Effects of mindfulness meditation and Acceptance and Commitment Therapy in patients with obstructive sleep apnea with residual excessive sleepiness: A randomized controlled pilot study

Objective: Assessing the effects of Mindfulness-Based Stress Reduction (MBSR) and Acceptance and Commitment Therapy (ACT) on symptoms of OSA, especially on the main outcome, excessive daytime sleepiness (EDS). Methods: Parallel randomized controlled trial. 16 OSA patients with residual EDS (rEDS) were randomized and assigned to the two programs via a central computer system using REDCap. Participants completed a standardized 8-week MBSR program or a time-matched program on Acceptance and Commitment Therapy (ACT). Both programs were conducted online. Participants answered questionnaires online at baseline (pre), post-intervention (post), three months after the intervention (follow-up) and were blinded to whether their group was the treatment or control group but not to group allocation. Three participants dropped out early. Most analyses are based on the remaining 13 patients. Results: There was a significant difference between the MBSR (n=7) and ACT group (n=6) in changes of EDS between pre and post (p=.043) and a significant reduction of EDS for patients in the ACT group at post (p=.034). This EDS reduction averaging 2.17 points on the Epworth Sleepiness Scale reached the prespecified bar for clinical significance of two points on that scale. Insomnia symptoms reduced significantly following ACT (p=.017). In MBSR, both participants and the MBSR-trainer judged movement-based exercises to be most efficacious. Conclusion ACT shows potential as adjunctive therapy for OSA with rEDS, although further studies are needed. It seems promising to develop therapeutic approaches for OSA with rEDS using ACT, especially if they are tailored to patients' needs. Trial registration drks.de; Identifier: DRKS00026812