Sleep disruption as a predictor of quality of life among patients in the subpopulations and intermediate outcome measures in COPD study (SPIROMICS)

Zeidler, Michelle; Martin, Jennifer L.; Kleerup, Eric C.; Schneider, Hartmut; Mitchell, Michael N.; Hansel, Nadia N.; Sundar, Krishna M.; Schotland, Helena M.; Basner, Robert C.; Wells, James M.; Krishnan, Jerry A.; Criner, Gerard J.; Cristenson, Stephanie; Krachman, Samuel L.; Badr, M. Safwan

doi:10.1093/sleep/zsy044

Cited by 39 publications

(30 citation statements)

References 29 publications

(30 reference statements)

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“…Poor sleep quality in COPD has previously been associated with reduced health-related quality of life 7,9 and reduced physical activity during the day. 17 However, to our knowledge, this study is the first population-based longitudinal analysis evaluating exacerbation risk in Data are presented as median (interquartile range) or No.…”

Section: Discussionmentioning

confidence: 99%

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Impaired Sleep Quality in COPD Is Associated With Exacerbations

Shorofsky

Bourbeau

Kimoff

et al. 2019

Chest

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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.

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Section: Discussionmentioning

confidence: 99%

“…8 Sleep quality is an important predictor of health-related quality of life in COPD. [7][8][9] Acute exacerbations of COPD are common in the course of the disease and lead to deterioration in health status and increased mortality. 10 Therefore, there has been a growing interest in sleep quality in COPD and its effect on exacerbations.…”

mentioning

confidence: 99%

Impaired Sleep Quality in COPD Is Associated With Exacerbations

Shorofsky

Bourbeau

Kimoff

et al. 2019

Chest

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“…Previous studies have reported sleep problems in patients with COPD using COPD‐specific and non‐COPD‐specific measures. The majority of sleep studies in COPD have relied on two non‐disease‐specific measures, that is, the Pittsburgh Sleep Quality Index and/or the Epworth Sleep Scale . These generic measures, which cover broadly defined domains such as functional status and perceptions, may not perform well in patients with COPD considering no data of reliability or validity tests to justify their use in this population .…”

Section: Discussionmentioning

confidence: 99%

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

Lee

Kim

Lee

et al. 2019

Clinical Respiratory J

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Introduction Although sleep problems have an important impact on daily life and health outcome measures in patients with chronic obstructive pulmonary disease (COPD), patterns of sleep disturbance in patients with mild‐moderate COPD remain unknown. Objective The aim of this study was to investigate patterns of sleep disturbance and factors associated with sleep impairment in patients with mild‐moderate COPD. Methods This prospective cross‐sectional study enrolled 148 male patients with COPD. At enrolment, all patients completed a disease‐specific sleep measure, the COPD and Asthma Sleep Impact Scale (CASIS) to assess sleep impairment. Health‐related quality of life (HRQL) was measured using the St. George's Respiratory Questionnaire (SGRQ) and the 36‐item Short‐Form health survey (SF‐36). Anxiety and depression status were assessed using the Hospital Anxiety and Depression Scale (HADS). Self‐efficacy was measured by the COPD Self‐Efficacy Scale (CSES). Results The mean age of the subjects was 67 years [standard deviation (SD) = 8.11]. The proportion of patients who indicated that they had a bad night's sleep was 33.1%. Univariated analysis showed that CASIS score was significantly correlated with the modified Medical Research Council (mMRC) dyspnea scale, SGRQ, SF‐36 Physical Component Summary, SF‐36 Mental Component Summary, HADS‐anxiety, HADS‐depression and CSES scores (all P < 0.05). In a multivariate analysis, SGRQ and CSES were independently associated with CASIS score. Conclusion Poorer HRQL and lower self‐efficacy are significantly associated with sleep disturbance and perhaps may be improved by better sleep quality. Future research is required to enhance sleep quality in patients with mild‐moderate COPD.

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“…Sleep quality is impaired in patients with chronic respiratory disease [3] and diminished sleep efficiency with a reduction in REM sleep has been reported in patients with COPD, which correlates with awake arterial oxygen tension (P aO 2 ) but not with the degree of airflow obstruction [4], although lung hyperinflation has been associated with poor sleep quality in COPD patients [5]. Sleep disturbance in COPD is associated with reduced quality of life measures such as the Short Form-12 and the St George's Respiratory Questionnaire [6].…”

Section: Introductionmentioning

confidence: 99%

Sleep in chronic respiratory disease: COPD and hypoventilation disorders

et al. 2019

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COPD and obstructive sleep apnoea (OSA) are highly prevalent and different clinical COPD phenotypes that influence the likelihood of comorbid OSA. The increased lung volumes and low body mass index (BMI) associated with the predominant emphysema phenotype protects against OSA whereas the peripheral oedema and higher BMI often associated with the predominant chronic bronchitis phenotype promote OSA. The diagnosis of OSA in COPD patients requires clinical awareness and screening questionnaires which may help identify patients for overnight study. Management of OSA-COPD overlap patients differs from COPD alone and the survival of overlap patients treated with nocturnal positive airway pressure is superior to those untreated. Sleep-related hypoventilation is common in neuromuscular disease and skeletal disorders because of the effects of normal sleep on ventilation and additional challenges imposed by the underlying disorders. Hypoventilation is first seen during rapid eye movement (REM) sleep before progressing to involve non-REM sleep and wakefulness. Clinical presentation is nonspecific and daytime respiratory function measures poorly predict nocturnal hypoventilation. Monitoring of respiration and carbon dioxide levels during sleep should be incorporated in the evaluation of high-risk patient populations and treatment with noninvasive ventilation improves outcomes.

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Sleep disruption as a predictor of quality of life among patients in the subpopulations and intermediate outcome measures in COPD study (SPIROMICS)

Abstract: ClinicalTrials.gov NCT01969344.

Cited by 39 publications

References 29 publications

Impaired Sleep Quality in COPD Is Associated With Exacerbations

Impaired Sleep Quality in COPD Is Associated With Exacerbations

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

Sleep in chronic respiratory disease: COPD and hypoventilation disorders

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