The edition · Pulmonology
Digital CBT for insomnia improved sleep and lowered apnoea severity in patients with both insomnia and sleep apnoea
A blinded trial in 88 patients with COMISA. Also: two years of twice-yearly depemokimab, a self-directed weight programme that fell short in sleep apnoea, and cryobiopsy for peripheral lung lesions.
The edition in brief
A randomised trial in 88 patients with co-morbid insomnia and obstructive sleep apnoea found six weekly sessions of clinician-guided digital CBT for insomnia improved insomnia severity (−9.5 vs −4.0 points) and sleep quality at three months compared with sleep hygiene education, and reduced the apnoea–hypopnoea index by about 6 events per hour after treatment, with only a transient rise in sleepiness. An integrated two-year analysis of SWIFT-1, SWIFT-2 and the AGILE extension found twice-yearly depemokimab kept annualised asthma exacerbation rates low in eosinophilic asthma with no treatment-related serious events. The POWER trial in 696 US veterans with OSA and obesity found a self-directed lifestyle programme produced only 1.1 kg extra weight loss at a year, not significant against its threshold. The Cryo-RCT found cryobiopsy raised diagnostic yield for peripheral lung lesions (83% vs 75%) at the cost of more bleeding and pneumothorax. The pearl covers inhaler technique.
Twice-yearly depemokimab held exacerbation rates down over two years
Twice-yearly depemokimab maintained low exacerbation rates over two years in eosinophilic asthma, offering a less frequent dosing option where available.
A self-directed weight programme did little for veterans with sleep apnoea
Self-directed lifestyle programmes produced minimal weight loss in OSA; more intensive support or drug therapy is likely needed.
Cryobiopsy raised diagnostic yield for peripheral lung lesions
Consider cryobiopsy for peripheral lung lesions where expertise exists, accepting more moderate bleeding for a higher diagnostic yield.
Check inhaler technique before escalating
Before stepping up asthma or COPD treatment, watch the patient use their inhaler and correct the technique.
Treat insomnia in sleep apnoea with CBT-I, not just sleep hygiene
For patients with both insomnia and OSA, offer CBT-I — including guided digital programmes — rather than sleep hygiene advice alone.
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