Novel Treatment of Comorbid Insomnia and Sleep Apnea in Older Veterans

This study is enrolling participants by invitation only.
Sponsor:
Information provided by (Responsible Party):
Department of Veterans Affairs
ClinicalTrials.gov Identifier:
NCT02027558
First received: December 11, 2013
Last updated: June 25, 2014
Last verified: June 2014
  Purpose

The purpose of this study is to determine whether a novel intervention combining cognitive behavioral therapy for insomnia plus a positive airway pressure (PAP) behavioral adherence program provided by allied health personnel for older Veterans with obstructive sleep apnea and comorbid insomnia improves nighttime sleep, PAP adherence, mood and health-related quality of life.


Condition Intervention
Insomnia
Apnea
Behavioral: Behavioral Education Intervention I
Behavioral: Behavioral Education Intervention II

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Novel Treatment of Comorbid Insomnia and Sleep Apnea in Older Veterans

Resource links provided by NLM:


Further study details as provided by Department of Veterans Affairs:

Primary Outcome Measures:
  • PAP adherence [ Time Frame: Three months after baseline assessment ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Sleep/wake patterns [ Time Frame: Three and six months after baseline assessment ] [ Designated as safety issue: No ]

Estimated Enrollment: 120
Study Start Date: January 2014
Estimated Study Completion Date: March 2017
Estimated Primary Completion Date: June 2016 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Behavioral Education Intervention
Manual-based education program focusing on sleep and sleep apnea provided by allied health personnel in individual sessions.
Behavioral: Behavioral Education Intervention I
Manual-based education program focusing on sleep and sleep apnea provided by allied health personnel in individual sessions.
Experimental: Behavioral Education Intervention II
Manual-based education program focusing on sleep and sleep apnea provided by allied health personnel in individual sessions.
Behavioral: Behavioral Education Intervention II
Manual-based education program focusing on sleep and sleep apnea provided by allied health personnel in individual sessions.

Detailed Description:

Sleep disturbance is common in older adults and is associated with increased healthcare utilization, more depressive symptoms, and other adverse effects on health-related quality of life. Obstructive sleep apnea (OSA) is a disorder characterized by repetitive episodes of complete or partial upper airway obstruction occurring during sleep. OSA increases in prevalence with age, and is associated with increased risk of cardiovascular disease, decreased quality of life, and increased mortality. Insomnia also increases in prevalence with age, and is associated with numerous adverse outcomes, including cognitive decline, decreased quality of life, increased healthcare costs and increased mortality. The diagnostic criteria for insomnia include a decreased ability to fall asleep or stay asleep, frequent nighttime awakening or poor quality sleep that is associated with daytime impairment such as fatigue, impaired attention, or daytime sleepiness. Increasing evidence suggests that insomnia often coexists with OSA, particularly in older adults, and predicts worse outcomes of OSA. Both OSA and insomnia have a higher prevalence among Veterans, compared to the general population.

Little is known of the best approaches to manage the large number of patients with coexisting OSA and comorbid insomnia. Guidelines for best practice typically address these conditions separately, where positive airway pressure (PAP) is the standard for the treatment of OSA, and cognitive behavioral therapy for insomnia (CBT-I) is considered first-line treatment for chronic insomnia. CBT-I is particularly recommended for insomnia in older adults, where adverse effects of sleeping medications are most problematic. Early adherence to PAP therapy (i.e., within the first week of PAP therapy) is one of the strongest predictors of long-term PAP adherence. However, adherence rates to PAP therapy in patients with OSA are low. In addition, CBT-I has not been widely implemented for treatment of insomnia (in part due to limited access to mental health specialists able to provide CBT-I), untreated OSA limits response to treatment of insomnia, and untreated insomnia negatively impacts PAP adherence.

Based on this evidence and findings from our prior work, we believe that an integrated, behavioral treatment approach which addresses both OSA and insomnia early in the course of PAP therapy is needed to maximize patient adherence and treatment success when these conditions coexist. We propose a randomized controlled trial to test a novel, behavioral approach integrating best practices for management of both conditions among older Veterans with OSA who are prescribed PAP therapy and have comorbid insomnia. The purpose of this project is to determine whether this intervention improves nighttime sleep, PAP adherence, mood and health-related quality of life.

  Eligibility

Ages Eligible for Study:   50 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Meets diagnostic criteria for insomnia
  • Diagnosis of obstructive sleep apnea (AHI > or = 15) and prescription of PAP therapy
  • Age > or =50
  • Community-dwelling
  • Live within a 30-mile radius of VA GLAHS
  • Have transportation to VA GLAHS to attend the intervention/control programs

Exclusion Criteria:

  • Significant cognitive impairment (MMSE < 24)
  • History of mania, major psychopathology or a psychiatric hospitalization in prior two years
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT02027558

Locations
United States, California
VA Greater Los Angeles Healthcare System, Sepulveda, CA
Sepulveda, California, United States, 91343
VA Greater Los Angeles Healthcare System, West Los Angeles, CA
West Los Angeles, California, United States, 90073
Sponsors and Collaborators
Investigators
Principal Investigator: Cathy A. Alessi, MD VA Greater Los Angeles Healthcare System, Sepulveda, CA
  More Information

No publications provided

Responsible Party: Department of Veterans Affairs
ClinicalTrials.gov Identifier: NCT02027558     History of Changes
Other Study ID Numbers: IIR 12-353
Study First Received: December 11, 2013
Last Updated: June 25, 2014
Health Authority: United States: Federal Government

Keywords provided by Department of Veterans Affairs:
cognitive behavioral therapy
insomnia
apnea

Additional relevant MeSH terms:
Apnea
Sleep Apnea Syndromes
Sleep Initiation and Maintenance Disorders
Respiration Disorders
Respiratory Tract Diseases
Signs and Symptoms, Respiratory
Signs and Symptoms
Sleep Disorders, Intrinsic
Dyssomnias
Sleep Disorders
Nervous System Diseases
Mental Disorders

ClinicalTrials.gov processed this record on July 23, 2014