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
Bibliographic record
Abstract
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 VO 2peak 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. Clinical Trial information “ Cognitive behavioural therapy combined with exercise training for adults with both insomnia and obstructive sleep apnea ” - ( https://doi.org/10.1186/ISRCTN63989489 )
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.004 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.003 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.010 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".