Enhancing pulmonary rehabilitation in veterans with chronic obstructive pulmonary disease through internet-based cognitive-behavioral treatment for insomnia
Project Number1I01RX003513-01A1
Former Number1I01RX003513-01
Contact PI/Project LeaderLUYSTER, FAITH S
Awardee OrganizationVETERANS HEALTH ADMINISTRATION
Description
Abstract Text
Chronic obstructive pulmonary disease (COPD) is a progressive lung disease that is highly prevalent among
veterans. Pulmonary rehabilitation which incorporates exercise training and self-management education is
recommended as standard management for COPD and aims to increase daily activity and quality of life through
improvement in symptoms and exercise tolerance and prompting health behavior change. Although insomnia is
common is veterans with COPD, the self-management education component of pulmonary rehabilitation does
not address sleep, thus potentially explaining the lack of improvement in sleep following pulmonary
rehabilitation. Insomnia can substantially impact the intended treatment goals of pulmonary rehabilitation as it
has been found to be associated with limitations in activities of daily living (ADL), lower levels of physical activity,
poor quality of life, greater COPD symptoms, and reduced exercise performance. Given that sleep is not
addressed as part of pulmonary rehabilitation, untreated insomnia may partly account for the declines in quality
of life and exercise capacity and absence of increased daily activity often reported following pulmonary
rehabilitation. Implementing an insomnia-specific treatment in COPD patients undergoing pulmonary
rehabilitation is likely to lead to improvements in sleep that could facilitate maintenance of gains in quality of
life and exercise capacity and enhance daily activity levels following pulmonary rehabilitation. Cognitive-
behavioral therapy for insomnia (CBT-I) not only improves sleep-specific symptoms of insomnia but also
improves quality of life, reduces ADL limitations, and improves condition-specific symptoms. We postulate that
CBT-I as an adjunct to home-based pulmonary rehabilitation for COPD patients with insomnia will lead to
improvement in sleep quality that will facilitate achievement of optimal and enduring functional outcomes
following pulmonary rehabilitation. To test this hypothesis, we will conduct a randomized controlled trial of
veterans with COPD and insomnia enrolled in home-based pulmonary rehabilitation assessed pre-pulmonary
rehabilitation, post-pulmonary rehabilitation and at 6-month follow-up to test the impact of Internet-based CBT-
I during home-based pulmonary rehabilitation on sleep and health-related functioning relative to home-based
pulmonary rehabilitation only. We also examine whether sleep mediates the effects of treatment on health-
related functioning.
Public Health Relevance Statement
Veterans with chronic obstructive pulmonary disease (COPD) are a vulnerable group for developing insomnia,
with about 37% having comorbid insomnia. Pulmonary rehabilitation is a key component of COPD management,
yet it does not address sleep. Comorbid insomnia may interfere with veterans achieving maximum benefits from
pulmonary rehabilitation. Implementing an insomnia-specific treatment in veterans with COPD undergoing
pulmonary rehabilitation will likely lead to improved sleep that could help improve and sustain the benefits
gained from pulmonary rehabilitation. We propose a randomized clinical trial to compare the effects of Internet-
based cognitive-behavioral therapy for insomnia plus home-based pulmonary rehabilitation versus home-based
pulmonary rehabilitation only on sleep and health-related functioning.
NIH Spending Category
No NIH Spending Category available.
Project Terms
2019-nCoVAchievementActivities of Daily LivingBehaviorBeliefChronicChronic Obstructive Airway DiseaseCognitive TherapyComorbid InsomniaDisease ManagementEducationEnrollmentEnsureExerciseExercise ToleranceExposure toFatigueGoalsHealthHealth behavior changeHomeInternetInterventionLeadLightLungLung diseasesMaintenanceMeasuresMediatingMorbidity - disease rateOutcomePatient Self-ReportPatientsPerformancePhysical activityQuality of lifeQuestionnairesRandomizedRandomized Clinical TrialsRandomized Controlled TrialsReportingRiskSelf ManagementSeveritiesSleepSleep DisordersSleeplessnessSpirometrySymptomsSystemTestingTransportationUnited States Department of Veterans AffairsVeteransVulnerable PopulationsWalkingWorkactigraphybarrier to carebasecare deliverycomparative efficacycostdaily functioningdiariesexercise capacityexercise trainingfollow-upfunctional outcomeshealth care service utilizationimprovedindexinginnovationmultidisciplinaryprimary outcomepulmonary functionpulmonary rehabilitationremote deliveryrespiratorysecondary outcomesleep healthsleep qualitytelehealthtreatment effecttreatment program
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