Language
en
Open access
Locations
  • Psychosomatic Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • National Institutes of Health (UL1TR000124)
  • National Institute on Aging (K23AG045937, P30AG028748)
  • National Center for Advancing Translational Sciences
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
cognitive behavioral therapy for insomnia, sleep-disordered breathing, older adults, veterans, apnea-hypopnea index, positive airway pressure, sleep quality, sleep latency, wake after sleep onset, sleep efficiency, sleep education
MeSH terms
Aged, Aged, 80 and over, Female, Humans, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Sleep Apnea Syndromes, Veterans, Cognitive Behavioral Therapy, Outcome Assessment, Health Care, Continuous Positive Airway Pressure

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