Sleep disorders and their management in patients with COPD

Network analysis of smoking-related sleep characteristics in Chinese adults

The associations between multiple sleep characteristics and smoking behavior are inconsistent, and it is unclear which sleep characteristics are most crucial for tobacco prevention. This study aimed to explore the associations between smoking status/intensity and multiple sleep characteristics and to identify the potential core domain of smoking-related sleep using network analysis. Data were obtained from a survey of cancer-related risk factors among Chinese adults. Logistic regression models were used to quantify the associations between sleep characteristics and smoking status/intensity. Network analyses were employed to identify the core sleep characteristics. A total of 5,228 participants with a median age of 44 years old were included in the study. Current smoking was significantly positively associated with long nap time, difficulty falling asleep, late bedtime, getting up after 7 am, and waking up earlier than expected. There was significant positive association between current smoking and short sleep duration in young adults under 45 years old. Late bedtime and getting up after 7 am were only associated with current heavy smoking, but not current light smoking. Network analyses showed that multiple smoking-related sleep characteristics were interconnected, with difficulty falling asleep and late bedtime as central characteristics in the network. The study found that the associations between sleep characteristics and smoking varied by age and smoking intensity and highlights the potential benefits of sleep health promotion in smoking cessation, with a particular focus on difficulty falling asleep and late bedtime.

Risks of Zolpidem among Patients with Chronic Obstructive Pulmonary Disease

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.

Lung function indices do not affect the incidence of coronary heart disease in patients with sleep-disordered breathing

BACKGROUND

Currently, it's unclear whether sleep-disordered breathing (SDB) and reduced lung function could synergistically increase the incidence of coronary heart disease (CHD). Furthermore, the predictive value of different lung function indices for the incidence of CHD remains unknown.

METHODS

We enrolled 3749 participants from the Sleep Heart Health Study (SHHS) to conduct a retrospective study. The individuals were divided into the SDB and non-SDB subgroups according to Apnoea-Hypopnoea Index (AHI). Cox regression models were used to evaluate the association between lung function and CHD. We also conducted a ROC analysis to assess the predictive value of different lung function indices.

RESULTS

512 cases of CHD were identified during an average of 10.40 years of follow-up in participants without CVD at baseline. We observed that lung function was a better predictor of CHD in non-SDB participants compared with SDB participants. Reduced lung function was associated with a higher risk of CHD in participants without SDB, while the inverse association became non-significant in participants with SDB. Furthermore, the incremental contribution of lung function to CHD diminished with increasing severity of SDB.

CONCLUSION

We need to focus more on the lung function of individuals without SDB rather than those with SDB to reduce the risk of CHD.

Characteristics of the nocturnal desaturation waveform pattern of SpO2 in COPD patients: an observational study

BACKGROUND

Nocturnal desaturation is common in patients with chronic obstructive pulmonary disease (COPD) and impacts disease exacerbation and prognosis. In our previous study, we developed a diagnostic algorithm to classify nocturnal desaturation from SpO₂ waveform patterns based on data from patients receiving home oxygen therapy. In this study, we aimed to investigate nocturnal desaturation in patients with COPD based on SpO₂ waveform patterns and the associations between the waveforms and clinical data.

METHODS

We investigated patients diagnosed with COPD and measured SpO₂ and nasal airflow with a type 4 portable long-term recordable pulse oximeter. Then, we classified the SpO₂ waveforms with the algorithm and compared the clinical data.

RESULTS

One hundred fifty-three patients (136 male and 17 female) were analysed. One hundred twenty-eight of the 153 (83.7%) patients had nocturnal desaturation, with an intermittent pattern (70.6%), sustained pattern (13.1%) and periodic pattern (68.0%). Intriguingly, desaturation with an intermittent pattern was associated with the apnoea-hypopnea index obtained with the portable monitor, and desaturation with a sustained pattern was associated with the cumulative percentage of time at a SpO₂ below 90%.

CONCLUSIONS

We found that nocturnal desaturation was frequently observed in patients with COPD and could be classified into 3 types of waveform patterns.

Review on Biomedical Sensors, Technologies and Algorithms for Diagnosis of Sleep Disordered Breathing: Comprehensive Survey

This paper provides a comprehensive review of available technologies for measurements of vital physiology related parameters that cause sleep disordered breathing (SDB). SDB is a chronic disease that may lead to several health problems and increase the risk of high blood pressure and even heart attack. Therefore, the diagnosis of SDB at an early stage is very important. The essential primary step before diagnosis is measurement. Vital health parameters related to SBD might be measured through invasive or non-invasive methods. Nowadays, with respect to increase in aging population, improvement in home health management systems is needed more than even a decade ago. Moreover, traditional health parameter measurement techniques such as polysomnography are not comfortable and introduce additional costs to the consumers. Therefore, in modern advanced self-health management devices, electronics and communication science are combined to provide appliances that can be used for SDB diagnosis, by monitoring a patient's physiological parameters with more comfort and accuracy. Additionally, development in machine learning algorithms provides accurate methods of analysing measured signals. This paper provides a comprehensive review of measurement approaches, data transmission, and communication networks, alongside machine learning algorithms for sleep stage classification, to diagnose SDB.

Non-respiratory complaints are main reasons for disturbed sleep post lung transplant

BACKGROUND

Poor sleep is prevalent in lung transplant recipients and affects quality of life negatively. To improve quality of sleep, it's important to identify the causes of poor sleep. We conducted a survey to identify the reasons for poor sleep quality in the recipients.

METHODS

We surveyed lung transplant recipients (2003-2010) at Baylor College of Medicine/The Methodist Hospital lung transplant center. We used a compilation of questionnaires, including the Pittsburgh Sleep Quality Index (PSQI), Berlin Questionnaire, Epworth Sleepiness Scale (ESS) and Short Form 36 (SF36). Descriptive analysis was performed on the responses.

RESULTS

Of the 167 participants, 54 responded (32.3%) with mean age 60.6 years (SD 9.8), 48% male, and a mean post-transplant body mass index (BMI) of 27 (SD 4.7). The responders reported a long mean sleep latency of 33.2 min (SD 32.5), poor sleep quality (74% with PSQI score > 5), excessive daytime sleepiness (ESS > 9 in 29%), poor physical QOL with SF36 mean score of 41.3 (SD 9.4), and high risk for OSA (48.2%). About 30% and 72% reported sleep initiation and maintenance insomnia, respectively. The poor sleep quality was due to "getup to go to bathroom" (85%), "cough or snore loudly" (33%), "have pain" (27.8%), and "feel too cold" (27.8%). Furthermore, 5% reported "Can't breathe comfortably" as reason for poor sleep.

CONCLUSIONS

The recipients reported poor sleep and quality of life. The non-respiratory complaints were important factors for poor sleep. Attention to these factors may help to outline better management strategies to improve sleep in lung transplant recipients.

Insomnia symptoms, objectively measured sleep, and disease severity in chronic obstructive pulmonary disease outpatients

BACKGROUND

Sleep disturbances are known to have a negative impact on a range of clinical outcomes in chronic obstructive pulmonary disease (COPD). We examined the associations of insomnia symptoms and objectively measured sleep parameters to a composite score for body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index (a multidimensional index of COPD severity), arterial blood gases, nocturnal respiratory disturbances, periodic limb movements (PLM), psychologic distress, pain, age, and sex.

METHODS

The sample comprised 73 COPD outpatients (mean age, 63.6years; standard deviation {SD}, 7.5; range 47-85years; 41.1% women). Insomnia symptoms were measured with the Bergen Insomnia Scale (BIS) and sleep efficiency (SE), slow-wave sleep (SWS), and total sleep time (TST) were assessed with clinical polysomnography (PSG).

RESULTS

BODE index was positively associated with composite BIS score (P=.040). Patients with more severe COPD presented more complaints of nonrestorative sleep compared to patients with less severe COPD (P=.010). In multivariate analysis, the composite BIS score was independently associated with PLM (P<.001), nocturnal respiratory disturbances (P=.001), pain (P=.031), and psychologic distress (P=.044) but not with the BODE index. Objectively measured sleep variables were not associated with any of the health-related variables.

CONCLUSION

Insomnia symptoms in COPD patients result from a wide range of health-related factors. More severe COPD may be associated with a subjective experience of nonrestorative sleep but not with objectively measured sleep variables.

Interventions to support a palliative care approach in patients with chronic obstructive pulmonary disease: an integrative review

BACKGROUND

End-stage chronic obstructive pulmonary disease (COPD) is a debilitating, life-limiting condition. A palliative approach is appropriate for individuals with end-stage COPD, yet currently few interventions embrace this holistic, multidisciplinary and inclusive perspective.

OBJECTIVE

To describe interventions to support a palliative care approach in patients with end-stage COPD.

DESIGN

Integrative review. DATA SOURCES AND REVIEW METHOD: Peer reviewed articles meeting the search criteria were accessed from Medline, PsychINFO, CINAHL and Google Scholar databases as well as Caresearch online resource. The domains of quality palliative care developed by Steinhauser were used as the conceptual framework to synthesise information.

RESULTS

This review has shown that a range of palliative interventions are used to address the needs of individuals with end-stage COPD. Although evidence exists for discrete elements of palliative management in this patient group, there is limited evidence for health service coordination and models that integrate the multiple domains of palliative care with active management.

CONCLUSION

Further investigation is required to address the complex personal, provider and system elements associated with managing end-stage COPD. A comprehensive and collaborative approach is required to address the complex and varied needs of individuals with end-stage COPD and their families.

Integrated management strategies for chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) remains the fourth leading cause of death, is associated with significant morbidity and places a substantial time and cost burden on the health care system. Unfortunately, treatment for COPD remains underutilized and continues to focus on the acute care of complications. The chronic care model (CCM) shifts this focus from the acute management of symptoms and complications to the prevention and optimal management of the chronic disease. This model utilizes resources from the community and the health care system and emphasizes self-management, provides comprehensive clinic support, and implements evidence-based guidelines and technology into clinical practice to ensure delivery of the highest quality of care. The goal of this review is to use a case-based approach to provide practical information about how integrated care using the CCM can be applied to the clinical care of a complex patient with COPD, shifting the management goals for COPD from reactive to proactive and ultimately improving outcomes.