Journal article
Effect of a Self Directed Lifestyle-based Weight Management Program among Patients with Comorbid COPD and Sleep Apnea: A Secondary Analysis of the INSIGHT COPD Trial
Annals of the American Thoracic Society, Vol.23(3), pp.419-428
03/2026
DOI: 10.1513/AnnalsATS.202504-410OC
PMCID: PMC13048511
PMID: 41135051
Abstract
Excess weight contributes to impaired physical function among individuals with chronic obstructive pulmonary disease (COPD) and sleep apnea. Self-directed lifestyle-based weight management programs are an accessible option to promote weight loss and improve physical function, but their effectiveness has not been clearly demonstrated.
To test whether a self-directed lifestyle program improves 6-minute walk test (6MWT) distance among individuals with COPD and comorbid sleep apnea.
We performed a subset analysis of participants previously enrolled in the INSIGHT-COPD randomized clinical trial (low-intensity lifestyle intervention vs. usual care) who self-reported a diagnosis of sleep apnea. Our primary outcome was between-group differences for change in 6MWT distance (minimally important difference [MID] 30 m). Secondary outcomes included between-group differences in weight (a loss of 3% defines meaningful reduction) and quality of life (SF-12 Physical Component Score [PCS], MID 3-3.5 points). We also tested whether sleep apnea modified the effect of the intervention across the entire INSIGHT-COPD population.
Among 285 participants with sleep apnea (141 randomly allocated to intervention, 144 to usual care), those randomized to intervention could walk further (difference in 6MWT distance of 25.5 m, 95% CI 8.2 m to 42.9 m; 23.4% vs. 20.1% had a MID increase in 6MWT distance) and had a greater reduction in weight (difference in weight of -2.4 kg, 95% CI -3.9 to -0.9 kg; 36.2% vs 23.6% had a 3% reduction in weight) at 12 months. The intervention group also reported a greater physical-function related quality-of-life (difference in SF-12 PCS of 1.78 pts, 95% CI 0.10 to 3.49) in comparison to usual care at 12 months.
Among patients with COPD and sleep apnea, a self-directed video-based weight management program led to favorable changes 6MWT distance compared to usual care, though this did not meet the threshold of a clinically important improvement. However, fewer participants in the intervention group saw a decline in 6MWT distance, and more achieved meaningful weight loss. To effectively improve function in this population, additional interventions beyond self-directed weight management will be necessary.
Details
- Title: Subtitle
- Effect of a Self Directed Lifestyle-based Weight Management Program among Patients with Comorbid COPD and Sleep Apnea: A Secondary Analysis of the INSIGHT COPD Trial
- Creators
- Aristotle G Leonhard - University of WashingtonScott Coggeshall - VA Puget Sound Health Care SystemEmily Gleason - VA Puget Sound Health Care SystemMargaret Collins - VA Puget Sound Health Care SystemIgor Barjaktarevic - University of California, Los AngelesRebecca Bascom - Penn State Milton S. Hershey Medical CenterJessica Bon - Wake Forest UniversityAlejandro P Comellas - University of IowaPhilip T Diaz - The Ohio State UniversityNicola A Hanania - Baylor College of MedicineMeiLan K Han - Michigan MedicineNadia N Hansel - Johns Hopkins UniversityTravis Hee Wai - University of Puget SoundJerry A Krishnan - University of Illinois ChicagoStephen C Lazarus - University of California, San FranciscoJun Ma - University of Illinois ChicagoVeeranna Maddipati - East Carolina UniversityM Jeffery Mador - University at Buffalo, State University of New YorkBarry J Make - National Jewish HealthCharlene E McEvoy - HealthPartnersCatherine Meldrum - Michigan MedicineMark W Millard - Baylor University Medical CenterMarilyn L Moy - Harvard UniversityCheryl S Pirozzi - University of UtahRobert Plumley - VA Puget Sound Health Care SystemLoretta G Que - Duke Medical CenterRobert M Reed - Sinai HospitalFrank C Sciurba - University of PittsburghSanjay Sethi - Jacobs (Spain)Paul F Simonelli - Geisinger Medical CenterKaharu Sumino - Washington University in St. LouisAnupama Tiwari - Albany Medical Center HospitalKirk Voelker - Sarasota Memorial HospitalChristine H Wendt - Minneapolis VA Health Care SystemStephen R Wisniewski - University of PittsburghDavid H Au - VA Puget Sound Health Care SystemLucas M Donovan - University of WashingtonLaura C Feemster - University of Washington
- Resource Type
- Journal article
- Publication Details
- Annals of the American Thoracic Society, Vol.23(3), pp.419-428
- DOI
- 10.1513/AnnalsATS.202504-410OC
- PMID
- 41135051
- PMCID
- PMC13048511
- NLM abbreviation
- Ann Am Thorac Soc
- ISSN
- 2329-6933
- eISSN
- 2325-6621
- Publisher
- American Thoracic Society
- Grant note
- Puget Sound Health Care System, Birmingham VA Medical CenterWhite River Junction VA Medical CenterNetwork Management Core for the Pulmonary Trials CooperativeNational Heart, Lung, and Blood Institute: 1U01HL128868 Veterans AffairsVA St Louis Health Care SystemBuffalo VA Medical CenterUniversity of Washington Division of Pulmonary, Critical Care, and Sleep MedicineNIHDepartment of Veterans AffairsVA Boston Healthcare System, Minneapolis VA Health Care System
A.G.L. received support during the period of this work from an NIH T32 training grant through the University of Washington Division of Pulmonary, Critical Care, and Sleep Medicine (NIH 5T32HL007287-45).
- Language
- English
- Electronic publication date
- 10/24/2025
- Date published
- 03/2026
- Academic Unit
- Pulmonary, Critical Care, and Occupational Medicine; ICTS; Internal Medicine
- Record Identifier
- 9985019045602771
Metrics
27 Record Views