{"doi":"10.1093/sleep/zsaa235","title":"Randomized controlled trial of an integrated approach to treating insomnia and improving the use of positive airway pressure therapy in veterans with comorbid insomnia disorder and obstructive sleep apnea","abstract":"STUDY OBJECTIVES: Cognitive behavioral therapy for insomnia (CBTI) for comorbid insomnia and obstructive sleep apnea (OSA) has had mixed results. We integrated CBTI with a positive airway pressure (PAP) adherence program and tested effects on sleep and PAP use. METHODS: 125 veterans (mean age 63.2, 96% men, 39% non-Hispanic white, 26% black/African American, 18% Hispanic/Latino) with comorbid insomnia and newly-diagnosed OSA (apnea-hypopnea index ≥ 15) were randomized to 5-weekly sessions integrating CBTI with a PAP adherence program provided by a \"sleep coach\" (with behavioral sleep medicine supervision), or 5-weekly sleep education control sessions. Participants and assessment staff were blinded to group assignment. Outcomes (baseline, 3 and 6 months) included Pittsburgh Sleep Quality Index (PSQI), 7-day sleep diary (sleep onset latency [SOL-D], wake after sleep onset [WASO-D], sleep efficiency [SE-D]), 7-day actigraphy (SE-A), and objective PAP use (hours/night and nights ≥ 4 h). Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and Functional Outcomes of Sleep Questionnaire-10 (FOSQ-10) were also collected. RESULTS: Compared to controls, intervention participants showed greater improvement (baseline to 3 and 6 months, respectively) in PSQI (-3.2 and -1.7), SOL-D (-16.2 and -15.5 minutes), SE-D (10.5% and 8.5%), SE-A (4.4% and 2.6%) and more 90-day PAP use (1.3 and 0.9 more hours/night, 17.4 and 11.3 more nights PAP ≥ 4 h). 90-day PAP use at 3 months was 3.2 and 1.9 h/night in intervention versus controls. Intervention participants also had greater improvements in ISI, ESS, and FOSQ-10 (all p < 0.05). CONCLUSIONS: An intervention integrating CBTI with a PAP adherence program delivered by a supervised sleep coach improved sleep and PAP use in adults with comorbid insomnia and OSA. TRIAL REGISTRATION: ClinicalTrials.govStudy name: Novel Treatment of Comorbid Insomnia and Sleep Apnea in Older VeteransURL: https://clinicaltrials.gov/ct2/results?cond=&term=NCT02027558&cntry=&state=&city=&dist=Registration: NCT02027558.","journal":"SLEEP","year":2020,"id":60862,"datarank":2.0406291375494257,"base_score":4.110873864173311,"endowment":4.110873864173311,"self_citation_contribution":0.6166310796259968,"citation_network_contribution":1.4239980579234288,"self_endowment_contribution":0.6166310796259968,"citer_contribution":1.4239980579234288,"corpus_percentile":null,"corpus_rank":null,"citation_count":60,"citer_count":57,"citers_with_citation_signal":45,"citers_with_endowment":45,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9285,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT02027558"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":321246,"name":"Constance H. Fung","orcid":"0000-0002-0140-7932","position":1,"is_corresponding":false},{"id":278413,"name":"Joseph M. Dzierzewski","orcid":"0000-0002-9788-8813","position":2,"is_corresponding":false},{"id":322168,"name":"Lavinia Fiorentino","orcid":null,"position":3,"is_corresponding":false},{"id":321247,"name":"Carl Stepnowsky","orcid":"0000-0002-4633-3228","position":4,"is_corresponding":false},{"id":126231,"name":"Juan Carlos Tapia","orcid":null,"position":5,"is_corresponding":false},{"id":321248,"name":"Yeonsu Song","orcid":"0000-0002-2244-2323","position":6,"is_corresponding":false},{"id":321249,"name":"Michelle Zeidler","orcid":"0000-0003-0997-9713","position":7,"is_corresponding":false},{"id":321250,"name":"Karen Josephson","orcid":"0000-0003-4237-5858","position":8,"is_corresponding":false},{"id":322169,"name":"Michael Mitchell","orcid":null,"position":9,"is_corresponding":false},{"id":322170,"name":"Stella Jouldjian","orcid":null,"position":10,"is_corresponding":false},{"id":321251,"name":"Jennifer L. Martin","orcid":"0000-0003-0849-3391","position":11,"is_corresponding":false},{"id":321245,"name":"Cathy Alessi","orcid":"0000-0002-0396-9066","position":0,"is_corresponding":true}],"reference_count":71,"raw_metadata":null,"created_at":"2026-07-18T21:09:05.493770Z","pmid":"33221910","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}