ArticleSleep & breathing = Schlaf & Atmung2025
Determinants of treatment response to cognitive behavioral therapy in veterans presenting with comorbid insomnia and sleep apnea.
Article in Sleep & breathing = Schlaf & Atmung, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
3 citing papers in PubMed.
- Comorbid Insomnia and Sleep Apnea Mechanistic Convergence, Phenotypic Heterogeneity, and Clinical Implications.Current sleep medicine reports · 2026Article
- Infra-slow EEG neurofeedback for insomnia: a single-case experimental study in primary care.Frontiers in human neuroscience · 2026Article
- Insomnia, Sleep Apnea, and Incidence of Hypertension and Cardiovascular Disease Among Men and Women US Veterans.Journal of the American Heart Association · 2025Article
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Authors and funding
6 authors.
Funding
Abstract
purposeAlthough cognitive behavioral therapy for insomnia (CBT-I) is considered the preferred treatment for insomnia in patients with comorbid insomnia and obstructive sleep apnea (COMISA), the remission rate with CBT-I is generally considered lower than in insomnia-only populations. There is also a sizable variability in individual treatment responses. Due to the limited availability of CBT-I, we sought to identify specific clinical attributes that predict benefit from Brief Behavioral Therapy for Insomnia (BBTI)-an adaptation of CBT-I-in patients with COMISA.
methodsWe conducted a retrospective analysis of the National Veterans Health Administration (VHA) electronic medical records covering veterans diagnosed with COMISA between January 2021 and December 2023. Insomnia Severity Index (ISI) scores were recorded at baseline and after 12±1 weeks after BBTI. A positive response to BBTI was defined as a reduction in ISI score of ≥ 8 from baseline. A multivariate generalized linear model analysis was performed to delineate predictive factors of BBTI responsiveness.
results131 eligible cases received BBTI over 6 weeks, 56 (43%) of whom did not respond. Non-whites (OR 3.5, 95% CI [1.4, 8.8]) and shorter sleep time (OR 0.98, 95% CI [0.98, 0.99] were independent predictors of blunted response to BBTI. These findings remained true even when depression and AHI were forced into the regression model. Patients with a total sleep duration of < 4.1 h were at greatest risk of being nonresponsive to BBTI.
conclusionThese findings indicate that identifying insomnia phenotypes in patients with COMISA would help deliver personalized care while maximizing BBTI treatment resources.
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