Elliot J Brooker, Shane A Landry, Pedro R Genta, Gabriel T Abdelmessih, Bradley A Edwards, Sean P A Drummond
{"title":"失眠的认知行为疗法与睡眠呼吸暂停严重程度的降低有关，但与伴发失眠和睡眠呼吸暂停的患者的内源性特征无关。","authors":"Elliot J Brooker, Shane A Landry, Pedro R Genta, Gabriel T Abdelmessih, Bradley A Edwards, Sean P A Drummond","doi":"10.5664/jcsm.11636","DOIUrl":null,"url":null,"abstract":"<p><strong>Study objectives: </strong>Cognitive behavioral therapy for insomnia (CBT-I) improves obstructive sleep apnea (OSA) severity in comorbid insomnia and sleep apnea (COMISA), though the mechanisms underlying this change are unstudied. CBT-I, which promotes sleep continuity and reduces hyperarousal, may improve OSA by raising the respiratory arousal threshold. We aimed to investigate the effect of CBT-I on OSA severity and its impact on the arousal threshold and other endotype traits.</p><p><strong>Methods: </strong>In this single-arm trial, 25 patients with COMISA (13F:12M, <i>M<sub>age</sub></i>=53.7, <i>SD<sub>age</sub></i>=8.7 years) completed a seven-week individual CBT-I program. Patients met diagnostic criteria for insomnia and demonstrated an apnea-hypopnea index (AHI) ≥ 10 events/h (<i>M<sub>AHI</sub></i>=35.2, <i>SD<sub>AHI</sub></i>=16.4 events/h). Overnight polysomnography before and after CBT-I measured OSA severity, sleep architecture, and the four OSA endotypes (i.e., collapsibility, muscle compensation, loop gain, arousal threshold).</p><p><strong>Results: </strong>There was a 7.7±10.2 event/h reduction in the AHI from baseline to post treatment (<i>p</i>=.001), however, no change in any of the OSA endotype traits studied (all <i>p</i>>.05). Secondary analyses showed a relationship whereby increases in N3 sleep were associated with decreases in AHI (<i>r</i><sup>2</sup>=.19, <i>p</i>=.03). Significant improvements were also found in insomnia severity and sleep diary-based sleep efficiency, sleep onset latency, and wake after sleep onset at post-treatment (all <i>p</i><.001).</p><p><strong>Conclusions: </strong>CBT-I is beneficial in improving insomnia symptoms and we provide further support CBT-I improves OSA severity. Despite no change in the OSA endotype traits, the improvement in the AHI may be associated with increased amounts N3 sleep. These results underscore the importance of managing insomnia in COMISA.</p><p><strong>Clinical trial registration: </strong>Registry: Australian and New Zealand Clinical Trial Registry; Identifier: ACTRN12622000226707.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":""},"PeriodicalIF":3.5000,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Cognitive behavioral therapy for insomnia is associated with reduced sleep apnea severity, but not its endotype traits in those with comorbid insomnia and sleep apnea.\",\"authors\":\"Elliot J Brooker, Shane A Landry, Pedro R Genta, Gabriel T Abdelmessih, Bradley A Edwards, Sean P A Drummond\",\"doi\":\"10.5664/jcsm.11636\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study objectives: </strong>Cognitive behavioral therapy for insomnia (CBT-I) improves obstructive sleep apnea (OSA) severity in comorbid insomnia and sleep apnea (COMISA), though the mechanisms underlying this change are unstudied. CBT-I, which promotes sleep continuity and reduces hyperarousal, may improve OSA by raising the respiratory arousal threshold. We aimed to investigate the effect of CBT-I on OSA severity and its impact on the arousal threshold and other endotype traits.</p><p><strong>Methods: </strong>In this single-arm trial, 25 patients with COMISA (13F:12M, <i>M<sub>age</sub></i>=53.7, <i>SD<sub>age</sub></i>=8.7 years) completed a seven-week individual CBT-I program. Patients met diagnostic criteria for insomnia and demonstrated an apnea-hypopnea index (AHI) ≥ 10 events/h (<i>M<sub>AHI</sub></i>=35.2, <i>SD<sub>AHI</sub></i>=16.4 events/h). Overnight polysomnography before and after CBT-I measured OSA severity, sleep architecture, and the four OSA endotypes (i.e., collapsibility, muscle compensation, loop gain, arousal threshold).</p><p><strong>Results: </strong>There was a 7.7±10.2 event/h reduction in the AHI from baseline to post treatment (<i>p</i>=.001), however, no change in any of the OSA endotype traits studied (all <i>p</i>>.05). Secondary analyses showed a relationship whereby increases in N3 sleep were associated with decreases in AHI (<i>r</i><sup>2</sup>=.19, <i>p</i>=.03). Significant improvements were also found in insomnia severity and sleep diary-based sleep efficiency, sleep onset latency, and wake after sleep onset at post-treatment (all <i>p</i><.001).</p><p><strong>Conclusions: </strong>CBT-I is beneficial in improving insomnia symptoms and we provide further support CBT-I improves OSA severity. Despite no change in the OSA endotype traits, the improvement in the AHI may be associated with increased amounts N3 sleep. These results underscore the importance of managing insomnia in COMISA.</p><p><strong>Clinical trial registration: </strong>Registry: Australian and New Zealand Clinical Trial Registry; Identifier: ACTRN12622000226707.</p>\",\"PeriodicalId\":50233,\"journal\":{\"name\":\"Journal of Clinical Sleep Medicine\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.5000,\"publicationDate\":\"2025-03-13\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Clinical Sleep Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.5664/jcsm.11636\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Sleep Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5664/jcsm.11636","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Cognitive behavioral therapy for insomnia is associated with reduced sleep apnea severity, but not its endotype traits in those with comorbid insomnia and sleep apnea.
Study objectives: Cognitive behavioral therapy for insomnia (CBT-I) improves obstructive sleep apnea (OSA) severity in comorbid insomnia and sleep apnea (COMISA), though the mechanisms underlying this change are unstudied. CBT-I, which promotes sleep continuity and reduces hyperarousal, may improve OSA by raising the respiratory arousal threshold. We aimed to investigate the effect of CBT-I on OSA severity and its impact on the arousal threshold and other endotype traits.
Methods: In this single-arm trial, 25 patients with COMISA (13F:12M, Mage=53.7, SDage=8.7 years) completed a seven-week individual CBT-I program. Patients met diagnostic criteria for insomnia and demonstrated an apnea-hypopnea index (AHI) ≥ 10 events/h (MAHI=35.2, SDAHI=16.4 events/h). Overnight polysomnography before and after CBT-I measured OSA severity, sleep architecture, and the four OSA endotypes (i.e., collapsibility, muscle compensation, loop gain, arousal threshold).
Results: There was a 7.7±10.2 event/h reduction in the AHI from baseline to post treatment (p=.001), however, no change in any of the OSA endotype traits studied (all p>.05). Secondary analyses showed a relationship whereby increases in N3 sleep were associated with decreases in AHI (r2=.19, p=.03). Significant improvements were also found in insomnia severity and sleep diary-based sleep efficiency, sleep onset latency, and wake after sleep onset at post-treatment (all p<.001).
Conclusions: CBT-I is beneficial in improving insomnia symptoms and we provide further support CBT-I improves OSA severity. Despite no change in the OSA endotype traits, the improvement in the AHI may be associated with increased amounts N3 sleep. These results underscore the importance of managing insomnia in COMISA.
Clinical trial registration: Registry: Australian and New Zealand Clinical Trial Registry; Identifier: ACTRN12622000226707.
期刊介绍：
Journal of Clinical Sleep Medicine focuses on clinical sleep medicine. Its emphasis is publication of papers with direct applicability and/or relevance to the clinical practice of sleep medicine. This includes clinical trials, clinical reviews, clinical commentary and debate, medical economic/practice perspectives, case series and novel/interesting case reports. In addition, the journal will publish proceedings from conferences, workshops and symposia sponsored by the American Academy of Sleep Medicine or other organizations related to improving the practice of sleep medicine.
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