Clinician-guided digital CBT-I improves sleep quality and apnea severity in patients with co-morbid insomnia and OSA: A Double-Blind, Randomized Clinical Trial
In brief
Digital insomnia therapy cut apnea events by 6 per hour after six weeks
In 88 patients with insomnia and obstructive sleep apnea, clinician-guided online cognitive behavioral therapy improved insomnia and sleep quality more than sleep hygiene education at three months. It also reduced apnea events by 6 per hour after treatment, while the comparison group worsened by 2; brief increases in sleepiness occurred, but no related adverse events were reported. Longer-term effects remain unknown.
- Journal
- American journal of respiratory and critical care medicine (Q1)
- Published
- 29 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Yuan Shi, Xujun Feng, Zhaohua Chen, Siqi Guan, Yihui Zhang, Fei Lei, et al.
- PMID
- 42958645
- DOI
- 10.1093/ajrccm/aamag567
Why clinicians should know about it
- Picked for Pulmonary and Respiratory Medicine (paper of the day, 31 October 2026): Digital CBT‑I improved insomnia severity and apnea index
Abstract
RATIONALE: Cognitive behavioral therapy for insomnia (CBT-I) is the accepted first-line treatment for insomnia, but its scalability and safety in patients with co-morbid insomnia and obstructive sleep apnea (COMISA) remain unclear. Clinician-guided digital CBT-I (D-CBT-I) is a potential treatment option that may address these limitations in COMISA. OBJECTIVE: To evaluate the effectiveness of clinician-guided D-CBT-I versus sleep hygiene education (SHE) in patients with COMISA. METHODS: This randomized trial (n = 88) compared clinician-guided D-CBT-I (6 weekly online sessions: sleep restriction, sleep hygiene, stimulus control, cognitive restructuring, relapse prevention) with SHE alone. Blinded outcome assessments were conducted at baseline, posttreatment (6 weeks), and 3-month follow-up. Primary outcomes were Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) scores at posttreatment and 3-month follow-up. Secondary outcomes included daytime sleepiness, sleep parameters, OSA severity, neurocognitive function, and adverse events. MEASUREMENTS AND MAIN RESULTS: At 3-month follow-up, intention-to-treat analysis showed significantly greater improvements with D-CBT-I versus SHE on ISI (-9.5 vs. -4.0 points; d = -1.18, P = 0.001) and PSQI (-4.9 vs. -1.8 points; d = -0.87, P = 0.001); D-CBT-I also reduced subjective sleepiness (Epworth Sleepiness Scale; -3.4 vs. -1.0 points; d = -0.68, P < 0.001). At posttreatment, D-CBT-I reduced the apnea-hypopnea index (attended in-laboratory polysomnography; -6.0 vs. +2.0 events/h; d = -0.64, P = 0.019). Although transient increases in ESS occurred at weeks 2-4, no functional impairment or sleepiness-related adverse events were reported. Additional benefits were observed in metacognition and executive function. CONCLUSION: Clinician-guided D-CBT-I improved insomnia and OSA severity, and enhanced cognitive function in COMISA patients. TRIAL REGISTRATION: Chinese Clinical Trial Registry; NO.: ChiCTR2500099854; URL: https://www.chictr.org.cn/showproj.html?proj=267457.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.