Exploring the effect of a culturally adapted and personalized digital CBT-I app in insomnia patients with mild-to-moderate OSA: a secondary analysis of a randomized controlled trial

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BACKGROUND: This study aimed to evaluate the effectiveness of a culturally adapted, interactive, and personalized digital cognitive behavioral therapy (CBT-I) for individuals with co-morbid insomnia and sleep apnea (COMISA), and to compare the treatment outcomes with those of insomnia alone. METHODS: This secondary analysis utilized data from a prior randomized controlled trial. The efficacy of digital CBT-I (dCBT-I) on insomnia severity and mental health was assessed in both COMISA and insomnia-only groups at postintervention and at 1-, 3-, and 6-month follow-ups. RESULTS: Among 38 insomnia participants who completed the dCBT-I, 20 underwent sleep studies (4 males, 16 females; mean age 52.3 ± 13.0 years). Seven were diagnosed as mild-to-moderate obstructive sleep apnea (COMISA), and 13 did not (insomnia alone). Compared with baseline, the insomnia severity index scores significantly decreased at postintervention and the 1-, 3-, and 6-month follow-ups in both the COMISA and insomnia alone groups (P < .05), with large effect sizes (Cohen's d > 1.0). No significant differences were observed between the two groups in insomnia severity index scores at baseline, postintervention, and at 1-, 3-, and 6-month follow-ups (P > .05). Mixed-effects models indicated no significant group × time interaction on insomnia severity index scores (P > .05). Wake time after sleep onset, sleep efficiency of the sleep diaries, and health questionnaire (PHQ-9) scores also improved significantly postintervention and at follow-up in both groups. CONCLUSIONS: This self-guided, culturally adapted, and personalized dCBT-I effectively improved insomnia severity, sleep quality, and depressive symptoms among individuals with COMISA. While treatment effects were comparable between COMISA and insomnia-alone groups, the observed numerical differences may reflect limited statistical power. Larger studies are warranted to determine whether individuals with comorbid obstructive sleep apnea respond differently to dCBT-I. Key messages What is already known on this topic: Cognitive behavioral therapy for insomnia may improve outcomes in patients with comorbid insomnia and sleep apnea. What this study adds: This study shows that an interactive, personalized, and culturally adapted digital cognitive behavioral therapy for insomnia program is also effective for comorbid insomnia and sleep apnea patients. How this study might affect research, practice, or policy: These findings support broader implementation of tailored digital cognitive behavioral therapy for insomnia in the treatment of comorbid insomnia and sleep apnea.

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