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 × 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 × 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.

Group-based trajectories and predictors of adherence to physical distancing during the COVID-19 pandemic.

Objective: This study sought to identify psychosocial predictors of trajectories of adherence to physical distancing alongside changes in public health measures during the COVID-19 pandemic. Design: A three-time point longitudinal survey during the first two waves of the COVID-19 pandemic. Methods: Participants (N = 1003) completed self-report measures of adherence to physical distancing over an 8-month period at the start (T1) and end (T2) of the first wave of the pandemic, and the start of the second wave of the pandemic (T3). Participants also completed measures of their health beliefs related to the self and others, social norms, emotional distress, and sociodemographic characteristics. Results: Using group-based trajectory modeling, four trajectories of adherence to physical distancing emerged: a high-adherence trajectory, a slow-declining trajectory, a fluctuating trajectory, and a fast-declining trajectory. The most important psychosocial predictors of poorer adherence trajectories included perceptions of lower self-efficacy and higher barriers to adherence, as well as lower prosocial attitudes towards physical distancing. Conclusion: Public health messages targeting these factors may be most relevant to promote sustained adherence to physical distancing over time in the context of a pandemic.

Socio-demographic, social, cognitive, and emotional correlates of adherence to physical distancing during the COVID-19 pandemic: a cross-sectional study.

OBJECTIVES: In order for physical distancing directives to be effective at lowering and flattening the epidemic peak during a pandemic, individuals must adhere to confinement guidelines. Recent reviews highlight the paucity of research on empirical correlates of adherence to physical distancing and quarantine directives. METHODS: In this cross-sectional study, 1003 individuals were recruited using quota sampling to form a sample approximately representative of the population of Quebec (Canada) in terms of age, gender, and urbanicity. Participants completed an online survey on adherence to physical distancing during the COVID-19 pandemic. This survey evaluated socio-demographic, health, cognitive, emotional, and social factors related to physical distancing. RESULTS: Individuals aged 70 and older (OR = 1.67, 95% CI = 1.04-2.67), women (OR = 1.35, 95% CI = 1.02-1.79), and those who were not essential workers (OR = 3.28, 95% CI = 2.24-4.81) reported more physical distancing. Injunctive personal norms (OR = 1.67, 95% CI = 1.23-2.31), perceived benefits of physical distancing to others (OR = 1.47, 95% CI = 1.12-1.93), and descriptive social norms (OR = 1.26, 95% CI = 1.04-1.52) were independent predictors of adherence status. Individuals adhered more to physical distancing if they believed that it was their civic duty to do so and that physical distancing helped protect others, and if they perceived that most other people were following these directives. In contrast, perceived personal risk and emotional factors were not independently related to physical distancing. CONCLUSION: These results highlight the importance of health beliefs and perceived social norms in shaping responses to physical distancing directives. These findings offer insights into ways to frame public health communications to promote physical distancing during a pandemic.

RéSUMé: OBJECTIFS: Afin d'assurer l'efficacité des directives de distanciation physique à aplatir la courbe épidémique lors d'une pandémie, les membres de la communauté doivent respecter les règles de confinement. Des revues de la littérature mettent en évidence le manque de données empiriques sur les corrélats de l'adhérence aux directives de distanciation physique et de quarantaine. MéTHODES: Dans cette étude transversale, 1 003 individus ont été recrutés en utilisant une méthode d'échantillonnage par quota afin de constituer un échantillon approximativement représentatif de la population du Québec, Canada, en termes d'âge, de genre, et de ruralité. Les participants ont complété une enquête en ligne sur l'adhérence à la distanciation physique durant la pandémie de la COVID-19. Cette enquête a évalué l'association entre l'adhérence à la distanciation physique et les facteurs sociodémographiques, médicaux, cognitifs, émotionnels, et sociaux. RéSULTATS: Les individus âgés de 70 ans et plus (RC = 1,67, IC95% = 1,04­2,67), les femmes (RC = 1,35, IC95% = 1,02­1,79) et ceux qui n'étaient pas des travailleurs essentiels (RC = 3,28, IC95% = 2,24­4,81) ont rapporté plus de distanciation physique. Les normes injonctives personnelles (RC = 1,67, IC95% = 1,23­2,31), la perception de bénéfices de la distanciation physique pour les autres (RC = 1,47, IC95% = 1,12­1,93), et les normes sociales descriptives (RC = 1,26, IC95% = 1,04­1,52) étaient des facteurs prédictifs indépendants de l'adhérence. L'adhérence à la distanciation physique était plus probable chez les individus qui croyaient qu'il était de leur devoir civique de respecter les directives et que la distanciation physique aidait à protéger les autres, et qui percevaient que la plupart des autres personnes respectaient aussi ces directives. La perception du risque personnel et les facteurs émotionnels n'étaient pas associés de façon indépendante à la distanciation physique. CONCLUSION: Ces résultats soulignent l'importance des croyances sur la santé et des normes sociales perçues dans la réponse aux directives de distanciation physique. Ces résultats suggèrent différentes façons d'optimiser la présentation des communications de santé publique afin de promouvoir la distanciation physique lors d'une pandémie.