The Effect of a Nurse-Led Hybrid Pulmonary Rehabilitation Program on Sleep Quality in Patients with Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is frequently accompanied by sleep-related problems resulting from persistent respiratory dysfunction, which can markedly impair patients’ quality of life, self-care capacity, and functional independence. Pulmonary rehabilitation, the most effective nonpharmacological intervention, may improve clinical outcomes in these patients when delivered with guidance from rehabilitation nurses. Objectives: This trial aimed to evaluate the effectiveness of a nurse-led hybrid pulmonary rehabilitation program in improving sleep quality among patients with COPD. Methods: This randomized controlled study was conducted at the Pulmonary Clinic of Masih Daneshvari Hospital in Tehran, Iran, between November 2024 and April 2025. Using block randomization, 50 patients with COPD were recruited through convenience sampling and randomly allocated to intervention and control groups, with 25 participants in each group. Data were collected using a demographic data form and the Pittsburgh Sleep Quality Index (PSQI). The control group received conventional treatment, whereas the intervention group received a 4-week nurse-led pulmonary rehabilitation program delivered in 3 sessions via a hybrid approach that combined in-person and online sessions with ongoing monitoring. Data were analyzed using SPSS version 26, change analysis, the Mann-Whitney U test, independent and paired t-tests, and analysis of covariance. Results: At baseline, no differences in sleep quality were observed between the intervention and control groups (P > 0.05). After the intervention, PSQI scores in the intervention group decreased significantly from 10.56 ± 4.84 to 4.84 ± 3.26 (P < 0.001), indicating a marked improvement in sleep quality; however, no significant change was observed in the control group (P = 0.432). Postintervention analysis showed a significant between-group difference (P < 0.001), with a very large effect size (Cohen d = 3.60). After adjustment for baseline values using analysis of covariance, the between-group difference in posttest PSQI scores remained significant (F = 80.78, P < 0.001), with a large effect size (partial eta squared = 0.632). Conclusions: This randomized controlled trial demonstrated that a 4-week nurse-led pulmonary rehabilitation program resulted in a statistically significant improvement in sleep quality scores among patients with COPD. The structured intervention, which included continuous monitoring and a hybrid delivery model, was effective. These findings suggest that incorporating targeted rehabilitation programs into clinical practice may improve the management of sleep disturbances in this population.