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）是一种进行性肺病，在 老兵肺康复包括运动训练和自我管理教育， 建议作为COPD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，促进健康行为改变。虽然失眠是 常见的是患有COPD的退伍军人，肺康复的自我管理教育部分 没有解决睡眠问题，因此可能解释了肺移植后睡眠缺乏改善的原因。 康复活动. Inflammatory可以显著影响肺康复的预期治疗目标，因为它 已发现与日常生活活动（ADL）的限制，较低的身体活动水平， 生活质量差，COPD症状加重，运动能力下降。鉴于睡眠不是 作为肺康复的一部分，未经治疗的失眠可能部分导致质量下降， 生活和运动能力以及缺乏日常活动的增加，经常报告肺部感染后 康复活动.在接受肺动脉高压治疗的COPD患者中实施失眠特异性治疗 康复可能会导致睡眠的改善，这可能有助于维持睡眠质量的提高。 生活和运动能力，并提高肺康复后的日常活动水平。认知- 失眠的行为疗法（CBT-I）不仅可以改善失眠的睡眠特异性症状， 改善生活质量，减少ADL限制，并改善疾病特异性症状。我们推测 CBT-I作为COPD失眠患者家庭肺康复的辅助治疗， 改善睡眠质量，促进实现最佳和持久的功能结果 肺康复后。为了验证这一假设，我们将进行一项随机对照试验， COPD和失眠的退伍军人参加了以家庭为基础的肺康复， 康复，肺康复后和6个月随访，以测试基于互联网的CBT的影响- 我在家庭肺康复期间对相对于家庭的睡眠和健康相关功能的影响 只做肺康复我们还研究了睡眠是否介导了治疗对健康的影响- 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.