Cognitive behavioral therapy for insomnia (CBT-I) is effective for the treatment of comorbid insomnia and sleep apnea (COMISA), producing large improvements in insomnia severity, sleep efficiency, and sleep quality, regardless of whether obstructive sleep apnea (OSA) is treated or untreated «Sweetman A, Farrell S, Wallace DM, ym. The effect ...»1, «Sweetman A, Richardson C, Smith A, ym. The Effect ...»2, «Sweetman A, Lechat B, Catcheside PG, ym. Polysomno...»3, «Ong JC, Crawford MR, Wallace DM. Sleep Apnea and I...»4, «Sweetman A, McEvoy RD, Smith S, ym. The effect of ...»5, «Sharafkhaneh A, Thomas A, Ulmer C, ym. The Managem...»6, «Ragnoli B, Pochetti P, Raie A, ym. Comorbid Insomn...»7, «Ong JC, Crawford MR, Dawson SC, ym. A randomized c...»8, «Tu AY, Crawford MR, Dawson SC, ym. A randomized co...»9.
Meta-analyses and randomized controlled trials demonstrate that CBT-I leads to significant reductions in Insomnia Severity Index scores and improvements in sleep parameters in COMISA populations, with effect sizes comparable to those seen in insomnia alone «Sweetman A, Farrell S, Wallace DM, ym. The effect ...»1, «Sweetman A, Richardson C, Smith A, ym. The Effect ...»2, «Sweetman A, Lechat B, Catcheside PG, ym. Polysomno...»3, «Sweetman A, McEvoy RD, Smith S, ym. The effect of ...»5, «Ong JC, Crawford MR, Dawson SC, ym. A randomized c...»8, «Tu AY, Crawford MR, Dawson SC, ym. A randomized co...»9.CBT-I is safe in COMISA, including in moderate and severe OSA, though close monitoring for transient increases in daytime sleepiness during initial sleep restriction is recommended «Sweetman A, McEvoy RD, Smith S, ym. The effect of ...»5. CBT-I also improves acceptance and adherence to positive airway pressure (PAP) therapy in COMISA, and combined treatment with CBT-I and PAP yields superior insomnia outcomes compared to PAP alone «Sweetman A, Lack L, Catcheside PG, ym. Cognitive a...»10, «Ragnoli B, Pochetti P, Raie A, ym. Comorbid Insomn...»7, «Ong JC, Crawford MR, Dawson SC, ym. A randomized c...»8, «Tu AY, Crawford MR, Dawson SC, ym. A randomized co...»9. CBT-I may also reduce OSA severity, potentially through increased N3 sleep, though it does not alter OSA endotype traits «Ong JC, Crawford MR, Wallace DM. Sleep Apnea and I...»4.The Department of Veterans Affairs guideline recommends CBT-I as first-line therapy for insomnia in COMISA, delivered via individual, group, or digital modalities «Sharafkhaneh A, Thomas A, Ulmer C, ym. The Managem...»6. Digital CBT-I is effective and accessible, with sustained improvements in insomnia, depression, anxiety, and sleepiness «Sweetman A, Richardson C, Smith A, ym. The Effect ...»2. Multidisciplinary, patient-centered care integrating CBT-I and PAP is recommended to optimize outcomes in COMISA «Ong JC, Crawford MR, Wallace DM. Sleep Apnea and I...»4, «Ragnoli B, Pochetti P, Raie A, ym. Comorbid Insomn...»7.CBT-I should be considered the standard of care for insomnia in COMISA, with strong evidence supporting its efficacy, safety, and role in improving PAP adherence and sleep outcomes. «Sweetman A, Farrell S, Wallace DM, ym. The effect ...»1, «Sweetman A, Richardson C, Smith A, ym. The Effect ...»2, «Sweetman A, Lechat B, Catcheside PG, ym. Polysomno...»3, «Ong JC, Crawford MR, Wallace DM. Sleep Apnea and I...»4, «Sweetman A, McEvoy RD, Smith S, ym. The effect of ...»5, «Sharafkhaneh A, Thomas A, Ulmer C, ym. The Managem...»6, «Ragnoli B, Pochetti P, Raie A, ym. Comorbid Insomn...»7, «Ong JC, Crawford MR, Dawson SC, ym. A randomized c...»8, «Tu AY, Crawford MR, Dawson SC, ym. A randomized co...»9, «Sweetman A, Lack L, Catcheside PG, ym. Cognitive a...»10.