{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T03:38:55Z","timestamp":1792813135116,"version":"4.5.0"},"reference-count":58,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"vor","delay-in-days":91,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"name":"University of Washington Division of Pulmonary, Critical Care, and Sleep Medicine","id":[{"id":"https:\/\/ror.org\/00cvxb145","id-type":"ROR","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","award":["5T32HL007287-45"],"award-info":[{"award-number":["5T32HL007287-45"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["1U01HL128868"],"award-info":[{"award-number":["1U01HL128868"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Network Management Core for the Pulmonary Trials Cooperative"},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["U01HL128954"],"award-info":[{"award-number":["U01HL128954"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000738","name":"Veterans Affairs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Puget Sound Health Care System, Birmingham VA Medical Center","id":[{"id":"https:\/\/ror.org\/0242qs713","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Buffalo VA Medical Center","id":[{"id":"https:\/\/ror.org\/00jbkk316","id-type":"ROR","asserted-by":"crossref"}]},{"name":"VA Boston Healthcare System, Minneapolis VA Health Care System","id":[{"id":"https:\/\/ror.org\/02ry60714","id-type":"ROR","asserted-by":"crossref"}]},{"name":"VA St Louis Health Care System","id":[{"id":"https:\/\/ror.org\/04qmkfe11","id-type":"ROR","asserted-by":"crossref"}]},{"name":"White River Junction VA Medical Center","id":[{"id":"https:\/\/ror.org\/02et65004","id-type":"ROR","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000738","name":"Department of Veterans Affairs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.atsjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To test whether a self-directed lifestyle program improves 6-minute walk test (6MWT) distance among individuals with COPD and comorbid sleep apnea.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design and Methods<\/jats:title>\n                    <jats:p>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\u2009m). 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>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\u2009m, 95% CI 8.2\u2009m to 42.9\u2009m; 23.4% vs 20.1% had a MID increase in 6MWT distance) and had a greater reduction in weight (difference in weight of \u22122.4\u2009kg, 95% CI \u22123.9 to \u22120.9\u2009kg; 36.2% vs 23.6% had a 3% reduction in weight) at 12\u2009months. 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\u2009months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among patients with COPD and sleep apnea, a self-directed video-based weight management program led to favorable changes in 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.<\/jats:p>\n                    <jats:p>Clinical trial registered with www.clinicaltrials.gov (NCT 02634268).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1513\/annalsats.202504-410oc","type":"journal-article","created":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T20:13:14Z","timestamp":1761336794000},"page":"419-428","update-policy":"https:\/\/doi.org\/10.1164\/crossmarkpolicies","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.1093","volume":"23","author":[{"given":"Aristotle G","family":"Leonhard","sequence":"first","affiliation":[{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington , Seattle, WA,","place":["United States"]},{"name":"Health Systems Research, Veterans Affairs Puget Sound Healthcare System, Seattle Division , Seattle, WA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Coggeshall","sequence":"additional","affiliation":[{"name":"Health Systems Research, Veterans Affairs Puget Sound Healthcare System, Seattle Division , Seattle, WA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Gleason","sequence":"additional","affiliation":[{"name":"Health Systems Research, Veterans Affairs Puget Sound Healthcare System, Seattle Division , Seattle, WA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Collins","sequence":"additional","affiliation":[{"name":"Health Systems Research, Veterans Affairs Puget Sound Healthcare System, Seattle Division , Seattle, WA,","place":["United 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