1208 Integrating Digital CBT-I into a Comprehensive Value-Based Telehealth Sleep Service

Abstract Introduction Value-based care is a disruptive healthcare delivery model emphasizing patient outcomes and cost-effectiveness rather than volume of service. While this model has been applied to the treatment of obstructive sleep apnea (OSA), it has not yet been examined for chronic insomnia. This study examined preliminary real-world data for integrating an FDA-cleared digital cognitive behavioral therapy for insomnia (dCBT-I) into a value-based telehealth sleep service. Methods Data were collected as part of ongoing clinical care from patients presenting to a comprehensive value-based sleep service between January 1 and November 30 2025. Following an initial telehealth visit with a board-certified sleep physician, patients diagnosed with insomnia were offered access (as appropriate) to Somryst, an FDA-cleared, automated, 6-session dCBT-I program supported by a care team trained to provide patient assistance. Renewals were granted as needed after the 9-week prescription for up to 12 months. Patients suspected of OSA received a home sleep apnea test and those who tested positive for OSA were subsequently offered positive airway pressure (PAP) therapy complemented by telehealth monitoring and patient support with supplies as needed for 12 months. All patient contact were completed remotely. Results Out of 603 patients diagnosed with insomnia and offered dCBT-I, 350 enrolled in treatment (58.0%) and 253 (42.0%) were still in progress or lost to follow-up. Those enrolled in treatment (M=50.3 years) were significantly older relative to those still in progress or lost to follow-up (M=45.6 years), p<.05. Among those enrolled in treatment, 89 (25.4%) received dCBT-I only, 105 (30.0%) received dCBT-I and PAP, and 156 (44.6%) received PAP only. Patients who received both dCBT-I and PAP (M=52.5 years) were significantly older than patients who received dCBT-I only (M=48.4 years), p<.05. No significant differences were found on gender or ethnicity. Conclusion Preliminary findings support the feasibility of a fully-connected value-based sleep service featuring dCBT-I and PAP delivered using virtual care. Specifically, the findings indicate the potential use of dCBT-I concurrently with PAP, which could be particularly important for improving outcomes in older patients with comorbid insomnia and sleep apnea (COMISA). Support (if any) Funding was provided by Nox Health.