Elsevier

Sleep Medicine

Volume 12, Issue 4, April 2011, Pages 367-372
Sleep Medicine

Original Article
Sleep profile and symptoms of sleep disorders in patients with stable mild to moderate chronic obstructive pulmonary disease

https://doi.org/10.1016/j.sleep.2010.08.017Get rights and content

Abstract

Background

Sleep problems associated with chronic obstructive pulmonary disease may have an important impact on quality of life and health outcome measures in patients. The aim of this study was to prospectively assess differences in symptom profile and polysomnographic parameters in patients with stable mild to moderate COPD and age, gender, and body-mass-index matched controls without airflow obstruction.

Methods

The Sleep Disorders Questionnaire was administered to both patients and controls prior to clinical and polysomnographic evaluation. Responses obtained from the questionnaire were used to construct four independent symptom scales: sleep apnea, periodic limb movement syndrome, psychiatric sleep disorder, and narcolepsy. Associations between each diagnostic scale and sleep parameters were considered by means of multiple analyses of covariance.

Results

Fifty-two patients with mild-to-moderate COPD (age 62 ± 8 years, BMI 29 ± 7 kg/sqm) and 52 age, gender, and body-weight matched controls without COPD were studied. Patients with COPD had overall lower sleep efficiency, a lower total sleep time, and lower mean overnight oxygen saturation compared to controls. Patients with COPD were significantly more likely to report symptoms such as insomnia and difficulty in initiating and maintaining sleep, resulting in overall higher psychiatric sleep disorder scale scores in patients compared with controls. Minimum oxygen saturation was an independent predictor for all symptom scales. After correcting for potentially confounding factors, including pack/years of smoking, total sleep time, sleep efficiency, arousal index, mean and minimum oxygen saturation, and apnea–hypopnea-index, the between group-differences for both the periodic limb movement and psychiatric sleep disorder scale scores remained statistically significant.

Conclusions

We observed significant differences in both quantity and quality of sleep between patients with stable mild to moderate chronic obstructive pulmonary disease and respective controls.

Introduction

Chronic obstructive pulmonary disease (COPD) is one of the world’s most leading causes of morbidity and mortality [1]. In addition to the typical respiratory symptom profile including shortness of breath, chronic cough, and sputum production, patients with COPD may also experience symptoms such as snoring, witnessed apneas, and/or excessive daytime sleepiness, thus being predisposed to the development of obstructive sleep apnea (OSA) [2], [3], [4]. The overall likelihood for these symptoms to be associated with an actual diagnosis of OSA, however, remains as low as 5% [5]. Similarly, more recent results from the Sleep Heart Health Study suggested no evidence of a higher prevalence of sleep apnea in patients with mild COPD [6].

Irrespective of the above mentioned sleep apnea symptoms, patients with COPD frequently report impaired quantity and quality of sleep [7], [8], [9], [10]. Kinsman et al. [9] reported that sleep disturbances ranked third after dyspnea and fatigue and nearly one-half of the patients had sleep difficulties “always” or “almost always.” Cormick et al. [10] similarly reported fragmented sleep and difficulty falling asleep in patients with severe COPD compared to respective controls. The presence of sleep problems in COPD is of particular importance, as sleep quality is a major determinant of overall health status and quality of life in these patients [11], [12], [13]. Most prior studies of sleep quality in patients with COPD, however, have focused on patients with moderate to severe COPD [10], [14] or have failed to exclude underlying sleep apnea using overnight sleep testing [3], [4], [7], [8].

The aim of the present report was to systematically investigate sleep profile and symptoms associated with sleep disorders in patients with stable mild to moderate COPD in comparison with matched controls.

Section snippets

Methods

Between July 2004 and March 2006 232 consecutive patients with COPD recruited from the hospital outpatient clinic were screened for eligibility in this study. Inclusion criteria were (1) diagnosis of COPD stage II and III for more than 12 months based on the definition of the European Respiratory Society (Ratio of Forced Expiratory Volume to Forced Vital Capacity <70% plus Forced Expiratory Volume between 30% and 80% predicted) [15]; (2) age > 40 years; (3) stable condition, defined as a stable

Clinical data and polysomnographic variables

The mean values for age, BMI, and the gender ratio were non-significant between groups, indicating a good population match (Table 1). Patients with COPD had an overall lower arterial paO2 and higher pack-years of smoking compared to controls without COPD.

There were no significant differences in AHI, arousal index, % sleep time spent in slow wave sleep, or sleepiness score between the groups. Patients with COPD, however, had overall lower sleep efficiency, a lower total sleep time, lower% sleep

Discussion

The present study investigated polysomnographic variables and symptoms associated with sleep disorders in patients with mild to moderate COPD and matched controls without airflow obstruction. We observed significant differences in overnight sleep parameters, calculated symptom scale scores and individual symptom frequencies between the two groups.

Conflict of Interest

The ICMJE Uniform Disclosure Form for Potential Conflicts of Interest associated with this article can be viewed by clicking on the following link: doi:10.1016/j.sleep.2010.08.017.

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Acknowledgment

AV collected the data and prepared the manuscript. PL assisted in interpretation of study findings and review of the manuscript. HL was responsible for statistical analysis. IM was responsible for performing and analysis of polysomnographic recordings. OCB was the principal investigator. He reviewed the dataset and provided funding through the Ludwig-Boltzmann-Institute for COPD. We are grateful to Helmuth Rauscher, MD for his support in data collection.

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