Obstructive sleep apnea, or OSA, affects over 1 billion adults worldwide. OSA is one of many sleep disorders. Individuals can suffer from more than one sleep disorder at a time. Insomnia (difficulty falling or staying asleep) is a separate sleep disorder that is very often seen in OSA patients. Depending on reports, insomnia can be present in 30%-60% of patients diagnosed with OSA. This research is being conducted to determine whether treating insomnia can help patients with OSA to have better outcomes when treating their OSA.
a diagnosis of insomnia (defined as ISI ≥10, or prescribed hypnotic medication (trazadone, zolpidem, eszopiclone, doxepin), or a diagnosis of insomnia [International Classification of Sleep Disorders 3 criteria]).
internet-capable device (e.g., smartphone, tablet, or computer)
able to download and use the COAST app for administration of the intervention
able to download and Inspire smartphone app utilized for clinical compliance information collection
-engaged in CBT-I in past 6 months
does not have access to or unable to use internet capable device (smartphone, tablet or computer)
Sequential
Digital Cognitive Behavioral Therapy (CBT-i)-COAST
DeviceThe COAST application will generate treatment recommendations after approximately one week of participant data entry. COAST's treatment recommendations are based on the core components of CBT-I-stimulus control, sleep restriction, cognitive therapy, and relaxation-with additional strategies targeting nightmares and daytime fatigue as needed. Weekly assessments and daily sleep diaries help the COAST algorithms make recommendations. The study clinician must review and approve, or change, all recommendations before they are sent to the participant. This tailored approach allows for modification of COAST's recommendations based on clinician expertise and knowledge of the participant. To further enhance the treatment process, the clinician is available by secure message to provide rapid support and/or schedule an appointment as needed. These features offer personalization for each participant, consistent with case-conceptualization based on individual sleep needs.
UAS adherence
UAS adherence will be measured by average hours of use per night
Change in Insomnia Severity Index (ISI)
The Insomnia Severity Index (ISI) is a patient's subjective assessment of their ability to fall and stay asleep. The ISI is a 7 item measure. Answers per item range from 0-4 (0 meaning none/very satisfied-4 meaning very severe/very dissatisfied). Scoring totals range from 0-28. Lower score is better. Higher score suggests worse insomnia.
UAS adherence-overall usage
UAS adherence measured by % days used. This will be calculated dividing the number of days the UAS was turned on by the number of days since last timepoint which will yield a percentage. The higher the percentage, the better the compliance. (1 month\~30 days; 3 months\~90 days; 6 months\~180 days)
UAS adherence- % nights with >= 4 hours of usage
4 hours of nightly usage is an historical OSA treatment benchmark for compliance. This outcome measure will be calculated by identifying the number of nights the UAS system was used for 4+ hours and dividing it by the overall number of nights used to achieve a percentage. This will be calculated for each timepoint in the study. Higher percentage suggests better compliance.
UAS average number of pauses per night
UAS systems have the ability to be paused during usage. Common reasons for "pausing" are for comfort (so they can more easily fall back to sleep), to use the restroom, to take a drink/or take medication. Increased pausing can be associated with discomfort (the UAS system being too strong) or associated with sleep disorders (such as incomplete control of OSA or low arousal threshold). Pause events will be tallied and divided by the total number of nights the UAS system was used. Lower number of average pauses leads to higher overall usage of the UAS system and is preferred. This information can also be used to direct clinicians to readjust UAS settings or reeducate patients.
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Thomas Kaffenberger
Lead sponsor
University of Pittsburgh
Sponsor institution
Inspire Medical Systems, Inc.
Collaborator
Noctem, LLC
Collaborator
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