Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Mar 30;24(1):98.
doi: 10.1186/s12931-023-02405-6.

The impact of impaired sleep quality on symptom change and future exacerbation of chronic obstructive pulmonary disease

Ling Lin  1   2   3 , Qing Song  1   2   3 , Jiaxi Duan  4 , Cong Liu  1   2   3 , Wei Cheng  1   2   3 , Aiyuan Zhou  5 , Yating Peng  1   2   3 , Zijing Zhou  1   2   3 , Yuqin Zeng  1   2   3 , Yan Chen  1   2   3 , Shan Cai  1   2   3 , Ping Chen  6   7   8
Affiliations

The impact of impaired sleep quality on symptom change and future exacerbation of chronic obstructive pulmonary disease

Ling Lin et al. Respir Res. .

Abstract

Purpose: Study the impact of impaired sleep quality on symptom change and future exacerbation of chronic obstructive pulmonary disease (COPD) patients.

Methods: This was a prospective study. Patients with COPD were recruited into the study and followed up for one year. Pittsburgh sleep quality index (PSQI) was collected at baseline. Symptom change was assessed with Minimum clinically important difference (MCID) in COPD Assessment Test (CAT) at 6-month visit, which is an indicator to assess symptom improvement. Exacerbation was recorded during the one-year visit. PSQI score > 5 was defined as poor sleep quality, whereas PSQI score ≤ 5 was defined as good sleep quality. MCID was defined as attaining a CAT decrease ≥ 2.

Results: A total of 461 patients were enrolled for final analysis. Two hundred twenty-eight (49.4%) patients had poor sleep quality. Overall, 224 (48.6%) patients attained MCID at 6-month visit and the incidence of exacerbation during the one-year visit was 39.3%. Fewer patients with impaired sleep quality achieved MCID than patients with good sleep quality. Good sleepers were significantly more likely to attain MCID (OR: 3.112, p < 0.001) than poor sleepers. Fewer poor sleepers in GOLD A and D groups attained MCID with ICS/LABA, and fewer poor sleepers in the GOLD D group attained MCID with ICS/LABA/LAMA than good sleepers. Poor sleep quality was a greater risk factor of future exacerbation in Cox regression analysis. The ROC curves showed that PSQI score had a predictive capacity for future exacerbation. More patients with poor sleep quality experienced future exacerbation in GOLD B and D group with treatment of ICS/LABA/LAMA compared to good sleepers.

Conclusions: COPD patients with impaired sleep quality were less likely to achieve symptom improvement and were at increased risk of future exacerbation compared to patients with good sleep quality. Besides, sleep disturbance may affect the symptom improvement and future exacerbation of patients with different inhaled medication or in different GOLD groups.

Keywords: COPD; Exacerbation; Sleep quality; Symptom change.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of the inclusion of study Abbreviations: COPD, Chronic Obstructive Pulmonary Diseases.
Fig. 2
Fig. 2
Baseline PSQI score in those with MCID and without MCID. Note: (A) Baseline total PSQI score in COPD patients with MICD and without MICD; (B) Percentage of patients with PSQI > 5 in COPD patients with MICD and without MICD; (C) Sleep quality score in COPD patients with MICD and without MICD; (D) Sleep quality score in COPD patients with MICD and without MICD; (E) Daily disturbance score in COPD patients with MICD and without MICD; ns indicates P-values > 0.05;*indicates P-values < 0.05, ** indicates P-values < 0.01, *** indicates P-values < 0.001 Abbreviations: MCID, minimum clinically important difference; PSQI, Pittsburgh sleep quality index.
Fig. 3
Fig. 3
Comparison of the symptoms improvement between different GOLD group or different main inhalation therapy in COPD patients with different sleep quality MCID response rate of different GOLD group in COPD patients. (B) MCID response rate of different GOLD group in COPD patients with different sleep quality. (C) MCID response rate of different inhaled medication in COPD patients. (D) MCID response rate of different inhaled medication in COPD patients with different sleep quality. (E) MCID response rate of different GOLD group in treatment of ICS/LABA. (F) MCID response rate of different GOLD group in treatment of ICS/LABA/LAMA. ns indicates P-values > 0.05, *indicates P-values < 0.05, **indicates P-values < 0.01,*** indicates P-values < 0.001 Abbreviations: GOLD, Global Initiative for Chronic Obstructive Lung Disease; ICS, inhaled corticosteroids; IQR, interquartile range; LABA, long-acting β-2-agonist; LAMA, long-acting muscarinic antagonist; MCID, minimum clinically important difference.
Fig. 4
Fig. 4
ROC curve of sleep quality for predicting future exacerbation AUC of PSQI score for predicting future exacerbation is 0.69(95% CI: 0.64–0.73, P<0.001), the sensitivity and the specificity is 62.3% and 71.3% Abbreviations: AUC, Area under of ROC curve; PSQI, Pittsburgh sleep quality index; ROC, Receiver operating characteristic.
Fig. 5
Fig. 5
Comparison of the incidence of exacerbation between different GOLD group or different main inhalation therapy in COPD patients with different sleep quality Incidence of future exacerbation of different GOLD group in COPD patients. (B) Incidence of future exacerbation of different GOLD group in COPD patients with different sleep quality. (C) Incidence of future exacerbation of different inhaled medication in COPD patients. (D) Incidence of future exacerbation of different inhaled medication in COPD patients with different sleep quality. (E) Incidence of future exacerbation of different GOLD different in treatment of ICS/LABA/LAMA. ns indicates P-values > 0.05;*indicates P-values < 0.05, **indicates P-values < 0.01,*** indicates P-values < 0.001
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Vogelmeier CF, Criner GJ, Martinez FJ, et al. Global strategy for the diagnosis, management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary. Am J Respir Crit Care Med. 2017;195(5):557–82. doi: 10.1164/rccm.201701-0218PP. - DOI - PubMed
    1. Global regional. National incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the global burden of Disease Study 2015. Lancet. 2016;388(10053):1545–602. doi: 10.1016/S0140-6736(16)31678-6. - DOI - PMC - PubMed
    1. Wang C, Xu J, Yang L, et al. Prevalence and risk factors of chronic obstructive pulmonary disease in China (the China Pulmonary Health [CPH] study): a national cross-sectional study. Lancet. 2018;391(10131):1706–17. doi: 10.1016/S0140-6736(18)30841-9. - DOI - PubMed
    1. Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the global burden of Disease Study 2010. Lancet. 2012;380(9859):2095–128. doi: 10.1016/S0140-6736(12)61728-0. - DOI - PMC - PubMed
    1. Chen YW, Camp PG, Coxson HO, et al. A comparison of Pain, fatigue, Dyspnea and their impact on Quality of Life in Pulmonary Rehabilitation participants with chronic obstructive Pulmonary Disease. Copd. 2018;15(1):65–72. doi: 10.1080/15412555.2017.1401990. - DOI - PubMed

MeSH terms

Substances