The Management of Chronic Insomnia Disorder and Obstructive Sleep Apnea: Synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines
Abstract
Description In September 2019, the U.S. Department of Veterans Affairs (VA) and the U.S. Department of Defense (DoD) approved a new joint clinical practice guideline for assessing and managing patients with chronic insomnia disorder and obstructive sleep apnea (OSA). This guideline is intended to give health care teams a framework by which to screen, evaluate, treat, and manage the individual needs and preferences of VA and DoD patients with either of these conditions. Methods In October 2017, the VA/DoD Evidence-Based Practice Work Group initiated a joint VA/DoD guideline development effort that included clinical stakeholders and conformed to the Institute of Medicine's tenets for trustworthy clinical practice guidelines. The guideline panel developed key questions, systematically searched and evaluated the literature, created three 1-page algorithms, and advanced 41 recommendations using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. Recommendations This synopsis summarizes the key recommendations of the guideline in 3 areas: diagnosis and assessment of OSA and chronic insomnia disorder, treatment and management of OSA, and treatment and management of chronic insomnia disorder. Three clinical practice algorithms are also included.
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CBT-I is the recommended first-line treatment for insomnia disorder, including in people with comorbid psychiatric conditions.
“Cognitive Behavioral Therapy for Insomnia (CBT-I) is the recommended first-line treatment for insomnia disorder, including among individuals with comorbid psychiatric conditions”
From Benefits of Cognitive Behavioral Therapy for Insomnia for Women Veterans with and without Probable Post-Traumatic Stress Disorder (2022) · cites this paper as Mysliwiec et al., 2020
CBT-I has been shown to improve insomnia symptoms for most patients, including those with comorbid conditions.
“has been shown to improve insomnia symptoms for most patients, including those with comorbid conditions”
From Novel Treatment Based on Acceptance and Commitment Therapy Versus Cognitive Behavioral Therapy for Insomnia: A Randomized Comparative Effectiveness Trial in Women Veterans (2023) · cites this paper as Mysliwiec et al., 2020
CBT-I is the first-line recommended treatment for insomnia disorder.
“The first-line recommended treatment for insomnia disorder, Cognitive-Behavioral Therapy for Insomnia (CBT-I)”
From Novel Treatment Based on Acceptance and Commitment Therapy Versus Cognitive Behavioral Therapy for Insomnia: A Randomized Comparative Effectiveness Trial in Women Veterans (2023) · cites this paper as Mysliwiec et al., 2020
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- Authors
- Mysliwiec, V., Martin, J. L., Ulmer, C. S., Chowdhuri, S., Brock, M. S., Spevak, C., & Sall, J.
- Affiliations
- The University of Texas at San Antonio Health Science Center (US)
- University of California, Los Angeles (US)
- Duke University (US)
- Wayne State University (US)
- Wilford Hall Ambulatory Surgical Center (US)
- Walter Reed National Military Medical Center (US)
- United States Department of Veterans Affairs (US)
- ORCID
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 2020-03-03
- Volume
- 172
- Issue
- 5
- Pages
- 325-336
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- OpenAlex
- W3008474234
- Cited by
- 129
- References
- 16
- Citations by year
- 2026: 11 · 2025: 25 · 2024: 18 · 2023: 23 · 2022: 21 · 2021: 25 · 2020: 6
- FWCI
- 18.14
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- chronic insomnia, obstructive sleep apnea, veterans, military personnel, sleep disorder diagnosis, sleep disorder treatment, screening
- MeSH terms
- Humans, Hypnotics and Sedatives, Sleep Initiation and Maintenance Disorders, United States, United States Department of Veterans Affairs, Cognitive Behavioral Therapy, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure, United States Department of Defense
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