A cross-sectional survey of night-time symptoms and impact of sleep disturbance on symptoms and health status in patients with COPD

Abstract

BackgroundSleep disturbance has been termed the forgotten dimension of chronic obstructive pulmonary disease (COPD), but it is clinically important as most patients are affected. This study examined the incremental burden of illness associated with sleep disturbance in COPD, with reference to health status and disease impact, and the degree of concordance between physicians and patients in reporting night-time COPD symptoms.MethodsReal-world data from >2,500 patients with COPD consulting for routine care were derived from respiratory Disease-Specific Programs conducted in Europe, the USA, and China. Night-time COPD symptom burden was assessed from patient and physician perspectives. Patients completed the Jenkins Sleep Evaluation Questionnaire (JSEQ), COPD assessment test (CAT), and EuroQol five-dimension questionnaire (EQ-5D). A regression approach was used to analyze the relationship between sleep disturbance (JSEQ score) and health status (EQ-5D score), adjusting for confounding variables.ResultsFrequency of night-time symptoms was high and was higher when reported by patients than physicians (69.7% and 65.7%, respectively). According to the JSEQ, 73.3% of patients had trouble falling asleep, 75.3% experienced night-time awakenings, 70.6% had trouble staying asleep, and 67.7% woke after a usual amount of sleep feeling worn out. Over half (52.7%) of patients received maintenance treatment where night-time symptom relief was stated by the physician as a treatment aim. A one unit increase in JSEQ score was associated with increased CAT score (0.7 units in Europe and the USA; 0.2 units in China). Sleep disturbance was significantly associated with worse health status (odds ratio [OR]: 1.27, 95% confidence interval [CI]: 1.18, 1.36, P<0.001 for Europe; OR: 1.23, 95% CI: 1.12, 1.38, P<0.001 for the USA; and OR: 1.19, 95% CI: 1.10, 1.28, P<0.001 for China).ConclusionsNight-time symptoms and sleep disturbance are common among patients with COPD, and sleep disturbance has a detrimental impact on COPD symptoms and health status.

The quality of life in Chinese population with chronic non-communicable diseases according to EQ-5D-3L: a systematic review

“…The AHRQ checklist score ranged from 4 to 10 points, median score was 7 points, while mode was 7 (details in Appendix Table 4 ). There was no study of a low quality, while 29 studies were of median quality [ 29 – 31 , 33 – 37 , 39 – 42 , 45 – 52 , 54 , 55 , 57 – 59 , 61 , 62 , 64 , 65 ] and 9 were of high quality [ 28 , 32 , 38 , 43 , 44 , 53 , 56 , 60 , 63 ].…”

“…The health utility values for COPD patients ranged from 0.64 to 0.80 in four studies [ 36 , 42 – 44 ]. The lowest value was calculated by UK value set [ 43 ]; however, the study that reported highest value did not describe the value set applied [ 44 ]. Patients with the highest value had a younger mean age and better post-bronchodilator FEV 1 of predicted than the lowest one.…”

Prevalence and associated factors of poor sleep quality among Chinese older adults living in a rural area: a population-based study

“…Nighttime symptoms are usually common among patients with COPD, including trouble falling asleep, experienced nighttime awakenings, trouble staying asleep, and woke after a usual amount of sleep feeling worn out [43].…”

Once-daily single-inhaler versus twice-daily multiple-inhaler triple therapy in patients with COPD: lung function and health status results from two replicate randomized controlled trials

“…This suggestion that FF/UMEC/VI may provide better protection against lung function deterioration is further supported by the lower proportion of patients experiencing a clinically important deterioration in trough FEV 1 of ≥100 mL with FF/UMEC/VI compared with BUD/FOR+TIO. Nighttime disturbances in patients with COPD are frequently reported, with over 65% of patients experiencing sleep disturbance owing to their symptoms [32,33]. These nighttime disturbances are associated with patients having worse health status and worsening of COPD symptoms compared with patients who do not experience sleep disturbance [33].…”