A Pilot Randomized Trial of Combined Cognitive-Behavioral Therapy and Exercise Training Versus Exercise Training Alone for the Management of Chronic Insomnia in Obstructive Sleep Apnea

Abstract

Rationale: Among individuals with obstructive sleep apnea, about 38% will present with comorbid chronic insomnia. Comorbid chronic insomnia and obstructive sleep apnea (COMISA) is associated with poorer daytime functioning and increased morbidity compared to either disorder alone. The treatment of insomnia among individuals with COMISA is suboptimal. Objectives: To assess the effects of an exercise-training intervention alone as well as a combined cognitive behavioral therapy and exercise training on insomnia symptoms in individuals with COMISA. Methods: In a pilot randomized-controlled trial, 19 individuals with COMISA were allocated to one of two arms, each comprising of 2 phases of 8 weeks. The first phase examined the effects of exercise training versus relaxation training on insomnia severity and cardiorespiratory fitness. The second phase compared changes in Insomnia Severity Index (ISI) following exercise training alone (EX) or combined Cognitive Behavioural Therapy for Insomnia and exercise training (CBTi-EX). Self-reported insomnia severity, objective sleep parameters during overnight polysomnography, and cardiopulmonary fitness were collected at baseline, 8 and 16 weeks. Results: Exercise training increased VO2peak and reduced insomnia severity (Hedges g = 0.82) when compared to relaxation training. Moreover, combined CBTi and exercise training yielded a larger improvement in insomnia severity (Hedges g =1.48) than exercise training alone (EX). We observed no change in objective sleep measures in both groups. Conclusions: Exercise training leads to moderate improvements in insomnia severity in individuals with COMISA. Combining exercise training with CBTi leads to larger reductions in insomnia symptoms, with effect sizes similar to the effects of CBTi alone in other populations with chronic insomnia.

Tailoring cognitive behavioural therapy for insomnia across contexts, conditions, and individuals: What do we know, where do we go?

“…Adjustments to sleeping environment were made for people with schizophrenia (Waite et al, 2016). CBT‐I has also been augmented with an exercise training programme for people with comorbid OSA (Cammalleri et al, 2023).…”