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Pérez-Carbonell L, Mignot E, Leschziner G, Dauvilliers Y. Understanding and approaching excessive daytime sleepiness. Lancet 2022; 400:1033-1046. [PMID: 36115367 DOI: 10.1016/s0140-6736(22)01018-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 05/10/2022] [Accepted: 05/19/2022] [Indexed: 10/14/2022]
Abstract
Excessive daytime sleepiness (EDS) is a public health issue. However, it remains largely undervalued, scarcely diagnosed, and poorly supported. Variations in the definition of EDS and limitations in clinical assessment lead to difficulties in its epidemiological study, but the relevance of this symptom from a socioeconomic perspective is inarguable. EDS might be a consequence of several behavioural issues leading to insufficient or disrupted sleep, as well as a consequence of sleep disorders including sleep apnoea syndrome, circadian disorders, central hypersomnolence disorders (narcolepsy and idiopathic hypersomnia), other medical or psychiatric conditions, or medications. Furthermore, EDS can have implications for health as it is thought to act as a risk factor for other conditions, such as cardiovascular and neurodegenerative disorders. Because of the heterogeneous causes of EDS and the complexity of its pathophysiology, management will largely depend on the cause, with the final aim of making treatment specific to the individual using precision medicine and personalised medicine.
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Affiliation(s)
| | - Emmanuel Mignot
- Center for Narcolepsy, Stanford University, Palo Alto, CA, USA
| | - Guy Leschziner
- Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK; Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Yves Dauvilliers
- Centre National de Référence Narcolepsie Hypersomnies, Unité des Troubles du Sommeil, Département de Neurologie, Hôpital Gui-de-Chauliac, Inserm INM, Université Montpellier, Montpellier, France
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2
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Psychometric properties of the Insomnia Severity Index for people with chronic obstructive pulmonary disease. Sleep Med 2022; 95:120-125. [DOI: 10.1016/j.sleep.2022.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/30/2022] [Accepted: 04/18/2022] [Indexed: 11/20/2022]
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3
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Lurie A, Roche N. Obstructive Sleep Apnea in Patients with Chronic Obstructive Pulmonary Disease: Facts and Perspectives. COPD 2021; 18:700-712. [PMID: 34595967 DOI: 10.1080/15412555.2021.1950663] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The co-occurrence of obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) in the same patient, named the overlap syndrome (OS), was first described in 1985. Although the American Thoracic Society underlined the limited knowledge of OS, stated research priorities for this condition, and recommended a "screening" strategy to identify OSA in COPD patients with chronic stable hypercapnia, research studies on OS remain scarce. This review aims to summarize the current knowledge and perspectives related to OSA in COPD patients. OS prevalence is 1.0-3.6% in the general population, 3-66% in COPD patients, and 7-55% in OSA patients. OS patients may have worse sleep quality than those with OSA or COPD alone. Scoring hypopneas may be difficult in COPD patients; desaturation episodes may have origins in these patients, namely upper airway obstruction, hypoventilation during paradoxical sleep, ventilation/perfusion mismatches, and obesity. The apnea-hypopnea index is similar in OSA and OS patients. Desaturations may be greater and more prolonged in OS patients than in patients with COPD or OSA alone. Low body mass index, hyperinflation, and less collapsible airways reduce the risk of OSA in COPD patients. OSA is a risk factor for pulmonary hypertension in COPD patients. Whether OS increases mortality and morbidity risks compared to COPD or OSA alone remains to be confirmed. No guidelines currently recommend specific approaches to the treatment of OSA in patients with COPD.
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Affiliation(s)
- Alain Lurie
- Clinique Ambroise Paré, Laboratoire du sommeil, Neuilly-sur-Seine, France.,Hôpital Cochin (AP-HP Centre), Pneumologie, Paris, France
| | - Nicolas Roche
- Hôpital Cochin (AP-HP Centre), Pneumologie, Université de Paris (Descartes), UMR 1016, Institut Cochin, Paris, France
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Hirata RP, Dala Pola DC, Schneider LP, Bertoche MP, Furlanetto KC, Hernandes NA, Mesas AE, Pitta F. Tossing and turning: association of sleep quantity-quality with physical activity in COPD. ERJ Open Res 2021; 6:00370-2020. [PMID: 33447609 PMCID: PMC7792763 DOI: 10.1183/23120541.00370-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/05/2020] [Indexed: 11/13/2022] Open
Abstract
The association between characteristics of sleep and physical activity in daily life (PADL) has not yet been investigated in depth in subjects with COPD. This study evaluated whether time spent per day in physical activity (PA) and sedentary behaviour are associated with sleep quantity and quality in this population. Sleep and PADL were objectively assessed by an activity monitor for 7 days and analysed on a minute-by-minute basis. Subjects also underwent spirometry and 6-min walking test (6MWT). Fifty-five subjects with moderate-to-severe COPD (28 male, 67±8 years) were studied. Subjects with total time in bed (TIB) per night ≥9 h had higher wake-after-sleep onset than TIB 7–9 h and TIB ≤7 h (195 (147–218) versus 117 (75–167) and 106 (84–156) min) and more fragmented sleep than TIB ≤7 h (8.2 (6.7–14.3) versus 6.3 (5.6–6.9) sleeping bouts; p<0.05 for all). Subjects with TIB ≥9 h also spent more time per day in sedentary behaviour and less time per day in PA of light and moderate-to-vigorous intensity than those with TIB 7–9 h and ≤7 h. In multiple linear regression, TIB ≥9 h was the only significant predictor of physical inactivity (β=−3.3 (−5.1, −1.6), p≤0.0001), accounting for 20% of its variation. Sleep fragmentation was frequent and more pronounced in physically inactive than active patients (7.5 (6.3–9.6) versus 6.4 (5.5–7.3) sleeping bouts; p=0.027). In summary, subjects with COPD with TIB ≥9 h·night−1 have more fragmented sleep, are more sedentary and less physically active than those with <9 h·night−1, independently of the awake time. Sleep quality is frequently poor and even worse in patients classified as physically inactive. This study shows, for the first time, that sleep quantity is a determinant factor of objectively assessed level of physical activity in subjects with COPDhttps://bit.ly/3diOIlC
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Affiliation(s)
- Raquel Pastrello Hirata
- Laboratory of Research in Respiratory Physiotherapy, Dept of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Daniele Caroline Dala Pola
- Laboratory of Research in Respiratory Physiotherapy, Dept of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Lorena Paltanin Schneider
- Laboratory of Research in Respiratory Physiotherapy, Dept of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Mariana Pereira Bertoche
- Laboratory of Research in Respiratory Physiotherapy, Dept of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Karina Couto Furlanetto
- Laboratory of Research in Respiratory Physiotherapy, Dept of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil.,Research Center in Health Sciences, University of Northern Paraná (UNOPAR), Londrina, Brazil
| | - Nidia Aparecida Hernandes
- Laboratory of Research in Respiratory Physiotherapy, Dept of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Arthur Eumann Mesas
- Postgraduate Program in Public Health, UEL, Londrina, Brazil.,Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Fabio Pitta
- Laboratory of Research in Respiratory Physiotherapy, Dept of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
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Chen R, Wang KX, Meng X, Zhou W. Does benralizumab effectively treat chronic obstructive pulmonary disease? A protocol of systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e20241. [PMID: 32443359 PMCID: PMC7253484 DOI: 10.1097/md.0000000000020241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This study aims to investigate the efficacy and safety of benralizumab for the treatment of patients with chronic obstructive pulmonary disease (COPD). METHODS This study will systematically and comprehensively search relevant literatures in electronic databases (MEDLINE, EMBASE, Cochrane Library, Global health, PsycINFO, Scopus, WANGFANG, and CNKI) from inception to the present without language and publication time restrictions. Two reviewers will independently carry out literature identification, data collection, and study quality assessment. Any disagreement will be settled down by a third reviewer through discussion and a consensus will be reached. RevMan 5.3 software will be used for statistical analysis performance. RESULTS This study will summarize up-to-date evidence to assess the efficacy and safety of benralizumab for the treatment of COPD. CONCLUSION The findings of this study will provide helpful evidence to determine whether benralizumab is effective or not for the treatment of COPD. SYSTEMATIC REVIEW REGISTRATION INPLASY202040039.
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Affiliation(s)
- Ru Chen
- Department of Respiratory Medicine
| | - Ke-xin Wang
- Department of Pediatrics, The Affiliated Hongqi Hospital of Mudanjiang Medical University
| | - Xue Meng
- Department of Respiratory Medicine
| | - Wen Zhou
- Second Ward of Neurology Department, The Second Affiliated Hospital of Mudanjiang Medical University, Mudanjiang 157000, China
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Ma RC, Yin YY, Wang YQ, Liu X, Xie J. Effectiveness of cognitive behavioural therapy for chronic obstructive pulmonary disease patients: A systematic review and meta-analysis. Complement Ther Clin Pract 2019; 38:101071. [PMID: 31743870 DOI: 10.1016/j.ctcp.2019.101071] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 11/11/2019] [Accepted: 11/11/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND and purpose: Cognitive behavioural therapy (CBT) has gained increasing attention for the treatment of psychological disorders. This study aims to establish the effectiveness of CBT on psychological and physical outcomes in patients with chronic obstructive pulmonary disease (COPD). METHODS Two waves of electronic searches of the PubMed, Cochrane library, EMBASE, Web of Science and China National Knowledge Infrastructure databases were conducted. Statistical analyses were performed using Revman Manager 5.3 and Stata 12.0 software. RESULTS Sixteen randomized controlled trials were eligible. There were significant improvements in anxiety (SMD = -0.23; 95% CI: -0.42 to -0.04; P = 0.02), depression (SMD = -0.29, 95% CI: -0.40 to -0.19, P < 0.01), quality of life (MD = -5.21; 95% CI: -10.25 to -0.17; P = 0.04), and mean visits to emergency departments in the CBT groups. No statistically significant differences were observed in fatigue (SMD = 0.88, 95% CI: -0.58 to 2.35, P = 0.24), exercise capacity (MD = 28.75, 95% CI: -28.30 to 85.80, P = 0.32), self-efficacy (SMD = 0.15, 95% CI: -0.05 to 0.34, P = 0.14), or sleep quality (MD = 1.21, 95% CI: -0.65 to 3.06, P = 0.20). CONCLUSION This meta-analysis suggests that CBT can serve as a complementary therapy to improve anxiety, depression, and quality of life in COPD patients and deserves more widespread application in clinical practice.
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Affiliation(s)
- Rui-Chen Ma
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin Province, 130021, PR China
| | - Ying-Ying Yin
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin Province, 130021, PR China
| | - Ya-Qing Wang
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin Province, 130021, PR China
| | - Xin Liu
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin Province, 130021, PR China
| | - Jiao Xie
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun, Jilin Province, 130021, PR China.
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Murphy PB, Suh ES, Hart N. Non-invasive ventilation for obese patients with chronic respiratory failure: Are two pressures always better than one? Respirology 2019; 24:952-961. [PMID: 31121638 DOI: 10.1111/resp.13588] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/10/2019] [Accepted: 05/02/2019] [Indexed: 01/02/2023]
Abstract
Obesity-related respiratory failure is increasingly common but remains under-diagnosed and under-treated. There are several clinical phenotypes reported, including severe obstructive sleep apnoea (OSA), isolated nocturnal hypoventilation with or without severe OSA and OSA complicating chronic obstructive pulmonary disease (COPD). The presence of hypercapnic respiratory failure is associated with poor clinical outcomes in each of these groups. While weight loss is a core aim of management, this is often unachievable, and treatment of sleep-disordered breathing with positive airway pressure (PAP) therapy is the mainstay of clinical practice. Although there are few long-term clinical efficacy trials, the lack of equipoise would prevent the utilization of an untreated control group. The current data support the use of PAP therapy to improve respiratory failure and is associated with improvements in health-related quality of life, reduced healthcare utilization and reduced mortality. Both continuous PAP (CPAP) and non-invasive ventilation (NIV) appear safe and effective in patients with obesity-related respiratory failure and OSA, with or without COPD, and the current evidence would not support a single therapy choice in all patients. There are no studies of CPAP in patients with isolated nocturnal hypoventilation, and NIV would be the current recommendation in this patient group. Whichever starting therapy is used, titration should be performed to correct sleep-disordered breathing and reverse chronic respiratory failure, with consideration of step-down of the treatment based on a clinical re-evaluation. In contrast, failure to reach physiological and clinical treatment targets should lead to the consideration of treatment escalation.
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Affiliation(s)
- Patrick B Murphy
- Lane Fox Respiratory Service, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Eui-Sik Suh
- Lane Fox Respiratory Service, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Nicholas Hart
- Lane Fox Respiratory Service, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences, King's College London, London, UK
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