0386 ASV Vs CPAP RCT: Changes in Insomnia Severity Index (ISI)

Abstract Introduction Complex insomnia (co-occurring chronic insomnia disorder and sleep apnea) is more prevalent than previously recognized, yet no RCTs have investigated different PAP modes in this cohort. Standard CPAP often produces adverse effects (expiratory pressure intolerance; iatrogenic central apneas) in complex insomnia patients. We hypothesized ASV would alleviate side-effects and yield greater improvements in insomnia severity compared to CPAP. Methods A prospective, single-blind (patients), RCT studied 40 chronic insomniacs, who had never seen a sleep specialist or received a sleep apnea diagnosis; and none believed they suffered a sleep breathing disorder or that it caused their chronic insomnia. Despite their insomnia chief complaint, all patients were diagnosed with OSA on PSG. Patients completed an intensive 15-week protocol, comprising 5 follow-up appointments (two-week intervals) interspersed with 3 in-lab retitrations (six-week intervals) to encourage regular PAP use [ASV (n=19), CPAP (n=21); ResMed AirCurveTM]. Results The sample suffered moderately severe insomnia (mean ISI=19.30) for an average of 9.81years with no baseline differences between groups. All patients reported failing multiple treatments for chronic insomnia, including sleep hygiene, OTC drugs, prescription sedatives, psychotropic medications and psychotherapy. At final follow-up, main effect showed a significant, large decrease in ISI (mean change -11.43, p=.0001); group x time interaction was statistically significant (p=.04), demonstrating ASV superiority (mean change -13.22, g=3.82) over CPAP (mean change -9.29, g=2.07). Clinically, ASV superiority manifested in 68.4% of patients no longer meeting criteria for a clinical insomnia disorder (ISI