Sleep quality in COPD patients: correlation with disease severity and health status

Abstract

Objective: To evaluate clinical predictors of poor sleep quality in COPD patients with and without obstructive sleep apnea (OSA). Methods: Consecutive stable patients with COPD were evaluated for OSA by means of overnight polysomnography; for sleep quality by means of the Pittsburgh Sleep Quality Index (PSQI); and for disease impact by means of the COPD Assessment Test. COPD severity was graded in accordance with the 2020 GOLD guidelines. Predictors of poor sleep quality were evaluated by multivariate logistic regression analysis. Results: We studied 51 patients with COPD alone and 51 patients with COPD and OSA. Both groups had similar age (66.2 ± 9.2 years vs. 69.6 ± 10.7, p = 0.09) and airflow limitation (p = 0.37). Poor sleep quality was present in 74.8% of the study participants, with no significant difference between COPD patients with and without OSA regarding PSQI scores (p = 0.73). Polysomnography showed increased stage 1 non-rapid eye movement sleep and arousal index, as well as reduced sleep efficiency and stage 3 non-rapid eye movement sleep, in the group of patients with COPD and OSA (p < 0.05). Independent predictors of poor sleep quality were GOLD grade C/D COPD (OR = 6.4; 95% CI, 1.79-23.3; p < 0.01), a COPD Assessment Test score = 10 (OR = 12.3; 95% CI, 4.1-36.5; p < 0.01), and lowest SaO2 < 80% (p < 0.0001). Conclusions: Poor sleep quality is quite common in patients with COPD and is associated with severe COPD and poor health status, having a negative impact on overall quality of life. Despite changes in polysomnography, OSA appears to have no impact on subjective sleep quality in COPD patients. Keywords: Pulmonary disease, chronic obstructive; Sleep Quality; Sleep apnea, obstructive; Health status.

Effect of an 8-week physical exercise program on functional physical fitness and quality of life in elderly people with Chronic Obstructive Pulmonary Disease residing at high altitude

“…The SpO 2 level is considered an assessment measure of lung function and cardiorespiratory stability in people with respiratory disease [28]. In our study, we found that the SpO 2 percentage at rest in people with COPD residing at high altitudes is notably lower (85 ± 1.2) than those reported in previous publications, in which resting values were higher than 90% [29][30][31]. This difference would irreversibly alter the pulmonary diffusion of O 2 in COPD patients living at altitude due to the decrease in barometric pressure leading to an environmental and alveolar PO 2 reduction [32].…”

Effects of non-invasive ventilation on sleep in chronic hypercapnic respiratory failure

“…Many patients with severe COPD complain of 'poor sleep', with 50%-80% of patients reporting sleep disturbance. [13][14][15][16][17] However, despite this high prevalence, there are limited data detailing sleep fragmentation and quality in COPD. 18 In patients with COPD, any regular physiological changes to ventilation during sleep are exaggerated due to the underlying pathophysiology.…”

“…28 Poor sleep in COPD has been associated with increased peripheral airway resistance, 29 and the presence of comorbid OSA in patients with COPD can result in worse subjective 14 and objective sleep efficiency. 15 Over the past two decades, interest in the provision of domiciliary NIV for the treatment of chronic respiratory failure in COPD has increased. Two recent landmark studies resulted in conditional recommendations in the most recent European Respiratory Society guidelines 30 for the addition of domiciliary NIV to oxygen therapy in patients with COPD with persistent shortterm hypercapnia following a severe exacerbation of COPD, 31 and in stable patients with COPD with chronic respiratory failure.…”