0555 Treatment Responses in US Military Personnel with Comorbid Insomnia and Obstructive Sleep Apnea

Abstract Introduction Comorbid insomnia and obstructive sleep apnea (COMISA) is the most prevalent sleep disorder in military sleep clinics. While there is no established COMISA treatment regimen, patients frequently receive cognitive behavioral therapy for insomnia (CBTI) and positive airway pressure (PAP) therapy. The aims of this study were to examine treatment responses in military personnel with COMISA and determine if there were differential responses to therapy in male and females. Methods In an observational study, 130 participants (38.5% females) were diagnosed with COMSIA and received CBTI and PAP therapy in a routine clinical setting. Treatment responses were assessed by changes from baseline to 12 weeks with the Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and Pittsburgh Sleep Quality Index (PSQI). Descriptive statistics, parametric and non-parametric pairwise comparisons were used to assess differences between sexes at baseline. Linear mixed effects models for longitudinal data were used to examine differences between sexes in treatment responses overtime. Results There were significant decreases from baseline to 12 weeks in the ISI among males (-5.45 (95% CI, −6.94 to −3.96), p <.0001), and females (-6.25 (95% CI, -8.18 to -4.31), p <.0001), ESS among males (-2.52 (95% CI, -3.67 to -1.36), p <.0001) and females (-2.21 (95% CI, -3.71 to -0.72), p = .0017), and PSQI among males (-3.94 (95% CI, -4.96 to -2.91), p <.0001) and females (-3.64 (95% CI, -4.98 to -2.31), p <.0001). PAP Adherence was 8.5% in women and 23.1% in men (p = .053). Treatment responses were not significantly differences between genders. Conclusion Although the majority of military personnel with COMISA were non-adherent to PAP, there were significant responses on the ISI, ESS, and the PSQI. This suggests the insomnia may have greater clinical significance than OSA. CBTI could be considered first line COMISA therapy in a military population that primarily has mild sleep disordered breathing. Support (if any) This work was supported by the Defense Health Agency, Defense Medical Research and Development Program, Clinical Research Intramural Initiative for Military Women’s Health (DM170708; Mysliwiec) and the US Air Force (USAF) Air Force Materiel Command (AFMC), Wright Patterson Air Force Base, Ohio (FA8650-18-2-6953; Peterson).