Associations among Chronic Obstructive Pulmonary Disease and Sleep-Disordered Breathing in an Urban Male Working Population in Japan

Abstract

Background: There are few reports about sleep disturbances in patients with chronic obstructive pulmonary disease (COPD) in Asian countries. Objectives: To investigate the associations between sleep-disordered breathing (SDB) with hypoxemia and sleep quality, including sleep duration, in patients with COPD, we measured SDB and sleep quality including the objective sleep duration determined by an actigraph and portable monitoring. Methods: A cross-sectional epidemiological health survey of 303 male employees (means ± SD: age 43.9 ± 8.2 years; BMI 24.0 ± 3.1) was conducted. Sleep quality was measured using the Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI). A respiratory disturbance index (RDI) ≥5 indicated SDB. Results: Nineteen subjects (6.3%) had COPD. Among these, 11 (3.6%) had COPD with SDB (overlap syndrome). Sleep duration, ESS, and PSQI scores were not significantly different between COPD patients and normal control subjects. However, COPD patients had significantly longer sleep latency (p = 0.019), a lower sleep efficiency (p = 0.017), and a higher sleep fragmentation index (p = 0.041) and average activity (p = 0.0097) during sleep than control subjects. They also had a significantly higher RDI and more severe desaturation during sleep than control subjects (p < 0.01). The differences remained after adjustment for age and BMI but disappeared following adjustment for RDI. Conclusions: COPD patients with even mild-to-moderate airflow limitations had nocturnal desaturation and RDI-related impaired sleep quality without significant symptoms.

Chronic Obstructive Pulmonary Disease and Diabetes Mellitus: A Systematic Review of the Literature

“…Treatment of COPD involves lifestyle modifications as well as the use of pharmacotherapies including bronchodilators and corticosteroids for AECOPD. Notably, COPD is known to be associated with several important chronic comorbid diseases, including hypertension, cardiovascular disease, obstructive sleep apnea and type-2 diabetes mellitus (T2DM) which are already partially interrelated [2,3,4,5,6]. …”

Overcoming sleep disordered breathing and ensuring sufficient good sleep time for a healthy life expectancy

“…We have reported on Japanese with several diseases and OSA in a small cohort (n = 300). 9 , 86 , 87 , 90 – 92 ) Now Kyoto University is doing a large genetic cohort study: the Nagahama Cohort Study (n = 10,000). The Nagahama City, which has 120,000 peoples, is located middle in Japan near the Biwa Lake.…”

“…The Nagahama City, which has 120,000 peoples, is located middle in Japan near the Biwa Lake. Using an accelerometer (Actigraphy ® ) and pulse oximetry as in previous studies, 9 , 86 , 87 , 90 – 92 ) we have measured SDB with intermittent hypoxemia, objective and subjective sleep duration, and many health-related parameters along with the genetic data.…”

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“…Although actigraphs have become an important tool for the direct assessment of COPD patients [11] , the ability of these devices to measure sleep quality in this population is unclear. Despite an increased effort to use actigraphs to diagnose sleep disturbance in patients with conditions such as COPD, their usage remains controversial because they tend to misclassify quiescent wakefulness as sleep (especially in those with fragmented sleep) [12] , and the challenges in optimizing the duration of consecutive immobile and active minutes for sleep onset and end, respectively. Only two studies used an actigraph to either characterize sleep abnormalities in COPD [11] , or to customize the scoring settings [13] .…”