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

Abstract

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...

Sleep disturbance in patients with mild‐moderate chronic obstructive pulmonary disease

“…Patients often had problems waking up feeling rested, waking up during the night or falling back asleep. Several factors, such as respiratory symptoms, hypoxia, psychological disorders and use of medications may contribute to sleep disturbance in patients with COPD . In our study, dyspnea, HRQL, anxiety, depression and self‐efficacy were correlated with sleep disturbance.…”

“…Moreover, disturbed sleep has been associated with poor COPD‐related outcomes, such as exacerbations and mortality . Sleep disturbance in COPD is a complex clinical problem with multiple contributing factors, such as nocturnal symptoms, hypercapnia, medication use, nicotine use and comorbid disorders . However, little is known concerning quality of sleep and factors associated with sleep disturbance in patients with mild or moderate COPD, although more than two‐thirds of patients with COPD have Global Initiative for Chronic Obstructive Lung Disease (GOLD) grade 1 (mild) or 2 (moderate) disease.…”

Sleep apnoea in Australian men: disease burden, co-morbidities, and correlates from the Australian longitudinal study on male health

“…Lower prevalence in our study may also be due to possible under-reporting resulting from the use of aforementioned definition for sleep apnoea and other diseases. If this lower prevalence does reflect under-diagnosis, it could indicate an increase in future burden of the disease as sleep apnoea concurrent with asthma or COPD leads to higher morbidity and mortality [41, 46] and underdiagnosed diseases usually present later with more complications.…”

Efficacy of non‐invasive ventilation for hypercapnic acute respiratory failure in a general ward: details and comments

“…There is information regarding this effect in severe conditions (improved sleep, etc.). 5 Second, the authors described a high rate of response with NIV on the first day: 101/112 patients responded initially (first few hours). These data need more precise analysis because we may expect a lower and slower response especially for the more severe acidosis subgroup.…”