Insomnia in Patients with COPD

Budhiraja, Rohit; Parthasarathy, Sairam; Budhiraja, Pooja; Habib, Michael P.; Wendel, Christopher; Quan, Stuart F.

doi:10.5665/sleep.1698

Cited by 107 publications

(85 citation statements)

References 37 publications

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“…However, a recent study did not show an adverse influence of any inhalers on sleep. 4 In fact, univariate analyses revealed lower insomnia prevalence in patients on β-agonist inhalers, although the effects were not statistically significant in multivariate analyses. Inhaled steroids are commonly used in COPD, but their effect on sleep has not been systematically assessed.…”

Section: Etiologymentioning

confidence: 94%

“…A recent study found a high prevalence of insomnia disorder (27.3%), defi ned as presence of insomnia symptoms along with daytime manifestations, in patients with COPD. 4 Whether COPD severity is related to worse sleep is unclear. Some studies suggest worse sleep in more severe COPD, 9 while other studies have not shown an association between FEV1 and reported sleep quality.…”

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confidence: 99%

“…Some studies suggest worse sleep in more severe COPD, 9 while other studies have not shown an association between FEV1 and reported sleep quality. 4,10 Associated respiratory symptoms such as cough and sputum production appear to be better predictors of sleep disturbances.1,10,11 However, in one Medicine, Vol. 11, No.…”

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confidence: 99%

“…3, 2015 R Budhiraja, TA Siddiqi and SF Quan study, severity of dyspnea using the Medical Research Council dyspnea scale did not correlate with prevalence of insomnia. 4 The authors hypothesized that nocturnal dyspnea may have a different etiology than diurnal dyspnea. While the latter may be related to exertion and inability to do tasks due to shortness of breath, several other factors, such as nocturnal hypoxemia and associated increased pulmonary vascular pressures, may contribute to nocturnal dyspnea.…”

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confidence: 99%

“…Several factors may plausibly contribute to these sleep disturbances ( Table 1). 4 COPD can be associated with disabling dyspnea. Dyspnea may be worse supine and while in bed attempting to sleep (vide supra).…”

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confidence: 99%

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Sleep Disorders in Chronic Obstructive Pulmonary Disease: Etiology, Impact, and Management

Budhiraja

Siddiqi

Quan

2015

Journal of Clinical Sleep Medicine

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151

125

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Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality and may frequently be complicated by sleep disorders. Insomnia and obstructive sleep apnea are commonly encountered in patients with COPD. Nocturnal hypoxemia is also prevalent in COPD may occur despite adequate awake oxygenation and can be especially severe in rapid eye movement sleep. Additionally, several factors-some of them unique to COPD-can contribute to sleep-related hypoventilation. Recognition of hypoventilation can be vital as supplemental oxygen therapy itself can acutely worsen hypoventilation and lead to disastrous consequences. Finally, accruing data establish an association between restless leg syndrome and COPDan association that may be driven by hypoxemia and/or hypercapnia. Comorbid sleep disorders portend worse sleep quality, diminished quality of life, and multifarious other adverse consequences. The awareness and knowledge regarding sleep comorbidities in COPD has continued to evolve over past many years. There are still several lacunae, however, in our understanding of the etiologies, impact, and therapies of sleep disorders, specifi cally in patients with COPD. This review summarizes the latest concepts in prevalence, pathogenesis, diagnosis, and management of diverse sleep disorders in COPD. Keywords: COPD, insomnia, obstructive sleep apnea, restless legs syndrome, hypoventilation Citation: Budhiraja R, Siddiqi TA, Quan SF. Sleep disorders in chronic obstructive pulmonary disease: etiology, impact, and management. J Clin Sleep Med 2015;11(3):259-270.pii: jc-00080-14 http://dx.doi.org/10.5664/jcsm.4540 T hat sleep is adversely affected in chronic obstructive pulmonary disease (COPD) has been long recognized. 1 COPD affects 5% to 10% of the adult population in the United States and is a major contributor to global disease burden. 2 The prevalence of insomnia symptoms, insomnia disorder, restless leg syndrome, and hypoxemia is increased in COPD. [3][4][5] Furthermore, polysomnographic (PSG) evaluation generally reveals decreased sleep effi ciency and lower mean overnight oxygen saturation in COPD patients compared to controls. 6 In COPD, the pathogenesis of sleep disorders appears to be a complex and multifactorial process, likely consequent to one or more of the following: physiological changes associated with sleep, hypoxemia, hypercapnia, infl ammation, COPD medications, and/or nicotine use. Comorbid disorders as well as primary sleep disturbances may also contribute to disrupted sleep in COPD patients. For example, nocturnal gastroesophageal refl ux (GERD) is associated with both symptoms of sleep apnea and COPD, and may contribute to the pathogenesis, and concomitant occurrence of both disorders.7 GERD may also infl uence sleep quality which could potentially contribute to some of the sleep complaints reported by persons with COPD. 8 The following sections describe the diverse sleep disorders and sleep-related abnormalities encountered in patients with COPD. Sleep Disorders in Chronic Obstructiv...

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Section: Etiologymentioning

confidence: 94%

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confidence: 99%

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confidence: 99%

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