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Chen M, Chang S, Xu Y, Guo H, Liu J. Dietary Beetroot Juice - Effects in Patients with COPD: A Review. Int J Chron Obstruct Pulmon Dis 2024; 19:1755-1765. [PMID: 39099609 PMCID: PMC11296515 DOI: 10.2147/copd.s473397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 07/20/2024] [Indexed: 08/06/2024] Open
Abstract
Chronic Obstructive Pulmonary Disease (COPD) exerts a severe toll on human health and the economy, with high prevalence and mortality rates. The search for bioactive components effective in the treatment of COPD has become a focal point of research. Beetroot juice, readily accessible and cost-effective, is noted for its ability to enhance athletic performance and for its preventive and therapeutic impact on hypertension. Beetroot juice is a rich source of dietary nitrates and modulates physiological processes via the nitrate-nitrite- nitric oxide pathway, exerting multiple beneficial effects such as antihypertensive, bronchodilatory, anti-inflammatory, antioxidant, hypoglycemic, and lipid-lowering actions. This paper provides a review of the existing research on the effects of beetroot juice on COPD, summarizing its potential in enhancing exercise capacity, lowering blood pressure, improving vascular function, and ameliorating sleep quality among patients with COPD. The review serves as a reference for the prospective use of beetroot juice in the symptomatic improvement of COPD, as well as in the prevention of exacerbations and associated comorbidities.
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Affiliation(s)
- Mingming Chen
- The First Clinical Medical College of Lanzhou University, Lanzhou City, Gansu Province, People’s Republic of China
| | - Shuting Chang
- The First Clinical Medical College of Lanzhou University, Lanzhou City, Gansu Province, People’s Republic of China
| | - Yunpeng Xu
- The First Clinical Medical College of Lanzhou University, Lanzhou City, Gansu Province, People’s Republic of China
| | - Hong Guo
- Department of Critical Care Medicine, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou City, Gansu Province, People’s Republic of China
| | - Jian Liu
- The First Clinical Medical College of Lanzhou University, Lanzhou City, Gansu Province, People’s Republic of China
- Gansu Provincial Maternity and Child-Care Hospital (Gansu Provincial Center Hospital), Lanzhou City, Gansu Province, People’s Republic of China
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Li X, Jin Y. Zolpidem-triggered atrial fibrillation in a patient with cardiomyopathy: a case report. BMC Cardiovasc Disord 2024; 24:339. [PMID: 38965461 PMCID: PMC11225507 DOI: 10.1186/s12872-024-04016-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 06/26/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Zolpidem is a non-benzodiazepine hypnotic widely used to manage insomnia. Zolpidem-triggered atrial fibrillation (AF) in patients with cardiomyopathy has never been reported before. CASE PRESENTATION A 40-year-old man with Duchenne muscular dystrophy-related cardiomyopathy attempted suicide and developed new-onset AF after zolpidem overdose. One year before admission, the patient visited our clinic due to chest discomfort and fatigue after daily walks for 1 month; both electrocardiography (ECG) and 24-hour Holter ECG results did not detect AF. After administration of cardiac medication (digoxin 0.125 mg/day, spironolactone 40 mg/day, furosemide 20 mg/day, bisoprolol 5 mg/day, sacubitril/valsartan 12/13 mg/day), he felt better. AF had never been observed before this admission via continuous monitoring during follow-up. Sixteen days before admission, the patient saw a sleep specialist and started zolpidem tartrate tablets (10 mg/day) due to insomnia for 6 months; ECG results revealed no significant change. The night before admission, the patient attempted suicide by overdosing on 40 mg of zolpidem after an argument, which resulted in severe lethargy. Upon admission, his ECG revealed new-onset AF, necessitating immediate cessation of zolpidem. Nine hours into admission, AF spontaneously terminated into normal sinus rhythm. Results from the ECG on the following days and the 24-hour Holter ECG at 1-month follow-up showed that AF was not detected. CONCLUSIONS This study provides valuable clinical evidence indicating that zolpidem overdose may induce AF in patients with cardiomyopathy. It serves as a critical warning for clinicians when prescribing zolpidem, particularly for patients with existing heart conditions. Further large-scale studies are needed to validate this finding and to explore the mechanisms between zolpidem and AF.
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Affiliation(s)
- Xiaolin Li
- Department of Nutrition, The Fourth Affiliated Hospital of School of Medicine, International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, 322000, China
| | - Yunpeng Jin
- Department of Cardiology, The Fourth Affiliated Hospital of School of Medicine, International School of Medicine , International Institutes of Medicine, Zhejiang University, Yiwu, 322000, China.
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Castaneda JM, Hee Wai T, Spece LJ, Duan KI, Leonhard A, Griffith MF, Plumley R, Palen BN, Feemster LC, Au DH, Donovan LM. Risks of Zolpidem among Patients with Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2024; 21:68-75. [PMID: 37916873 DOI: 10.1513/annalsats.202307-654oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/30/2023] [Indexed: 11/03/2023] Open
Abstract
Rationale: Nonbenzodiazepine benzodiazepine receptor agonists (NBZRA, e.g., zolpidem) are frequently used to treat insomnia among patients with chronic obstructive pulmonary disease (COPD). However, multiple observational studies find that patients with COPD who are prescribed NBZRAs have greater risks for mortality and respiratory complications than patients without such prescriptions. Without an active comparator, these studies are susceptible to confounding by indication. Objectives: Compare the risk of death or inpatient COPD exacerbation among patients receiving zolpidem relative to patients receiving other hypnotics. Methods: Using nationwide Veterans Health Administration (VA) data, we identified patients with clinically diagnosed COPD and new receipt of zolpidem or another hypnotic available on VA formulary without prior authorization (melatonin, trazodone, doxepin). We excluded those receiving traditional benzodiazepines or multiple concurrent hypnotics. We propensity-matched patients receiving zolpidem to other hypnotics on 32 variables, including demographics, comorbidities, and markers of COPD severity. We compared risk of the primary composite outcome of death or inpatient COPD exacerbation over 1 year. In secondary analyses, we propensity-matched patients receiving zolpidem to those without hypnotic receipt. Results: Among 283,740 patients meeting inclusion criteria, 1,126 (0.4%) received zolpidem and 3,057 (1.1%) received other hypnotics. We propensity-matched patients receiving zolpidem 1:1 to peers receiving other hypnotics. We did not find a difference in the primary composite outcome of death or inpatient exacerbation (hazard ratio, 0.97; 95% confidence interval [CI], 0.77-1.23). In secondary analyses comparing patients receiving zolpidem to matched peers without hypnotic receipt, we observed greater risk of death or inpatient exacerbation with zolpidem (hazard ratio, 1.40; 95% CI, 1.09-1.81). Conclusions: Among patients with COPD, we did not observe greater risks after new receipt of zolpidem relative to other hypnotics. However, we did observe greater risks relative to those without hypnotic receipt. This latter finding may reflect: 1) residual, unmeasured confounding related to insomnia; or 2) true adverse effects of hypnotics across classes. Future work is needed to better understand the risks of hypnotics in COPD.
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Affiliation(s)
- Jason M Castaneda
- Division of Pulmonary, Critical Care, and Sleep Medicine, The University of Washington, Seattle, Washington
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Travis Hee Wai
- University of British Columbia, Vancouver, British Columbia, Canada; and
| | - Laura J Spece
- Division of Pulmonary, Critical Care, and Sleep Medicine, The University of Washington, Seattle, Washington
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Kevin I Duan
- University of British Columbia, Vancouver, British Columbia, Canada; and
| | - Aristotle Leonhard
- Division of Pulmonary, Critical Care, and Sleep Medicine, The University of Washington, Seattle, Washington
| | - Matthew F Griffith
- Division of Pulmonary, Critical Care, and Sleep Medicine, The University of Washington, Seattle, Washington
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- University of Colorado, Aurora, Colorado
| | - Robert Plumley
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Brian N Palen
- Division of Pulmonary, Critical Care, and Sleep Medicine, The University of Washington, Seattle, Washington
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Laura C Feemster
- Division of Pulmonary, Critical Care, and Sleep Medicine, The University of Washington, Seattle, Washington
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - David H Au
- Division of Pulmonary, Critical Care, and Sleep Medicine, The University of Washington, Seattle, Washington
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Lucas M Donovan
- Division of Pulmonary, Critical Care, and Sleep Medicine, The University of Washington, Seattle, Washington
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
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El-Solh AA, Lawson Y, Wilding GE. Association Between Hypnotic Use and All-Cause Mortality in Patients with Chronic Obstructive Pulmonary Disease and Insomnia. Int J Chron Obstruct Pulmon Dis 2023; 18:2393-2404. [PMID: 37942297 PMCID: PMC10629458 DOI: 10.2147/copd.s430609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/27/2023] [Indexed: 11/10/2023] Open
Abstract
Purpose Hypnotics are commonly prescribed in patients with COPD to manage insomnia. Given the considerable risks associated with these drugs, the aim of the study was to evaluate the risk of all-cause mortality associated with hypnotics in a cohort of veterans with COPD presenting with insomnia. Methods We conducted a retrospective cohort study that used Veterans Health Administration Corporate Data Warehouse with data supplemented by linkage to Medicare, Medicaid, and National Death Index data from 2010 through 2019. The primary outcome was all-cause mortality. Analyses were conducted using propensity score 1:1 matching to balance baseline characteristics. Results Of the 5759 veterans with COPD (mean [SD] age, 71.7 [11.2]; 92% men), 3585 newly initiated hypnotic agents during the study period. During a mean follow-up of 7.4 (SD, 2.7) years, a total of 2301 deaths occurred, with 65.2 and 48.7 total deaths per 1000 person-years among hypnotic users and nonusers, respectively. After propensity matching, hypnotic use was associated with a 22% increased risk of mortality compared with hypnotic nonusers (hazard ratio [HR] 1.22; 95% confidence interval [CI],1.11-1.35). The benzodiazepine receptor agonists (BZRAs) group experienced a higher incidence rate of all-cause mortality compared to hypnotic nonusers (Incidence rate ratio [IRR] 1.27; 95% CI, 1.14-1.43). Conversely, the mortality rate of non-BZRA hypnotics decreased after the first 2 years and was not significantly different for hypnotic nonusers (IRR 1.04; 95% CI, 0.82-1.11). Conclusion Among patients with COPD and insomnia, treatment with hypnotics was associated with a higher risk of all-cause mortality. The association was observed in patients prescribed BZRAs. The risk of mortality for non-BZRAs moderated after the first 2 years, indicating a class effect.
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Affiliation(s)
- Ali A El-Solh
- Research Department, VA Western New York Healthcare System, Buffalo, NY, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine; Jacobs School of Medicine, Buffalo, NY, USA
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions; University at Buffalo, Buffalo, NY, USA
| | - Yolanda Lawson
- Research Department, VA Western New York Healthcare System, Buffalo, NY, USA
| | - Gregory E Wilding
- Department of Biostatistics, School of Public Health and Health Professions; University at Buffalo, Buffalo, NY, USA
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Sood A, Kuo YF, Westra J, Sharma G, Raji MA. Co-prescribing of Central Nervous System-Active Medications for COPD Patients: Impact on Emergency Room Visits and Hospitalization. Ann Pharmacother 2023; 57:382-396. [PMID: 35942598 PMCID: PMC10508332 DOI: 10.1177/10600280221113299] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Anxiety and chronic pain are common comorbidities in patients with chronic obstructive pulmonary disease (COPD), which are frequently managed with benzodiazepines (BZDs) and opioids, respectively. OBJECTIVE The purpose of this study was to determine whether different combinations of opioids, BZD, and their substitutes-gabapentinoids (GABA) and selective serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors (SSRIs/SNRIs)-are associated with lower risk of acute respiratory events in COPD patients with co-occurring chronic pain and anxiety. METHODS This retrospective cohort study used a nationally representative sample of Medicare beneficiaries with COPD, chronic pain, and anxiety. Patients were grouped based on drug combination (opioid + BZD/Z-hypnotics, opioid + GABA, opioid + SSRI/SNRI, BZD/Z-hypnotics + GABA, BZD/Z-hypnotics + SSRI/SNRI, GABA + SSRI/SNRI, or ≥3 drugs). The primary outcome was emergency room (ER) visit or hospitalization due to acute respiratory events assessed up to 180 days following initiation of drug combination. Overdose secondary to central nervous system (CNS)-related drugs was also assessed up to 180 days following initiation of drug combination. RESULTS The drug combination opioid + GABA was associated with decreased risk for ER visit (hazard ratio [HR] = 0.73; 95% CI = 0.61-0.87) and hospitalization (HR = 0.69; 95% CI = 0.55-0.85). Opioid + SSRI/SNRI also showed decreased risk for ER visit (HR = 0.84; 95% CI = 0.71-0.99). There was no significant difference in risk for CNS-related drug overdose among different drug combinations compared with opioid + BZD/Z-hypnotics. CONCLUSION AND RELEVANCE Opioids in combination with GABA and SSRI/SNRI demonstrate relatively lower risk for acute respiratory events among patients with COPD and comorbid chronic pain and anxiety. The findings emphasize the need for multimodal management in this vulnerable population.
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Affiliation(s)
- Akhil Sood
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, 77555-01777
| | - Yong-Fang Kuo
- Department of Preventive Medicine & Population Health, University of Texas Medical Branch, Galveston, TX, 77555-01777
| | - Jordan Westra
- Department of Preventive Medicine & Population Health, University of Texas Medical Branch, Galveston, TX, 77555-01777
| | - Gulshan Sharma
- Department of Pulmonary, Critical Care, & Sleep Medicine, University of Texas Medical Branch, Galveston, TX, 77555-01777
| | - Mukaila A. Raji
- Department of Geriatric Medicine, University of Texas Medical Branch, Galveston, TX, 77555-01777
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YAĞCI İ, PERİNCEK G. Relationship between Functional Status and Type D Personality and Psychiatric Symptoms of Patients with Chronic Obstructive Pulmonary Disease (COPD). PSIKIYATRIDE GUNCEL YAKLASIMLAR - CURRENT APPROACHES IN PSYCHIATRY 2022. [DOI: 10.18863/pgy.1090854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Emotional difficulties, adjustment difficulties, anxiety disorder, paranoid reactions and depression are among the common psychiatric disorders in patients with Chronic Obstructive Pulmonary Disease (COPD). Type D personality is characterized by social inhibition and negative affectivity. Individuals with Type D personality have difficulty in coping with chronic diseases. The aim of our study was to determine type D personality and psychiatric symptoms in patients with COPD. A patient group was formed with 44 people hospitalized with COPD in the Chest Diseases service and a control group was formed with 44 healthy people. A sociodemographic data form, the Beck Depression Inventory, State and Trait Anxiety Inventory, Somatosensory Amplification Scale, Type D Personality Scale, and BODE (Body mass index, Obstruction, Dyspnea, Exercise capacity) index, were used to. According to the results of our study, state and trait anxiety, depression and D-type personality, exaggeration of bodily sensations scale scores were statistically significantly higher in the patient group compared to the control group. Moreover, a high score on the somatosensory amplification scale and having a type D personality were correlated with the BODE index score. These results suggest that it is important for patients with COPD to be examined by a psychiatrist..
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Verma A, Singh A, Chaudhri S, Pandey A, Kumar N, Kant S, Chaudhary S. Sleep patterns in table chronic obstructive pulmonary disease patients at a tertiary care center: a hospital-based observational study. THE JOURNAL OF ASSOCIATION OF CHEST PHYSICIANS 2022. [DOI: 10.4103/jacp.jacp_19_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Alanazi AMM, Alqahtani MM, Alquaimi MM, Alotaibi TF, Algarni SS, Ismaeil TT, Alanazi AA, Alasmari MM, Alhuthail EA, Alasmari AM, Gibson-Young L, Jayawardene WP. Substance Use and Misuse among Adults with Chronic Obstructive Pulmonary Disease in the United States, 2015-2019: Prevalence, Association, and Moderation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:408. [PMID: 35010669 PMCID: PMC8744618 DOI: 10.3390/ijerph19010408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/18/2021] [Accepted: 12/29/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite the advancements in chronic obstructive pulmonary disease (COPD) treatment, complications related to COPD exacerbation remain challenging. One associated factor is substance use/misuse among adults with COPD. Fewer studies, however, examined the prevalence and association between COPD and substance use and misuse. In addition, limited knowledge existed about the moderation effects of serious psychological distress and gender among adults with COPD and substance use/misuse. We aimed, therefore, to measure such prevalence, association, and moderation from nationally representative samples in the United States. METHOD Data were drawn from the 2015-2019 National Survey on Drug Use and Health. Weighted logistic regressions were used to measure the associations of last-month tobacco (cigarettes, cigars, pipe, and smokeless tobacco products), other licit and illicit substance use (alcohol, marijuana, cocaine, crack, heroin, hallucinogens, and inhalants), and substance misuse (pain relievers, tranquilizers, stimulants, and sedatives) among adults with COPD. Serious psychological distress and gender were tested as moderators in the association between COPD and substance use/misuse. RESULTS The findings revealed that adults with COPD [Weighted N = 53,115,718) revealed greater odds of cigarettes [adjusted odds ratio (aOR) = 2.48 (95%CI = 1.80-3.42)) and smokeless tobacco (aOR = 3.65 (95%CI = 1.75-7.65)). However, they were less likely to use alcohol (aOR = 0.61 (95%CI = 0.45-0.84)). Adults with COPD who had serious psychological distress were more likely to use pipe tobacco and alcohol; however, they were less likely to use hallucinogens and inhalants. Finally, males compared to females with COPD were less likely to use smokeless tobacco. CONCLUSION Adults with COPD in the United States were more likely to use tobacco products and less likely to use alcohol. In addition, serious psychological distress and gender were moderators in associations between COPD and substance use but not in substance misuse. Future studies should longitudinally assess the factors that may contribute to the initiation and progression of substance use and misuse among adults with COPD.
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Affiliation(s)
- Abdullah M. M. Alanazi
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia; (M.M.A.); (T.F.A.); (S.S.A.); (T.T.I.)
- King Abdullah International Medical Research Center, Riyadh 11481, Saudi Arabia;
| | - Mohammed M. Alqahtani
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia; (M.M.A.); (T.F.A.); (S.S.A.); (T.T.I.)
- King Abdullah International Medical Research Center, Riyadh 11481, Saudi Arabia;
| | - Maher M. Alquaimi
- Department of Respiratory Care, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia;
| | - Tareq F. Alotaibi
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia; (M.M.A.); (T.F.A.); (S.S.A.); (T.T.I.)
- King Abdullah International Medical Research Center, Riyadh 11481, Saudi Arabia;
| | - Saleh S. Algarni
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia; (M.M.A.); (T.F.A.); (S.S.A.); (T.T.I.)
- King Abdullah International Medical Research Center, Riyadh 11481, Saudi Arabia;
| | - Taha T. Ismaeil
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia; (M.M.A.); (T.F.A.); (S.S.A.); (T.T.I.)
- King Abdullah International Medical Research Center, Riyadh 11481, Saudi Arabia;
| | - Ahmad A. Alanazi
- King Abdullah International Medical Research Center, Riyadh 11481, Saudi Arabia;
- Respiratory Services, Ministry of the National Guard—Health Affairs, Riyadh 11481, Saudi Arabia
| | - Moudi M. Alasmari
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah 22384, Saudi Arabia;
- King Abdullah International Medical Research Center, Jeddah 22384, Saudi Arabia
| | - Eyas A. Alhuthail
- Basic Sciences Department, College of Sciences and Health Professions, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia;
- Department of Biomedical Sciences, Institute of Clinical Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Ali M Alasmari
- National Heart and Lung Institute, Imperial College London, London SW7 2BX, UK;
- College of Medical Rehabilitation Sciences, Taibah University, Medina 42353, Saudi Arabia
| | | | - Wasantha P. Jayawardene
- Institute for Research on Addictive Behavior, School of Public Health-Bloomington, Indiana University, Bloomington, IN 47405, USA;
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Beng TS, Kim CLC, Shee CC, Ching DNL, Liang TJ, Kumar MKN, Guan NC, Khuen LP, Loong LC, Chin LE, Zainuddin SI, Capelle DP, Munn AC, Yen LK, Isahak NNHN. COVID-19, Suffering and Palliative Care: A Review. Am J Hosp Palliat Care 2021; 39:986-995. [PMID: 34525862 PMCID: PMC9294437 DOI: 10.1177/10499091211046233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
According to the WHO guideline, palliative care is an integral component of COVID-19 management. The relief of physical symptoms and the provision of psychosocial support should be practiced by all healthcare workers caring for COVID-19 patients. In this review, we aim to provide a simple outline on COVID-19, suffering in COVID-19, and the role of palliative care in COVID-19. We also introduce 3 principles of palliative care that can serve as a guide for all healthcare workers caring for COVID-19 patients, which are (1) good symptom control, (2) open and sensitive communication, and (3) caring for the whole team. The pandemic has brought immense suffering, fear and death to people everywhere. The knowledge, skills and experiences from palliative care could be used to relieve the suffering of COVID-19 patients.
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Affiliation(s)
- Tan Seng Beng
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Carol Lai Cheng Kim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chai Chee Shee
- Department of Medicine, Faculty of Medicine and Health Science, University Sarawak Malaysia, Sarawak, Malaysia
| | - Diana Ng Leh Ching
- Department of Medicine, Faculty of Medicine and Health Science, University Sarawak Malaysia, Sarawak, Malaysia
| | - Tan Jiunn Liang
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Ng Chong Guan
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Lim Poh Khuen
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Lam Chee Loong
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Loh Ee Chin
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sheriza Izwa Zainuddin
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - David Paul Capelle
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ang Chui Munn
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Lim Kah Yen
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Syed N, Road JD, Ryerson CJ, Guenette JA. Evaluation of the Vibe Actigraph in Patients With Chronic Obstructive Pulmonary Disease: A Pilot Study. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2020; 8:2700708. [PMID: 32879810 PMCID: PMC7458158 DOI: 10.1109/jtehm.2020.3018399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 07/10/2020] [Accepted: 08/05/2020] [Indexed: 12/22/2022]
Abstract
STUDY OBJECTIVE To validate the Vibe actigraph in assessing sleep-wake patterns compared to polysomnography (PSG) in patients with COPD. METHODS Nine stable COPD patients wore actigraphs while undergoing PSG. The correlation between total sleep time (TST), total sleep period (TSP), sleep onset latency (SOL), wake after sleep onset (WASO), and sleep efficiency was determined for corresponding measurements from the actigraph and PSG. Sensitivity, specificity, and positive and negative predictive values were calculated for the actigraph, considering PSG the gold standard. Levels of agreement between the variables of PSG and the actigraph were estimated using Bland-Altman plots. RESULTS A strong and statistically significant correlation was noted between PSG and the actigraph in detecting movement during sleep [mean activity score (counts)], TST and TSP (all rs = 0.83; p = 0.005). The median agreement of sleep and wake counts between PSG and the actigraph was 73% and the Cohen's Kappa value was 0.66. The medians of sensitivity and specificity of the actigraph for detecting sleep versus PSG were 84 and 66%, respectively. The median positive and negative predictive values of the actigraph were 74 and 72%, respectively. CONCLUSIONS This study demonstrated that, under controlled laboratory conditions, the Vibe actigraph in its default settings is a promising tool for the detection of sleep-wake parameters in a small number of ambulatory patients with COPD. Clinical Impact: The actigraph used in this pilot study suggests that these devices could provide clinically relevant information in COPD to better understand the relationship between sleep and health in this population.
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Affiliation(s)
- Nafeez Syed
- Centre for Heart Lung InnovationProvidence Health Care Research Institute, The University of British Columbia, St. Paul's HospitalVancouverBCV6Z 1Y6Canada.,Department of Physical TherapyThe University of British ColumbiaVancouverBCV6T 1Z4Canada.,Department of PhysiotherapyManipal College of Health ProfessionalsManipal Academy of Higher EducationManipal576 104India
| | - Jeremy D Road
- Division of Respiratory MedicineDepartment of MedicineThe University of British ColumbiaVancouverBCV6T 1Z4Canada
| | - Christopher J Ryerson
- Centre for Heart Lung InnovationProvidence Health Care Research Institute, The University of British Columbia, St. Paul's HospitalVancouverBCV6Z 1Y6Canada.,Division of Respiratory MedicineDepartment of MedicineThe University of British ColumbiaVancouverBCV6T 1Z4Canada
| | - Jordan A Guenette
- Centre for Heart Lung InnovationProvidence Health Care Research Institute, The University of British Columbia, St. Paul's HospitalVancouverBCV6Z 1Y6Canada.,Department of Physical TherapyThe University of British ColumbiaVancouverBCV6T 1Z4Canada.,Division of Respiratory MedicineDepartment of MedicineThe University of British ColumbiaVancouverBCV6T 1Z4Canada
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11
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Management of Insomnia in Chronic Lung Diseases. CURRENT PULMONOLOGY REPORTS 2020. [DOI: 10.1007/s13665-020-00253-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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13
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Palman AD. [Sleep and its' disturbanses in chronic obstructive pulmonary disease]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:113-118. [PMID: 30059060 DOI: 10.17116/jnevro201811842113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Physiology of breathing during sleep predisposes to the development or worsening of the respiratory disorders in patients with chronic obstructive pulmonary disease (COPD) even if waking respiratory function remains relatively normal. Physicians, who assess patient's state only during the day, in some cases can underestimate this problem. Respiratory abnormalities can provoke insomnia, which additionally affects patient's quality of life. Supplemental oxygen and pressure support ventilation improve blood gases during sleep, but in many cases, insomnia persists. In many cases, such patients need the treatment with hypnotics. Widely used drugs in insomnia are benzodiazepines. They are rather effective but can cause respiratory depression and respiratory failure in patients with COPD. Z-hypnotics are comparable to classical benzodiazepines but much more safe and rarely worsen respiratory parameters. Melatonin and melatonin receptor agonists, antihistamines, antidepressants and neuroleptics can be effective in some patients with insomnia, but insufficient data about their safety in case of respiratory pathology restrict the use of these drugs in patients with COPD. The orexin receptor antagonist suvorexant is a novel hypnotic with the potential benefits for patients with COPD because it strongly improves sleep but does not depress respiration and has a minimal negative impact on daytime cognitive function.
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Affiliation(s)
- A D Palman
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
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14
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Benzodiazepines and Z-Drugs: An Updated Review of Major Adverse Outcomes Reported on in Epidemiologic Research. Drugs R D 2018; 17:493-507. [PMID: 28865038 PMCID: PMC5694420 DOI: 10.1007/s40268-017-0207-7] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Various adverse events resulting from, or associated with, benzodiazepine and/or Z-drug use have been extensively reported on and discussed in great detail within the biomedical literature. It is widely accepted that motor vehicle accidents and falls leading to fractures in older adults are major adverse events that have been shown to occur more frequently in users of sedative-hypnotic medication, especially of the benzodiazepine and related Z-drug variety. However, the last few years have seen increasing reports in the literature raising the issue of benzodiazepine and Z-drug exposure in the development of other serious medical issues including dementia, infections, respiratory disease exacerbation, pancreatitis, and cancer. This article provides an overview and interpretation on the current state of evidence regarding each of these associations and proposes what gaps in the evidence for drug-exposure–harm associations need to be addressed in the future for the purpose of evaluating causality of harm as it relates to these drugs.
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Akinci B, Aslan GK, Kiyan E. Sleep quality and quality of life in patients with moderate to very severe chronic obstructive pulmonary disease. CLINICAL RESPIRATORY JOURNAL 2017; 12:1739-1746. [PMID: 29105336 DOI: 10.1111/crj.12738] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 09/21/2017] [Accepted: 10/15/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is highly associated with obstructive sleep apnea (OSA). Poor sleep quality is found to be related with decreased quality of life (QoL) in patients with COPD but no study assessed this relationship on the basis of nocturnal sleep parameters. OBJECTIVES The aim of this study is to explore the relationships between sleep quality, daytime sleepiness and QoL in patients suffering from moderate to very severe COPD with and without sleep apnea assessed objectively and to compare sleep quality, QoL and daytime sleepiness in patients suffering from COPD with and without sleep apnea. METHODS Fifty-one patients with stable moderate to very severe COPD (mean age, 59.8 ± 8.1 years) included in the study. The parameters of polygraphic sleep studies (Stardust II, Philips-Respironics) were noted. Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), The Modified Medical Research Council Dyspnea and SF-36 Health Quality Survey were performed. RESULTS The rate of OSA was 74.5% (Apnea-Hypopnea Index, >5). out of all the patients, 94% had poor sleep quality (PSQI, >5). Negative correlations were found between PSQI and physical role, social function and mental health of SF-36 subgroups (P < .05). There was no correlation between PSQI, ESS, SF-36, dyspnea and polygraphic parameters (P > .05). In the comparison of patients with or without OSA, the vitality of SF-36 subgroup was found lower in patients with OSA (P < .05). CONCLUSIONS In conclusion, irrespective of OSA, patients with COPD are suffering from poor sleep quality and poor sleep quality negatively affects the QoL. Also, COPD and OSA association causes worsened vitality in the terms of health-related QoL.
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Affiliation(s)
- Buket Akinci
- Division of Physiotherapy and Rehabilitation, Biruni University, Istanbul, Turkey
| | - Gökşen Kuran Aslan
- Division of Physiotherapy and Rehabilitation, Istanbul University, Istanbul, Turkey
| | - Esen Kiyan
- Department of Pulmonary Diseases, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Nunes DM, Gonçalves BSB, Tardelli Peixoto CA, De Bruin VMS, Louzada FM, De Bruin PFC. Circadian rest-activity rhythm in chronic obstructive pulmonary disease. Chronobiol Int 2017; 34:1315-1319. [PMID: 29053034 DOI: 10.1080/07420528.2017.1352594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
To characterize circadian rest-activity rhythm in COPD, 26 cases (66.9 ± 8.5y) and 15 controls (63.0 ± 10.7y) were assessed by actimetry. Rhythm fragmentation was measured by intradaily variability (IV), while synchronization to the 24-h light-dark cycle was measured by interdaily stability (IS). The average activity during the least active 5-h period (L5) and the average activity during the most active 10-h period (M10) were used to calculate the relative amplitude mean [RAm = (M10-L5)/(M10+L5)]. COPD patients presented higher IVm (0.242 ± 0.097 vs 0.182 ± 0.063) and L5 (36.849 ± 18.239 vs 19.888 ± 12.268) and lower RAm (0.696 ± 0.134 vs 0.833 ± 0.093) than controls. Future studies on the effects of chronotherapy measures in COPD are warranted.
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Affiliation(s)
- Deuzilane Muniz Nunes
- a Department of Pharmacy , Universidade Federal do Vale do São Francisco , Petrolina , Pernambuco , Brazil
| | - Bruno S B Gonçalves
- b School of Arts, Sciences and Humanities , Universidade de São Paulo , São Paulo , Brazil
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17
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Cleutjens FAHM, Pedone C, Janssen DJA, Wouters EFM, Incalzi RA. Sleep quality disturbances and cognitive functioning in elderly patients with COPD. ERJ Open Res 2016; 2:00054-2016. [PMID: 27957482 PMCID: PMC5140015 DOI: 10.1183/23120541.00054-2016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 06/18/2016] [Indexed: 02/03/2023] Open
Abstract
Information about the association between cognitive functions, such as copying function, and sleep disturbances in patients with chronic obstructive pulmonary disease (COPD) is lacking. This cross-sectional observational study aimed to investigate the association between copying function and self-reported sleep quality disturbances and disease severity in an elderly COPD population. Cognitive function performances, assessed using the Mini-Mental State Examination, were compared in 562 ambulatory COPD patients with and without sleep disturbances; assessed using the Established Populations for Epidemiologic Studies of the Elderly questionnaire; and stratified by Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades. Sleep disturbances overall were not correlated with cognitive functioning. A trend was revealed towards worse design copying in patients with sleep disturbances overall. GOLD I patients with difficulties falling asleep and nocturnal awakenings had worse copying ability compared to GOLD I patients without these sleep disturbances. Copying ability was worse for GOLD III than GOLD I, orientation was worse for GOLD II than GOLD I and language was worse for GOLD II and III than GOLD I. To conclude, sleep disturbances seem to be a weak correlate of cognitive functioning, and are not a marker of disease severity. Sleep disturbances are a weak correlate of cognitive functioning in COPDhttp://ow.ly/gUhD301PvcQ
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Affiliation(s)
- Fiona A H M Cleutjens
- Dept of Research and Education, CIRO Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Claudio Pedone
- Dept of Geriatrics, University Campus Bio-Medico, Rome, Italy
| | - Daisy J A Janssen
- Dept of Research and Education, CIRO Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Emiel F M Wouters
- Dept of Research and Education, CIRO Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
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Chung WS, Lai CY, Lin CL, Kao CH. Adverse Respiratory Events Associated With Hypnotics Use in Patients of Chronic Obstructive Pulmonary Disease: A Population-Based Case-Control Study. Medicine (Baltimore) 2015; 94:e1110. [PMID: 26166105 PMCID: PMC4504567 DOI: 10.1097/md.0000000000001110] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Insomnia is prevalent in patients with chronic obstructive pulmonary disease (COPD).We conducted a population-based case-control study to evaluate the effects of hypnotics on the risk of adverse respiratory events in patients with COPD.The case-control study was investigated using data retrieved from the Taiwan National Health Insurance Research Database. Patients with newly diagnosed adverse respiratory events (pneumonia, COPD with acute exacerbation, acute respiratory failure, and cardiopulmonary arrest) were included in the case group. Patients with COPD and no history of adverse respiratory events were randomly selected for the control group, which was frequency-matched with the case group according to index date, age (per 10 years), and sex. Patients who had used hypnotics within 1 month meant active users. The odds ratios (ORs) and 95% confidence intervals (CIs) of were calculated using univariable and multivariable logistic regression models.Most of the study participants were male (71.6%), and the mean ages of the participants in the case and control groups were 69.2 (±12.4) and 67.5 (±12.3) years, respectively. After potential confounding factors were adjusting for, the adjusted ORs of adverse respiratory events were 12.0 for active users of benzodiazepines (95% CI, 8.11-17.6) and 10.5 for active users of nonbenzodiazepines (95% CI, 7.68-14.2) compared with the adjusted ORs of those who never used hypnotics.The results of this epidemiological study suggested that hypnotics increased the risk of adverse respiratory events in patients with COPD.
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Affiliation(s)
- Wei-Sheng Chung
- From Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan (W-SC); Department of Health Services Administration, China Medical University, Taichung, Taiwan (W-SC); Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan (W-SC); Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan (C-YL); Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan (C-LL); College of Medicine, China Medical University, Taichung, Taiwan (C-LL); Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan (C-HK); and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan (C-HK)
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Chen SJ, Yeh CM, Chao TF, Liu CJ, Wang KL, Chen TJ, Chou P, Wang FD. The Use of Benzodiazepine Receptor Agonists and Risk of Respiratory Failure in Patients with Chronic Obstructive Pulmonary Disease: A Nationwide Population-Based Case-Control Study. Sleep 2015; 38:1045-50. [PMID: 25669186 DOI: 10.5665/sleep.4808] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 12/13/2014] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Insomnia is prevalent in patients with chronic obstructive pulmonary disease (COPD), and benzodiazepine receptor agonists (BZRAs) are the most commonly used drugs despite their adverse effects on respiratory function. The aim of this study was to investigate whether the use of BZRAs was associated with an increased risk of respiratory failure (RF) in COPD patients. DESIGN Matched case-control study. SETTING National Health Insurance Research Database (NHIRD) in Taiwan. PARTICIPANTS The case group consisted of 2,434 COPD patients with RF, and the control group consisted of 2,434 COPD patients without RF, matched for age, sex, and date of enrollment. MEASUREMENTS AND RESULTS Exposure to BZRAs during the 180-day period preceding the index date was analyzed and compared in the case and control groups. Conditional logistic regression was performed, and the use of BZRAs was associated with an increased risk of RF (adjusted odds ratio [aOR] 1.56, 95% confidence interval [CI] 1.14-2.13). In subgroup analysis, we found that the benzodiazepine (BZD) users had a higher risk of RF (aOR 1.58, 95% CI 1.14-2.20), whereas the risk in non-benzodiazepine (non-BZD) users was insignificant (aOR 0.85, 95% CI 0.51-1.44). A greater than 2-fold increase in risk was found in those who received two or more kinds of BZRAs and those using a combination of BZD and non-BZD medications. CONCLUSIONS The use of benzodiazepine receptor agonists was a significant risk factor for respiratory failure in patients with chronic obstructive pulmonary disease (COPD). Compared to benzodiazepine, the prescription of non-benzodiazepine may be safer for the management of insomnia in COPD patients.
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Affiliation(s)
- Su-Jung Chen
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, Taipei Veterans General Hospital Su-Ao and Yuan-Shan Branch, I-Lan, Taiwan.,Institute of Public Health and School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chiu-Mei Yeh
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taiwan
| | - Chia-Jen Liu
- Institute of Public Health and School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Yang-Ming University Hospital, I-Lan, Taiwan
| | - Kang-Ling Wang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Pesus Chou
- Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Fu-Der Wang
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Public Health and School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Dignani L, Toccaceli A, Lucertini C, Petrucci C, Lancia L. Sleep and Quality of Life in People With COPD. Clin Nurs Res 2015; 25:432-47. [DOI: 10.1177/1054773815588515] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Sleep disorders are very common in patients with chronic obstructive pulmonary disease (COPD). However, it is not clear how sleep disorders and quality of life (QoL) affect each other in the different stages of disease progression. This descriptive-correlational study investigated the relationship between QoL, quality of sleep, and degree of disease progression in 102 outpatients with COPD. The results showed that the QoL in patients with COPD is compromised and worsens with disease progression, and the quality of sleep is significantly associated with QoL and worsened as the disease progressed. The early identification of a risk of alteration of the quality of sleep, especially in nursing care, could facilitate a preventive approach for COPD patients that could positively affect their QoL.
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Jébrak G, Vicaire M, Murez A. BPCO : les patients parlent aux soignants. Enquête de la Fédération française des associations et amicales de malades insuffisants ou handicapés respiratoires (FFAAIR). Rev Mal Respir 2015; 32:500-12. [DOI: 10.1016/j.rmr.2014.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 08/05/2014] [Indexed: 10/24/2022]
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Matos P, Esquinas AM. Modafinil: a novel alternative to non-invasive ventilation in hypercapnic respiratory failure? Int J Chron Obstruct Pulmon Dis 2015; 10:711-3. [PMID: 25848247 PMCID: PMC4386785 DOI: 10.2147/copd.s83558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Paulo Matos
- Pneumology Department, Hospitais da Universidade de Coimbra, Coimbra, Portugal
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Effects of suvorexant, an orexin receptor antagonist, on breathing during sleep in patients with chronic obstructive pulmonary disease. Respir Med 2015; 109:416-26. [PMID: 25661282 DOI: 10.1016/j.rmed.2014.12.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 12/16/2014] [Accepted: 12/25/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVES There is a general concern that hypnotic medications in patients with respiratory disorders have the potential to decrease respiratory effort and blunt the arousal response to hypoxemia which may lead to sleep breathing disorders. We investigated whether suvorexant, an orexin receptor antagonist approved for treatment of insomnia at a maximum daily dose of 20 mg in the US, causes sleep breathing disorders in patients with chronic obstructive pulmonary disease (COPD). DESIGN This was a randomized, double-blind, placebo-controlled, 2-period, cross-over, study performed in 9 sleep laboratories/clinical research units in the United States. The participants were 25 COPD patients aged 39-72 y with mild-to-moderate airflow limitation based on GOLD spirometry criteria. In each period, patients received suvorexant (40 mg in <65 y-olds; 30 mg in ≥65 y-olds) or placebo for four consecutive nights. Respiratory function during sleep was measured by oxygen saturation using pulse oximetry (SpO2, primary endpoint) and Apnea Hypopnea Index (AHI, secondary endpoint). The study was powered to rule out a difference between treatments of -2 percentage points in SpO2 on Day 4. RESULTS There was no treatment effect following single and multiple doses of suvorexant on mean SpO2 during total sleep time (Day 1: suvorexant = 93.14%, placebo = 93.24%, difference = -0.10 [90% CI: -0.50, 0.31]; Day 4: suvorexant = 93.38%, placebo = 92.99%, difference = 0.39 [90% CI: -0.12, 0.91]). There was no clinically meaningful increase in mean AHI by suvorexant compared with placebo on Day 1 (difference = 0.72 [90% CI: -0.60, 2.04]) or Day 4 (difference = 2.05 [90% CI: 0.33, 3.77]). CONCLUSIONS These data do not suggest an overt respiratory depressant effect with 30-40 mg daily doses of suvorexant, up to twice the maximum recommended dose for treating insomnia in the US, in patients with mild-to-moderate COPD. Trial registration Clinicaltrials.gov identifier: NCT01293006.
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Holmedahl NH, Øverland B, Fondenes O, Ellingsen I, Hardie JA. Zopiclone effects on breathing at sleep in stable chronic obstructive pulmonary disease. Sleep Breath 2014; 19:921-30. [DOI: 10.1007/s11325-014-1084-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 09/05/2014] [Accepted: 11/10/2014] [Indexed: 10/24/2022]
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Theander K, Hasselgren M, Luhr K, Eckerblad J, Unosson M, Karlsson I. Symptoms and impact of symptoms on function and health in patients with chronic obstructive pulmonary disease and chronic heart failure in primary health care. Int J Chron Obstruct Pulmon Dis 2014; 9:785-94. [PMID: 25071370 PMCID: PMC4111648 DOI: 10.2147/copd.s62563] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Patients with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) seem to have several symptoms in common that impact health. However, methodological differences make this difficult to compare. Aim Comparisons of symptoms, impact of symptoms on function and health between patients with COPD and CHF in primary health care (PHC). Method The study is cross sectional, including patients with COPD (n=437) and CHF (n=388), registered in the patient administrative systems of PHC. The patients received specific questionnaires – the Memorial Symptom Assessment Scale, the Medical Research Council dyspnea scale, and the Fatigue Impact Scale – by mail and additional questions about psychological and physical health. Results The mean age was 70±10 years and 78±10 years for patients with COPD and CHF respectively (P=0.001). Patients with COPD (n=273) experienced more symptoms (11±7.5) than the CHF patients (n=211) (10±7.6). The most prevalent symptoms for patients with COPD were dyspnea, cough, and lack of energy. For patients with CHF, the most prevalent symptoms were dyspnea, lack of energy, and difficulty sleeping. Experience of dyspnea, cough, dry mouth, feeling irritable, worrying, and problems with sexual interest or activity were more common in patients with COPD while the experience of swelling of arms or legs was more common among patients with CHF. When controlling for background characteristics, there were no differences regarding feeling irritable, worrying, and sexual problems. There were no differences in impact of symptoms or health. Conclusion Patients with COPD and CHF seem to experience similar symptoms. There were no differences in how the patients perceived their functioning according to their cardinal symptoms; dyspnea and fatigue, and health. An intervention for both groups of patients to optimize the management of symptoms and improve function is probably more relevant in PHC than focusing on separate diagnosis groups.
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Affiliation(s)
- Kersti Theander
- Department of Nursing, Faculty of Health Science and Technology, Karlstad University, Karlstad, Sweden ; Primary Care Research Unit, County Council of Värmland, Karlstad, Sweden
| | - Mikael Hasselgren
- Primary Care Research Unit, County Council of Värmland, Karlstad, Sweden ; Department of Medicine, Örebro University, Örebro, Sweden
| | - Kristina Luhr
- Family Medicine Research Centre, Örebro County Council, Örebro, Sweden
| | - Jeanette Eckerblad
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Mitra Unosson
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Ingela Karlsson
- Department of Nursing, Faculty of Health Science and Technology, Karlstad University, Karlstad, Sweden
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Sleep Quality and Quality of Life in COPD Patients with and without Suspected Obstructive Sleep Apnea. SLEEP DISORDERS 2014; 2014:508372. [PMID: 24587911 PMCID: PMC3920678 DOI: 10.1155/2014/508372] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 11/03/2013] [Accepted: 11/05/2013] [Indexed: 11/29/2022]
Abstract
Present study was designed to obtain association between sleep apnea with sleep quality and quality of life in COPD patients. This cross-sectional descriptive study was conducted on 139 patients with COPD in a chest clinic of a university hospital. All patients were evaluated by pulmonary function test for determination of severity of their disease. Also, Berlin questionnaire, Epworth sleepiness scale, Pittsburgh Sleep Quality Index, and St. George Respiratory questionnaires (SGRQ) were employed for assessment of patients. Analysis of data showed that quality of sleep was significantly correlated with quality of life (P < 0.001). About half of the patients were at high risk for sleep apnea. The patients were divided into two groups according to the result of Berlin questionnaire. Significant differences were found between the groups for total score and each of three subscores of SGRQ suggesting worse quality of life in overlap syndrome (P < 0.001). Also, patients with overlap syndrome had worse quality of sleep compared to patients without it (8.1 ± 1.7 versus 6.2 ± 2.3; P < 0.001). Stepwise multiple regression analysis showed that severity of COPD, coexisting obstructive sleep apnea, and sleep quality accounted for the SGRQ significantly (r2 (coefficient of determination) = 0.08, 0.21, and 0.18, resp.). It is recommended that patient with COPD be evaluated for sleep apnea and sleep disorders during routine examinations and followups.
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Xiang YT, Wong TS, Tsoh J, Ungvari GS, Correll CU, Ko FW, Hui DS, Chiu HF. Insomnia in Older Adults with Chronic Obstructive Pulmonary Disease (COPD) in Hong Kong: A Case-Control Study. COPD 2013; 11:319-24. [DOI: 10.3109/15412555.2013.858314] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Verbraecken J, McNicholas WT. Respiratory mechanics and ventilatory control in overlap syndrome and obesity hypoventilation. Respir Res 2013; 14:132. [PMID: 24256627 PMCID: PMC3871022 DOI: 10.1186/1465-9921-14-132] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 11/15/2013] [Indexed: 02/07/2023] Open
Abstract
The overlap syndrome of obstructive sleep apnoea (OSA) and chronic obstructive pulmonary disease (COPD), in addition to obesity hypoventilation syndrome, represents growing health concerns, owing to the worldwide COPD and obesity epidemics and related co-morbidities. These disorders constitute the end points of a spectrum with distinct yet interrelated mechanisms that lead to a considerable health burden. The coexistence OSA and COPD seems to occur by chance, but the combination can contribute to worsened symptoms and oxygen desaturation at night, leading to disrupted sleep architecture and decreased sleep quality. Alveolar hypoventilation, ventilation-perfusion mismatch and intermittent hypercapnic events resulting from apneas and hypopneas contribute to the final clinical picture, which is quite different from the “usual” COPD. Obesity hypoventilation has emerged as a relatively common cause of chronic hypercapnic respiratory failure. Its pathophysiology results from complex interactions, among which are respiratory mechanics, ventilatory control, sleep-disordered breathing and neurohormonal disturbances, such as leptin resistance, each of which contributes to varying degrees in individual patients to the development of obesity hypoventilation. This respiratory embarrassment takes place when compensatory mechanisms like increased drive cannot be maintained or become overwhelmed. Although a unifying concept for the pathogenesis of both disorders is lacking, it seems that these patients are in a vicious cycle. This review outlines the major pathophysiological mechanisms believed to contribute to the development of these specific clinical entities. Knowledge of shared mechanisms in the overlap syndrome and obesity hypoventilation may help to identify these patients and guide therapy.
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Affiliation(s)
- Johan Verbraecken
- Department of Pulmonary Medicine and Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Wilrijkstraat 10, Edegem 2650, Belgium.
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Chronic obstructive pulmonary disease (COPD) patients' disease-related preferences : a study using conjoint analysis. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2013; 6:93-101. [PMID: 23526399 DOI: 10.1007/s40271-013-0007-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND In the management of chronic obstructive pulmonary disease (COPD), knowledge of disease attributes and preferences that are important to patients is crucial. This knowledge may support drug development and optimization of COPD management strategies. OBJECTIVE To assess patient preferences in COPD and to use the conjoint methodology in order to propose a self-assessment tool based on patients' preferences gained from this conjoint analysis. This tool might then be used in future observational study settings. METHODS A two-step procedure was applied: an initial qualitative research module consisting of interviews with eight COPD patients served to assess COPD patients' health state in-depth, their attitudes towards COPD and their information sources regarding the disease, symptomatology, unmet needs, and their preferences for future COPD medications. In the main quantitative research part of the study, 300 patients (with an average age of 55 years) from across Germany suffering from COPD (n = 225 with stage II and n = 75 with stage III COPD) participated. Each participant was presented with 15 different scenarios during the conjoint exercise. Additionally, the Clinical COPD Questionnaire (CCQ) had to be completed and attitudes towards COPD were assessed. RESULTS According to the participants, the three COPD attributes of the highest relative importance were dyspnea, performance capability, and sleep quality. Frequency of administration of the medication, onset of medication, and emotional state due to COPD base medication played only a minor role. COPD symptoms were reported to have the highest impact on quality of life, according to the CCQ. CONCLUSIONS Our study proposes an alternative utility-based approach of a self-reported health state concept, utilizing the fact that patients with moderate to severe COPD would trade, e.g., ease of administration and onset of medication for relief from dyspnea.
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Will minimizing dyspnea impact sleep quality? Sleep Breath 2013; 17:11. [DOI: 10.1007/s11325-012-0659-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 01/19/2012] [Accepted: 01/23/2012] [Indexed: 10/28/2022]
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de Matos Cavalcante AG, de Bruin PFC, de Bruin VMS, Nunes DM, Pereira EDB, Cavalcante MM, Andrade GM. Melatonin reduces lung oxidative stress in patients with chronic obstructive pulmonary disease: a randomized, double-blind, placebo-controlled study. J Pineal Res 2012; 53:238-44. [PMID: 22507631 DOI: 10.1111/j.1600-079x.2012.00992.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Chronic obstructive pulmonary disease (COPD), a major cause of death and disability, is attributed to an abnormal inflammatory response by the lungs to noxious substances, primarily from cigarette smoke. Although oxidative stress is regarded as central to the pathogenesis of COPD, very few studies have examined the effects of antioxidants in this condition. This was a randomized, double-blind, placebo-controlled study on the effects of melatonin in COPD. Thirty-six consecutive patients with clinically stable moderate to very severe COPD (30 men; mean±S.D.=66.6±7.8yr) were randomized to receive 3mg melatonin (N=18) or placebo for 3 months. Oxidative stress was evaluated by 8-isoprostane levels in exhaled breath condensate at baseline (T0) and after one (T1), two (T2), and three months (T3) of treatment. Additionally, exhaled breath condensate levels of IL-8, dyspnea severity (Medical Research Council scale), lung function (spirometry), and functional exercise capacity (six min walk test) were compared at baseline and after treatment. Patients receiving melatonin showed a decrease in 8-isoprostane (T0: mean±S.E.M.=20.41±2.92pg/mL; T1: 18.56±2.68pg/mL; T2: 12.68±2.04pg/mL; T3: 12.70±2.18pg/mL; P=0.04; repeated measures ANOVA) with significant differences from baseline after 2 (P=0.03) and 3months (P=0.01). Dyspnea was improved by melatonin (P=0.01), despite no significant changes in lung function or exercise capacity. Placebo-treated patients, but not those who were given melatonin, showed an increase in IL-8 (P=0.03). In summary, melatonin administration reduced oxidative stress and improved dyspnea in COPD. Further studies are necessary to determine the potential role for melatonin in the long-term management of these patients.
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Kamdar BB, Needham DM, Collop NA. Sleep deprivation in critical illness: its role in physical and psychological recovery. J Intensive Care Med 2012; 27:97-111. [PMID: 21220271 PMCID: PMC3299928 DOI: 10.1177/0885066610394322] [Citation(s) in RCA: 277] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Critically ill patients frequently experience poor sleep, characterized by frequent disruptions, loss of circadian rhythms, and a paucity of time spent in restorative sleep stages. Factors that are associated with sleep disruption in the intensive care unit (ICU) include patient-ventilator dysynchrony, medications, patient care interactions, and environmental noise and light. As the field of critical care increasingly focuses on patients' physical and psychological outcomes following critical illness, understanding the potential contribution of ICU-related sleep disruption on patient recovery is an important area of investigation. This review article summarizes the literature regarding sleep architecture and measurement in the critically ill, causes of ICU sleep fragmentation, and potential implications of ICU-related sleep disruption on patients' recovery from critical illness. With this background information, strategies to optimize sleep in the ICU are also discussed.
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Affiliation(s)
- Biren B. Kamdar
- Division of Pulmonary/Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Dale M. Needham
- Division of Pulmonary/Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA
| | - Nancy A. Collop
- Medicine and Neurology Director, Emory Sleep Center, Emory University, MD, USA
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Actigraphic assessment of sleep in chronic obstructive pulmonary disease. Sleep Breath 2012; 17:125-32. [PMID: 22351160 DOI: 10.1007/s11325-012-0660-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 11/22/2011] [Accepted: 01/23/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Previously, sleep in chronic obstructive pulmonary disease (COPD) has been objectively investigated only by lab-based polysomnography. The main purpose of this study was to evaluate sleep quality in COPD patients in their home environment using actigraphy. We also investigated the factors associated with sleep impairment and the relationship between objective and subjective sleep quality and daytime somnolence in these patients. METHODS Twenty-six patients with moderate to very severe COPD and 15 controls were studied by actigraphy for at least 5 days. Subjective sleep quality was evaluated by the Pittsburgh Sleep Quality Index and daytime sleepiness by the Epworth Sleepiness Scale (ESS). Dyspnea was quantified by the modified Medical Research Council (MMRC) scale. RESULTS COPD patients showed increased sleep latency (p = 0.003), mean activity (p = 0.003), and wake after sleep onset (p = 0.003) and reduced total sleep time (TST; p = 0.024) and sleep efficiency (p = 0.001), as compared to controls. In patients, severity of dyspnea was correlated with sleep activity (r = 0.41; p = 0.04) and TST (r = -0.46; p = 0.02) and multiple regression analysis showed that MMRC score was the best predictor of TST (p = 0.02) and sleep efficiency (p = 0.03). Actigraphy measures during daytime were not significantly different between patients and controls. Subjective sleep quality was poorer in patients than controls (p = 0.043). ESS scores were not significantly different between the two groups. Actigraphy measures were not correlated with subjective sleep quality or daytime somnolence in both groups. CONCLUSIONS Nocturnal sleep is markedly impaired in stable COPD patients studied by actigraphy in their home environment and this impairment is related to severity of dyspnea.
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Karlstad O, Tverdal A, Skurtveit S, Nafstad P, Furu K. A prospective study of asthma and subsequent use of hypnotics in young adults. Pharmacoepidemiol Drug Saf 2011; 20:370-7. [PMID: 21264987 DOI: 10.1002/pds.2101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 12/07/2010] [Accepted: 12/13/2010] [Indexed: 11/10/2022]
Abstract
PURPOSE To examine whether young adults with asthma are at higher risk of initiating hypnotic use. METHODS The study population was participants from the Norwegian youth health surveys, where all 10th grade students (15-17 years old) in five counties were invited. 10,164 participants with no prior use of hypnotics were linked to the Norwegian Prescription Database. Four groups were defined based on survey data about ever having had asthma and prescription data on asthma drugs received in the year prior to start of follow-up: (1) no asthma; (2) not active asthma; (3) active recently developed asthma; and (4) still active asthma. Incidence proportions were estimated as share of participants filling hypnotic prescriptions during 2005-July 2010. Incidence rate ratios (IRR), adjusted for potential confounders (illnesses, lifestyle and sociodemographic factors), were estimated with the number of hypnotic prescriptions filled during 2005-July 2010 as outcome. RESULTS The incidence proportion of filling hypnotic prescriptions was 6.1%, ranging from 5.7% in no asthma group to 9.5% in active recently developed asthma group. Crude IRR was 1.35 (95%CI 0.93-1.95) for not active asthma, 4.18 (1.83-9.55) for active recently developed asthma, and 1.63 (0.85-3.14) for still active asthma, with no asthma as reference. Adjusted IRR for active recently developed asthma group changed to 4.72 (2.07-10.75) while the other groups remained statistically not significant. CONCLUSIONS In this prospective study of young adults without prior use of hypnotics, an increased risk of initiating hypnotic use was present in asthmatics, especially among those who recently had received asthma drugs.
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Affiliation(s)
- Oystein Karlstad
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
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Glidewell RN, Moorcroft WH, Lee-Chiong T. Comorbid Insomnia: Reciprocal Relationships and Medication Management. Sleep Med Clin 2010. [DOI: 10.1016/j.jsmc.2010.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Missildine K, Bergstrom N, Meininger J, Richards K, Foreman MD. Sleep in hospitalized elders: a pilot study. Geriatr Nurs 2010; 31:263-71. [PMID: 20682404 DOI: 10.1016/j.gerinurse.2010.02.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Revised: 01/12/2010] [Accepted: 02/15/2010] [Indexed: 11/29/2022]
Abstract
Hospitalized elders frequently experience disturbed sleep related to environmental factors. To determine relationships between sleep and environmental noise and light, a descriptive exploratory study was conducted with 48 hospitalized older adults. Participants aged 70 years or older were monitored for sleep via wrist actigraphy, and noise and light levels were measured the first night of hospitalization. Sleep time was brief (mean, 3.75 hours) and fragmented (mean, 13 awakenings per night). The sleep environment was noisy with a median sound level of 49.65 dB(A). There was an average of 3 periods of elevated light levels (mean, 64 lux) lasting an average of 1.75 hours each night. No significant correlation was found among sleep and age, light, and sound. Recommendations include light and sound reduction measures and dedicated "do not disturb" times to allow for a full 90-minute sleep cycle.
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Abstract
Ramelteon is the first member of a novel class of hypnotics and acts as a selective melatonin receptor agonist. In 2005, ramelteon was approved by the US Food and Drug Administration for the treatment of insomnia characterized by sleep onset problems. Its unique mechanism of action made it a promising candidate compared with the widely used hypnotics that act on the benzodiazepine receptor complex. Several studies have examined its efficacy and safety as a hypnotic agent. The primary efficacy of ramelteon was found to lie in a decrease in latency to persistent sleep, as measured by polysomnographic tests. Other sleep-related measures, such as total sleep time and number of nightly awakenings, show less pronounced improvement when treated with ramelteon. In addition, no rebound insomnia or abuse potential was observed in clinical studies. Although additional studies are necessary, current data on the acute and next-morning effects of ramelteon did not indicate cognitive or psychomotor impairment. Overall, ramelteon is safe and well tolerated, although some questions remain regarding its long-term efficacy and safety. These issues and possibilities for use in other patient groups should be addressed in future research.
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Affiliation(s)
- Monique Aj Mets
- Utrecht University, Utrecht institute for Pharmaceutical Sciences, Division of Pharmacology, Utrecht, The Netherlands
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Current World Literature. Curr Opin Support Palliat Care 2009; 3:144-51. [DOI: 10.1097/spc.0b013e32832c6adb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Impaired sleep reduces quality of life in chronic obstructive pulmonary disease. Lung 2009; 187:159-63. [PMID: 19399553 DOI: 10.1007/s00408-009-9147-5] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Accepted: 03/29/2009] [Indexed: 10/20/2022]
Abstract
Disturbed sleep is reportedly common in chronic obstructive pulmonary disease (COPD), but the impact of quality of sleep on health-related quality of life (HRQL) has not been previously investigated in these individuals. The purpose of this study was to assess the impact of quality of sleep on HRQL in patients with COPD. In 30 clinically stable patients with moderate to very severe COPD, we evaluated subjective sleep quality using the Pittsburgh Sleep Quality Index (PSQI) and HRQL using the Saint George's Respiratory Questionnaire. Additionally, lung function was assessed by spirometry, severity of dyspnea by the Modified Medical Research Council scale, and functional exercise capacity by the Six-Minute Walk Test. Twenty-one (70%) patients showed poor quality of sleep (PSQI > 5). HRQL was significantly correlated with quality of sleep (P = 0.02), post-bronchodilator FEV1 (P = 0.04), and severity of dyspnea (P < 0.01). Multiple regression analysis showed that quality of sleep was the best predictor of quality of life in our subjects. Our data suggest that quality of sleep is major determinant of HRQL in COPD. Increased efforts to diagnose and treat sleep problems, including measures to improve factors that adversely affect sleep should receive great attention in the daily management of these patients.
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