title: Evaluating the treatment of obstructive sleep apnea comorbid with insomnia disorder using an incomplete factorial design.
abstract: Chronic insomnia disorder is a prevalent condition and a significant proportion of these individuals also have obstructive sleep apnea (OSA). These two sleep disorders have distinct pathophysiology and are managed with different treatment approaches. High comorbidity rates have been a catalyst for emerging studies examining multidisciplinary treatment for OSA comorbid with insomnia disorder. In this article, we describe a randomized clinical trial of cognitive behavioral treatment for insomnia (CBT-I) and positive airway pressure (PAP) for OSA. Participants are randomized to receive one of three treatment combinations. Individuals randomized to treatment Arm A receive sequential treatment beginning with CBT-I followed by PAP, in treatment Arm B CBT-I and PAP are administered concurrently. These treatment arms are compared to a control condition, treatment Arm C, where individuals receive PAP alone. Adopting an incomplete factorial study design will allow us to evaluate the efficacy of multidisciplinary treatment (Arms A & B) versus standard treatment alone (Arm C). In addition, the random allocation of individuals to the two different combined treatment sequences (Arm A and Arm B) will allow us to understand the benefits of the sequential administration of CBT-I and PAP relative to concurrent treatment of PAP and CBT-I. These findings will provide evidence of the clinical benefits of treating insomnia disorder in the context of OSA.
authors.affiliation: Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL 60612-3833, United States. Electronic address: Megan_Crawford@rush.edu.
authors.forename: Megan R
authors.initials: MR
authors.lastname: Crawford
authors.affiliation: Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL 60612-3833, United States.
authors.forename: Arlener D
authors.initials: AD
authors.lastname: Turner
authors.affiliation: Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL 60612-3833, United States.
authors.forename: James K
authors.initials: JK
authors.lastname: Wyatt
authors.affiliation: Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL 60612-3833, United States.
authors.forename: Louis F
authors.initials: LF
authors.lastname: Fogg
authors.affiliation: Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL 60612-3833, United States.
authors.forename: Jason C
authors.initials: JC
authors.lastname: Ong
mesh_terms: D015928:Cognitive Behavioral Therapy / Q000379:methods*; D015897:Comorbidity; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D006801:Humans; D012107:Research Design; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology / Q000628:therapy*; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology / Q000628:therapy*
keywords: Incomplete factorial design; Insomnia disorder; Obstructive sleep apnea; Randomized clinical trial