Impaired Sleep Quality in COPD Is Associated With Exacerbations

Abstract

BACKGROUND: COPD increases susceptibility to sleep disturbances, which may in turn predispose to increased respiratory symptoms. The objective of this study was to evaluate, in a population-based sample, the relationship between subjective sleep quality and risk of COPD exacerbations. METHODS: Data were obtained from the Canadian Cohort Obstructive Lung Disease (CanCOLD) study. Participants with COPD who had completed 18 months of follow-up were included. Sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI) and a three-factor analysis. Symptom-based (dyspnea or sputum change $ 48 h) and eventbased (symptoms plus medication or unscheduled health services use) exacerbations were assessed. Association of PSQI with exacerbation rate was assessed by using negative binomial regression. Exacerbation-free survival was also assessed. RESULTS: A total of 480 participants with COPD were studied, including 185 with one or more exacerbations during follow-up and 203 with poor baseline sleep quality (PSQI score > 5). Participants with subsequent symptom-based exacerbations had higher median baseline PSQI scores than those without (6.0 [interquartile range, 3.0-8.0] vs 5.0 [interquartile range, 2.0-7.0]; P ¼ .01), and they were more likely to have baseline PSQI scores > 5 (50.3% vs 37.3%; P ¼ .01). Higher PSQI scores were associated with increased symptombased exacerbation risk (adjusted rate ratio, 1.09; 95% CI, 1.01-1.18; P ¼ .02) and event-based exacerbation risk (adjusted rate ratio, 1.10; 95% CI, 1.00-1.21; P ¼ .048). The association occurred mainly in those with undiagnosed COPD. Strongest associations were with Factor 3 (sleep disturbances and daytime dysfunction). Time to symptom-based exacerbation was shorter in participants with poor sleep quality (adjusted hazard ratio, 1.49; 95% CI, 1.09-2.03). CONCLUSIONS: Higher baseline PSQI scores were associated with increased risk of COPD exacerbation over 18 months' prospective follow-up.

One-Year Evolution of Symptoms and Health Status of the COPD Multi-Dimensional Phenotypes: Results from the Follow-Up of the STORICO Observational Study

“…In the placebo group of the two largest trials on the pharmacological treatment of COPD, namely the UPLIFT and TORCH studies, neither health status nor lung function showed clinically significant changes over a 4-and 3-year interval, respectively. [26][27][28] Similar findings were documented for perceived dyspnea in the pooled Flight 1 and Flight 2 trials after one year of observation. 29 Finally, in a real-world population of COPD patients in conditions of usual care (the SALFORD study), overall dyspnea did not change significantly as it improved in 26.8% of patients but worsened in 20.9% over 12 months.…”

“…18 Furthermore, in a mixed Asthma-COPD population aged over 65 years, their prevalence increases with age. 25 Of note, in the CanCOLD study 26 impaired sleep quality was associated with increased rate of exacerbations over a period of 18 months. Finally, sleep disturbances have recently been proved to correlate with respiratory symptoms, poor lung function, exacerbations during the previous year, and depression in a large COPD cohort.…”

“…Exacerbations were distinctly rare in our populations. Interestingly, the rate of exacerbations in a populationbased sample of a longitudinal observational investigation (CanCOLD study) was 0.50 per year, 26 in the entire trial population of the SALFORD study, which had selecting criteria comparable to those of the STORICO study, 31% of patients had no COPD exacerbations in the year of follow-up. 31 These findings likely reflect a secular trend: in the recent TRIBUTE study, patients with severe to very severe COPD and a reported exacerbation rate of 1.2per year actually had 0.5 and 0.59 exacerbations over one year while assuming triple or dual bronchodilating therapy.…”

Metabolic profiles among COPD and controls in the CanCOLD population-based cohort

“…Study participants underwent the standard Can-COLD assessment procedures, which provide information about patients' characteristics (age, gender, smoking history), medical history and current medications, body weight and height, and pulmonary function. Although no sleep studies were done in CanCOLD, the presence of sleep apnea was documented based on the use of continuous airway positive pressure (CPAP) and on standardized questionnaires, including the Pittsburg Sleep Quality Index [31]. Additional pre-specified measures were done including measurements of waist and hip circumferences, blood sampling to determine glucose and lipid profiles, and a computed tomography (CT) abdominal scan at 4 th /5 th lumbar vertebrae level (L4-L5) to quantify body fat distribution [21].…”

Tossing and turning: association of sleep quantity–quality with physical activity in COPD

“…Actigraphy is a useful tool which is able to provide objective estimates of sleep/wake parameters similar to polysomnography and to bring more reliable information about sleep quantity and fragmentation than subjective evaluations [ 12 ]. Poor sleep quality is frequently reported in COPD [ 13 – 15 ] and is related to higher rates of exacerbation and hospitalisation [ 16 – 18 ]. Furthermore, there is evidence showing that poor sleep quality is associated with impairment of quadriceps muscle strength, exercise capacity and PADL [ 19 – 21 ].…”