title: Prospective randomized study of patients with insomnia and mild sleep disordered breathing.
abstract: BACKGROUND
  Patients with insomnia may present with mild and often unrecognized obstructive sleep apnea (OSA).
  
  
  OBJECTIVE
  To evaluate both subjective and objective outcomes of patients with complaints of insomnia and mild OSA who receive surgical treatment for OSA versus behavioral treatment with cognitive behavioral therapy for insomnia (CBT-I).
  
  
  METHODS
  Prospective study with crossover design of 30 patients with complaints of insomnia and mild OSA. Thirty subjects, matched for age and gender, were randomized with stratification to receive either CBT-I or surgical treatment of OSA as primary treatment. Patients were reassessed after completing the initial intervention and reassigned if agreeable to the alternative treatment option and assessed again on completion of both treatment arms. Outcome measures included clinical impression, Epworth Sleepiness Scale (ESS) score, Fatigue Severity Scale (FSS) score, and polysomnography (PSG) results.
  
  
  RESULTS
  Surgery resulted in greater improvements in total sleep time (TST), slow wave sleep and REM sleep duration, respiratory disturbance index, apnea-hypopnea index, minimum oxygen saturation, FSS, and ESS. CBT-I also improved TST and resulted in shorter sleep latency.
  
  
  CONCLUSIONS
  Surgical intervention for the management of patients with complaints of insomnia and mild OSA demonstrated greater improvement in both subjective and objective outcome measures. Initial treatment of underlying OSA in patients with insomnia was more successful in improving insomnia than CBT-I alone. However CBT-I as initial treatment improved TST compared to baseline; following surgical intervention, it had the additional benefit of further increasing TST and helped to control sleep onset difficulties that may be related to conditioning due to unrecognized symptoms of mild OSA.
authors.affiliation: Stanford University Sleep Medicine Program, Stanford, CA 94305, USA. cguil@stanford.edu
authors.forename: Christian
authors.initials: C
authors.lastname: Guilleminault
authors.forename: Kala
authors.initials: K
authors.lastname: Davis
authors.forename: Nelly T
authors.initials: NT
authors.lastname: Huynh
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods; D018592:Cross-Over Studies; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis / Q000453:epidemiology; D005221:Fatigue / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D017286:Polysomnography; D011446:Prospective Studies; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000453:epidemiology*; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000453:epidemiology*; D012894:Sleep Stages / Q000502:physiology