Table 5.
—CBTi Trials in Patients With Comorbid Illness
| Authors/Year | Study Design | Study Sample | Intervention | Outcome |
| SDB | ||||
| Krakow et al59/2004 | Assessed sequential CBTi and SDB therapy in patients with concurrent chronic insomnia and SDB | 17 patients (mean age, 42.9 y) with psychophysiologic insomnia who completed CBTi (but did not fully respond to therapy) and received a diagnosis of SDB after CBTi completion | Sequential CBTi and CPAP therapy (following CBTi, PSG was conducted to confirm SDB and titrate CPAP; SDB treatment of 3 mo) | Eight of 17 participants had nonclinical insomnia levels post-CBTi. Fifteen of 17 participants reached nonclinical insomnia levels post-SDB treatment. |
| Guilleminault et al60/2008 | Evaluated subjective and objective outcomes of different sequences of two treatments for OSA: surgical intervention and CBTi | 30 patients (mean age, 31.8 y [surgical intervention]; 30.9 y [CBTi]) with both insomnia and OSA | Participants randomized to one of two groups: (1) CBTi followed by surgical intervention or (2) surgical intervention followed by CBTi | Surgical intervention alone eliminated insomnia complaint in five of 15 patients; no patients receiving CBTi alone were remitted. Surgical intervention had greater initial improvements in subjective (sleepiness, fatigue), objective (TST, slow-wave sleep, WASO), and respiratory measures (AHI, RDI, SpO2). |
| COPD | ||||
| Kapella et al61/2011 | Evaluated effectiveness of CBTi in patients with comorbid insomnia and COPD | 23 patients (mean age, 65 y [CBTi]; 60 y [WE]) with COPD and concurrent insomnia symptoms (difficulty either initiating or maintaining sleep) | Participants randomized to one of two groups: (1) six weekly CBTi sessions or (2) six weekly WE sessions | After CBTi, significant improvements were observed in subjective insomnia severity, global sleep quality, SE, WASO, and attitudes about sleep. Significant improvements in depressed mood were observed after WE. |
| CAD | ||||
| Rybarczyk et al62/2002 | Compared effectiveness of group CBTi to self-guided audio relaxation in older adults with comorbid insomnia and chronic health conditions | 35 older adults (mean age, 66.5 y [CBTi]; 65.6 y [home relaxation]; 71.4 y [control]) with comorbid chronic health conditions (either CAD, osteoarthritis, or type 2 diabetes mellitus) | Participants randomized to one of three groups: (1) eight weekly group CBTi sessions or (2) home-based audio relaxation program. Delayed treatment control (given home relaxation intervention later) | CBTi significantly improved compared with control on SE, WASO, TIB, global quality of sleep, and beliefs and attitudes about sleep at 4 mo follow-up. Home relaxation improved SE, WASO, and global sleep quality compared with control at 4-mo follow-up. |
| Rybarczyk et al63/2011 | Evaluated two self-help methods of CBTi with older adults with comorbid insomnia and chronic health conditions, including CHD | 106 older adults (mean age, 68 y) with insomnia and either CHD, osteoarthritis, or no health condition | Participants randomized to one of two groups: (1) CBTi book or (2) CBTi multimedia | Across both treatments, participants experienced moderate to significant clinical changes in sleep that were durable at 1-y follow-up. |
AHI = apnea-hypopnea index; CHD = coronary heart disease; OSA = obstructive sleep apnea; PSG = polysomnography; RDI = respiratory disturbance index; SDB = sleep-disordered breathing; SE = sleep efficiency; SpO2 = oxygen saturation as measured by pulse oximetry; TIB = time in bed; TST = total sleep time; WASO = wake after sleep onset; WE = wellness education. See Table 2 and 4 legends for expansion of other abbreviations.