Enhancing pulmonary rehabilitation in veterans with chronic obstructive pulmonary disease through internet-based cognitive-behavioral treatment for insomnia

慢性阻塞性肺疾病(COPD)是一种进行性肺部疾病，在 退伍军人。结合运动训练和自我管理教育的肺康复是 建议作为慢性阻塞性肺疾病的标准管理，旨在通过以下方式增加日常活动和生活质量 改善症状和运动耐量，促使健康行为改变。虽然失眠是 常见的是患有COPD的退伍军人，这是肺康复的自我管理教育组成部分 没有解决睡眠问题，因此可能解释了肺源性肺炎后睡眠缺乏改善的原因 康复。失眠会大大影响肺康复的预期治疗目标，因为它 已被发现与日常生活能力(ADL)受限、体力活动水平较低、 生活质量差，COPD症状加重，运动能力下降。鉴于睡眠并不是 作为肺康复的一部分，未经治疗的失眠可能是质量下降的部分原因 生活和运动能力下降以及缺乏日常活动常见于肺源性心脏病后 康复。慢性阻塞性肺疾病肺手术患者实施失眠特效性治疗 康复可能导致睡眠的改善，这可能有助于保持睡眠质量的提高 在肺康复后，提高生活和运动能力，提高日常活动水平。认知型- 失眠行为疗法(CBT-I)不仅可以改善失眠的睡眠特异性症状，而且还可以 改善生活质量，减少ADL限制，并改善特定条件的症状。我们假定 CBT-I作为COPD失眠患者家庭肺康复的辅助工具将导致 睡眠质量的改善将有助于实现最佳和持久的功能结果 在肺部康复之后。为了验证这一假设，我们将进行一项随机对照试验 患有COPD和失眠的退伍军人在家庭肺康复中进行肺前评估 康复、肺后康复和6个月的随访，以测试基于互联网的CBT的影响- I居家肺康复期间睡眠与健康相关功能相对居家的影响 仅限肺部康复。我们还研究了睡眠是否会调节治疗对健康的影响-- 相关功能。

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.