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

Insomnia treatment among individuals with comorbid insomnia and obstructive sleep apnea is suboptimal. In a pilot randomized controlled trial, 19 individuals with comorbid insomnia and obstructive sleep apnea were allocated to one of two arms: EX + EX, consisting of two 8-week phases of exercise training (EX), or RE + CBTiEX, encompassing 8 weeks of relaxation training (RE) followed by 8 weeks of combined cognitive-behavioral therapy and exercise (CBTiEX). Outcomes included Insomnia Severity Index (ISI), polysomnography, and cardiorespiratory fitness measures. A mixed-model analysis of variance revealed a Group x Time interaction on peak oxygen consumption change, F(1, 14) = 10.1, p= .007, and EX increased peak oxygen consumption (p= .03, g ' = -0.41) and reduced ISI (p= .001, g ' = 0.82) compared with RE (p= .49, g= 0.16) post-8 weeks. Post-16 weeks, there was a significant Group x Time interaction (p = .014) driven by RE + CBTiEX yielding a larger improvement in ISI (p= .023, g ' = 1.48) than EX + EX (p= .88, g ' < 0.1). Objective sleep was unchanged. This study showed promising effects of regular EX alone and combined with cognitive-behavioral therapy for insomnia on ISI in comorbid insomnia and obstructive sleep apnea.