Factors associated with sleep disturbance in patients with chronic obstructive pulmonary disease

The Effect of Sleep Impairment, as Assessed by the CASIS Questionnaire, in Patients with Chronic Obstructive Pulmonary Disease on Disease Severity and Physical and Mental Health: A Cross-Sectional Study in Primary Care

The aim of our study was to assess the prevalence of sleep impairment among primary care patients with COPD and explore its impact on disease severity and overall health status. This cross-sectional study included 251 participants > 40 years old from the prospective COCARE COPD study. Data on sociodemographic characteristics, medical history, disease-specific quality of life [COPD Assessment Test (CAT)], COPD severity [Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 categorization based on CAT score and exacerbations], fatigue [Fatigue Severity Scale (FSS)], psychological parameters [Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7)], and sleep complaints [COPD and Asthma Sleep Impact Scale (CASIS) and Epworth Sleepiness Scale (ESS)] were collected. Multiple logistic regression analysis was conducted to test for associations of sleep impairment with COPD and overall health status, adjusting for confounders. Sleep impairment, indicated by a CASIS score ≥ 30, increased the risk of worse COPD health status (CAT ≥ 10 OR: 9.7, 95% CI: 5-19, p < 0.001), COPD severity (GOLD B OR: 8.9, 95% CI: 4.5-17.6, p < 0.001 and GOLD E OR: 17.4, 95% CI: 5.1-59.4, p < 0.001), excessive daytime sleepiness (ESS > 10, OR: 3.2, 95% CI: 1.3-8.1, p = 0.012), depressive symptoms (PHQ-9 ≥ 10, OR: 6.4, 95% CI: 2.1-19.1, p = 0.001), anxiety symptoms (GAD-7 ≥ 10, OR: 3.9, 95% CI: 1.6-9.2, p = 0.002), and fatigue (FSS ≥ 36, OR: 5.3, 95% CI: 2.8-9.8, p < 0.001). In conclusion, our findings suggest that sleep impairment, based on the CASIS questionnaire, is associated with worse physical and mental health in patients with COPD. Therefore, through consistent evaluation of sleep and targeted management strategies, healthcare providers could improve the quality of life for these patients.

Mental health and sleep quality among patients with asthma and COPD

This study aims to compare the mental health of patients with asthma and COPD in terms of anxiety, depression, and sleep quality and to examine the factors that predict sleep disturbance, anxiety, and depressive symptoms.

Methods

This quantitative cross-sectional study employed convenience sampling to enroll 200 patients with asthma and 190 patients with COPD. Data were gathered using a standardized self-administered questionnaire that contained sections on patients' characteristics, the Sleep Quality, Anxiety, and Depression.

Results

The prevalence of poor sleep quality was 17.5 and 32.6% among asthmatic and COPD patients, respectively. The incidence of anxiety and depression was 38 and 49.5% among the patients with asthma, respectively. Their prevalence in patients with COPD was 48.9 and 34.7%, respectively. The multivariate regression analysis showed that marital status (married), BMI, education level (pre-university level), presence of comorbid illness, and depression were significant predictors of PSQI in asthmatic patients. Moreover, age, gender (male), marital status (married), education level (pre-university level), depression, and anxiety were significant predictors of PSQI among COPD participants. According to this study, COPD, and asthma pose serious health risks, including reduced sleep quality, anxiety, and depression.

Prevalence and Predictors of Sleep Disturbance, Anxiety and Depression among Patients with Chronic Respiratory Diseases

BACKGROUND

Poor sleep quality, depression, and anxiety are common comorbidities among individuals with chronic respiratory diseases (CRDs). However, there has been no work to estimate their prevalence and assess their associations among the CRDs population in Saudi Arabia.

METHODS

A cross-sectional study was conducted in primary healthcare centers and included a total of 390 patients. Structured self-administered questionnaires were completed that included the Sleep Quality Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety and Depression Score (HADS). Multiple linear regression analyses were performed to assess the associations between patients' characteristics and sleep disturbance, anxiety and depression.

RESULTS

Poor sleep quality, depression, and anxiety affect 75%, 49.2%, and 36.4% of the study participants, respectively. The PSQI was significantly correlated with anxiety (r = 0.30) and depression (r = 0.16). Furthermore, a significant correlation was found between anxiety and depression (r = 0.44). The predictors of poor sleep quality were age, gender, and family history of CRDs, education level and anxiety and these variables accounted for 0.19% of the variance in PSQI. Variables that independently predicted an increased level of depression were age, gender, marital status, family history of CRDs, diagnosis, previous hospital admission, the presence of comorbidities, dyspnea last month and anxiety. On the other hand, the variables that independently predicted an increased level of anxiety were age, BMI, family history of CRDs, previous hospital admission, the presence of comorbidities, dyspnea last month and depression.

CONCLUSION

Healthcare providers managing patients with CRDs should be alert to the high prevalence of poor sleep quality, depression, and anxiety. Appropriate interventions to reduce the prevalence should be developed and timely applied.

Prevalence, risk factors and effects of restless legs syndrome in COPD patients

Restless legs syndrome (RLS), a sensory motor disorder, is commonly seen amongst chronic obstructive pulmonary disease (COPD) patients. We conducted a study to know its prevalence in COPD and analyse the possible cause and effect of RLS. It is an analytical cross-sectional study conducted between July 2016-December 2020.The prevalence of RLS was evaluated in patients of COPD using RLS diagnostic criteria. Spirometry, iron profile and arterial blood gas analysis was performed in all the patients to evaluate the cause of RLS. The effect was evaluated with diagnostic criteria for insomnia and patient health questionnaire (PHQ2) for depression. There were 205 participants with a mean age of 59±8 years, 182 (88.7%) men and 23 (11.2%) women. The mean body mass index (BMI) was 29±3.9 kg/m2. The prevalence of RLS was 31.2%. RLS was more common amongst women compared to men (60.8% vs 27.4%). RLS was more prevalent among hypoxemic (PaO2<60 mm Hg) and hypercapnic (PaCO2>45 mm Hg) patients (p<0.016; p<0.017). The ROC curve plotted between PaO2 and RLS occurrence showed that the patients having PaO2 less than 76 mm of Hg were more prone to develop RLS. RLS patients had a higher incidence of insomnia as compared to those without RLS (68.8% vs 36.8%, p<0.001). COPD with RLS patients had more depressive symptoms with a higher patient health questionnaire 2 (PHQ2) score (35.9% vs 14.2%, p<0.001) compared to non-RLS COPD patients. The multiple regression analysis also confirmed that RLS led to insomnia and depressive symptoms in COPD patients. To conclude, RLS is common in COPD patients. RLS leads to insomnia and depression, thus should be identified and treated.

Investigation on the Relationship between Sleep Quality and Depression and Anxiety in Hospitalized Patients with Different Levels of AECOPD

Purpose

To explore the correlations between sleep quality and depression and anxiety in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

Methods

A total of 131 AECOPD patients treated at No.6th People's Hospital affiliated to Shanghai Jiao Tong University School from January 2018 to December 2020 were selected and divided into the classes I (n = 30), II (n = 23), III (n = 37), and IV (n = 41) based on the severity of AECOPD. The Pittsburgh sleep quality index (PSQI) and the hospital anxiety and depression scale (HADS) were employed to assess the quality of sleep and anxiety/depression in AECOPD patients. The Pearson correlation analysis explored the associations between PSQI score and HADS anxiety/depression score. Binary logistic regression was utilized to determine risk factors for anxiety/depression in AECOPD patients.

Results

The PSQI score, HADS anxiety score, and HADS depression score in patients with AECOPD class III and class IV were significantly higher than those of classes I and II. The severe anxiety and depression ratio were significantly different among patients with classes I-IV AECOPD. The severity of AECOPD was significantly correlated with the PSQI score (r = 0.51, P < 0.001), HADS anxiety score (r = 0.66, P < 0.001), and HADS anxiety score (r = 0.65, P < 0.001). Binary logistic regression analysis showed that the COPD duration, the severity of AECOPD, and PSQI score were the risk factors for anxiety and depression in patients with AECOPD.

Conclusions

Poor sleep quality, anxiety, and depression are common in patients with AECOPD. Improvement of sleep quality may help to alleviate anxiety and depression in AECOPD patients.

Sleep-Related Breathing Complaints in Chronic Obstructive Pulmonary Disease

This review presents the normal physiologic changes in ventilation during sleep and how they can be detrimental to chronic obstructive pulmonary disease (COPD). Sleep-related breathing disorders (SRBDs) in COPD lead to higher morbidity and mortality if left unrecognized and untreated. The diagnosis of SRBDs requires a high index of suspicion, as symptoms may overlap with other sleep disorders. Mortality risk is improved when patients with COPD with OSA (overlap syndrome) are treated with positive airway pressure and when long-term nocturnal noninvasive ventilation is started on chronic stable hypercapnic COPD. Treatment of isolated nocturnal oxygen desaturation has not been associated with improved survival.

Resilience and health-related quality of life in patients with pulmonary diseases receiving ambulatory oxygen therapy

BACKGROUND

Pulmonary diseases affect health-related quality of life (HRQoL), but there are few data on patients' adaptation to a serious illness. This study assessed resilience and its associations with HRQoL, life satisfaction, anxiety and depression in patients with pulmonary diseases receiving ambulatory oxygen therapy.

METHODS

In this prospective cohort study, we enrolled 42 patients with pulmonary diseases receiving ambulatory oxygen therapy. The patients completed the following questionnaires at baseline and after one and three months; the Resilience Scale-25, the Life Satisfaction Scale-4, the 15D instrument of HRQoL, the Hospital Anxiety and Depression Scale (HADS) and the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0). To compare HRQoL, we recruited age- and gender-matched controls from the general population (n = 3574). The primary outcome was the proportion of patients with low resilience.

RESULTS

Half (42-48%) of the patients had low resilience, which was correlated with low HRQoL, low levels of life satisfaction and higher levels of anxiety and depression. Patients had very low HRQoL compared to controls. Dissatisfaction with life increased during the 3-months follow-up, but only a few patients had anxiety or depression. Patient satisfaction with assistive technology was high; the median QUEST 2.0 score (scale 1-5) was 4.00 at baseline, 3.92 at one month and 3.88 at three months.

CONCLUSIONS

Resilience was low in half of the patients with pulmonary diseases receiving ambulatory oxygen therapy. Higher resilience was positively correlated with HRQoL and life satisfaction and negatively correlated with anxiety and depression.

TRIAL REGISTRATION

ClinicalTrials.gov Protocol Record 507A023. Registered 17 September 2020-Retrospectively registered, https://clinicaltrials.gov/ct2/results?cond=&term=NCT04554225&cntry=&state=&city=&dist= .