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Maharjan S, Dua R, Saini LK, Kumar N, Gupta R. Prevalence and predictors of restless legs syndrome among patients having stable chronic obstructive pulmonary disease. Sleep Med 2024; 118:32-38. [PMID: 38588638 DOI: 10.1016/j.sleep.2024.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/13/2024] [Accepted: 03/27/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Patients having COPD share some factors, e.g., chronic hypoxemia, anemia of chronic disease and nicotine use, which are also the risk factors for RLS hence predispose them to experience RLS in higher then general population. There are limited studies with methodological constraints evaluating the prevalence and/or correlates of RLS among patients with COPD. METHODS Consecutive adult patients of either gender, having stable COPD as per GOLD guidelines 2021, were assessed for RLS using IRLSSG (2014) criteria (excluding RLS mimics) and the severity of RLS was determined in participants having RLS. Phenomenology of RLS, past medical history and laboratory parameters were gathered. Insomnia and depression were assessed using the insomnia severity index and PHQ-9, respectively. RESULTS Participants' (N = 210) mean age was 63.02 ± 8.19 years, and 83.8% of subjects were men. 12.9% of participants were found to have RLS. Among those having RLS, nearly half (51.9%) had moderate symptoms, and 18.5% experienced severe symptoms. RLS was more prevalent among younger, females, those having severe COPD, participants having exacerbation of COPD in the previous year, lower post-bronchodilator FEV1, higher dyspnea and COPD assessment test score. Multivariate analysis showed that younger age, female gender, lower post-bronchodilator FEV1, lower FEV1/FVC ratio and higher serum creatinine increased the odds of having RLS. Depressive symptoms were more frequent in participants having RLS. CONCLUSIONS The present study found that the prevalence of RLS among patients with stable COPD was higher than the general population. Female gender, younger age, higher airflow limitation and higher serum creatinine (though in the physiological range) increase the odds of having RLS. Stable patients with COPD having these characteristics must be screened for RLS.
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Affiliation(s)
- Sabbu Maharjan
- Departments of Psychiatry, All India Institute of Medical Sciences, Veerbhadra Marg, Rishikesh, 249203, India
| | - Ruchi Dua
- Departments of Pulmonary Medicine, All India Institute of Medical Sciences, Veerbhadra Marg, Rishikesh, 249203, India
| | - Lokesh Kumar Saini
- Departments of Pulmonary Medicine, All India Institute of Medical Sciences, Veerbhadra Marg, Rishikesh, 249203, India.
| | - Niraj Kumar
- Departments of Neurology, All India Institute of Medical Sciences, Veerbhadra Marg, Rishikesh, 249203, India
| | - Ravi Gupta
- Departments of Psychiatry, All India Institute of Medical Sciences, Veerbhadra Marg, Rishikesh, 249203, India
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Sampol J, Miravitlles M, Sáez M, Pallero M, Sampol G, Ferrer J. Poor sleep quality, COPD severity and survival according to CASIS and Pittsburgh questionnaires. Sci Rep 2023; 13:18656. [PMID: 37907621 PMCID: PMC10618283 DOI: 10.1038/s41598-023-45717-9] [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: 06/15/2023] [Accepted: 10/23/2023] [Indexed: 11/02/2023] Open
Abstract
Poor sleep quality is frequent among COPD patients and it has been related to worse outcomes. The objective of this study was to compare the COPD and Asthma Sleep Impact Scale (CASIS) and the generic Pittsburgh Sleep Quality Index (PSQI) questionnaires as reliable tools for evaluating sleep quality and its relationship with COPD characteristics and survival. Stable COPD patients were prospectively evaluated. Anthropometric, sociodemographic, comorbidity, lung function and treatment data were collected. All patients completed CASIS and PSQI, mMRC dyspnea severity scale, COPD Assessment Test (CAT), sleep apnoea STOP-Bang and Hospital Anxiety and Depression Scale (HADS) questionnaires. Body mass index, airflow Obstruction, Dyspnea and Exacerbations (BODEx) index was calculated. Life status was determined after a mean follow-up of 3.7 (SD 1) years. We included 200 patients, 69.5% male, mean age 65.8 (9) years. Poor sleep was detected in 100 (50%) and 84 patients (42%) according to PSQI and CASIS questionnaires, respectively, with an agreement of 63%. Poor sleep was related to female gender, more severe dyspnea and worse BODEx, HADS and CAT scores according to both questionnaires. PSQI was associated to chronic pain or inferior urinary tract symptoms and CASIS to exacerbations, shorter walked distance in the 6-min walking test and treatment with oral corticosteroids or chronic oxygen. Thirty nine (19.5%) patients died during follow-up. Mortality was not associated to PSQI nor CASIS results. Unlike PSQI, CASIS is more related to COPD severity and its results are not influenced by comorbidities with known impact on sleep quality. In our sample, poor sleep quality was not associated with increased mortality.
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Affiliation(s)
- Júlia Sampol
- Respiratory Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Medicine Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIIII), Barcelona, Spain
| | - Marc Miravitlles
- Respiratory Department, Vall d'Hebron University Hospital, Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIIII), Barcelona, Spain.
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.
| | - María Sáez
- Respiratory Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Mercedes Pallero
- Respiratory Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Gabriel Sampol
- Respiratory Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Medicine Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIIII), Barcelona, Spain
| | - Jaume Ferrer
- Respiratory Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Medicine Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIIII), Barcelona, Spain
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Abstract
With sleep occupying up to one-third of every adult's life, addressing sleep is essential to overall health. Sleep disturbance and deficiency are common in patients with chronic lung diseases and associated with worse clinical outcomes and poor quality of life. A detailed history incorporating nocturnal respiratory symptoms, symptoms of obstructive sleep apnea (OSA) and restless legs syndrome, symptoms of anxiety and depression, and medications is the first step in identifying and addressing the multiple factors often contributing to sleep deficiency in chronic lung disease. Additional research is needed to better understand the relationship between sleep deficiency and the spectrum of chronic lung diseases.
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Thi Truong BE, Sung FC, Lin CL, Hang LW, Teng YK, Tzeng YL. A follow-up study on restless legs syndrome in chronic obstructive pulmonary disease population. Sleep Med 2021; 80:9-15. [PMID: 33545488 DOI: 10.1016/j.sleep.2021.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/29/2020] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Restless legs syndrome (RLS) is prevalent in patients with chronic obstructive pulmonary disease (COPD). No large population-based cohort study has assessed the relationship. We evaluated the incidence of RLS among COPD patients by sociodemographic status (SES) and comorbidity using insurance claims data of Taiwan. METHODS From the database, we established a cohort consisting of 77,831 individuals aged ≥ 20 years newly diagnosed with COPD from 2000 to 2013. We also identified same number of individuals without COPD as the comparison cohort, frequency matched by sex, age and index year. Both cohorts were followed up to the end of 2013 to estimate the incidence and hazard ratio (HR) of developing RLS. RESULTS The incidence of RLS was 2.2-fold higher in COPD patients than in those free of COPD (6.67 and 3.08 per 10,000 person-years), with an adjusted HR (aHR) 1.68 (95% CI 1.41-2.01) after controlling for covariates. The incidence rates in both cohorts increased with age and higher in low socioeconomic group. The risk of RLS increased further among COPD patients with additional comorbidities. Compared to those without COPD and comorbidity, the aHR was 7.93 (95% CI 1.11-57.8) for those with iron deficiency, 3.95 (96% CI 1.92-8.13) with Parkinson's disease, 2.85 (95% CI 1.05-7.72) with polyneuropathy, or 1.81 (95% CI 1.14-2.87) with diabetes. CONCLUSION Patients with COPD are at an increased risk of developing RLS regardless of gender, age and occupation. The COPD patients with comorbidities should be particularly cautious about the RLS risk.
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Affiliation(s)
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; Department of Health Services Administration, China Medical University College of Public Health, Taichung, Taiwan; Department of Food Nutrition and Health Biotechnology, Asia University, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Liang-Wen Hang
- School of Nursing, China Medical University, Taichung, Taiwan; Center of Sleep Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Yu-Kuei Teng
- School of Nursing, China Medical University, Taichung, Taiwan; Department of Nursing, China Medical University Hospital, Taichung, Taiwan.
| | - Ya-Ling Tzeng
- School of Nursing, China Medical University, Taichung, Taiwan; Department of Nursing, China Medical University Hospital, Taichung, Taiwan.
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Ding Z, Stehlik R, Hedner J, Ulfberg J, Grote L. Chronic pulmonary disease is associated with pain spreading and restless legs syndrome in middle-aged women-a population-based study. Sleep Breath 2019; 23:135-142. [PMID: 29869108 PMCID: PMC6418064 DOI: 10.1007/s11325-018-1673-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/07/2018] [Accepted: 05/16/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Recent studies suggest an increased prevalence of chronic pain conditions and restless legs syndrome (RLS) in patients with chronic pulmonary disease (CPD). We analyzed the prevalence and risk factors for pain and RLS in a population-based sample of females with comorbid CPD. METHOD Questionnaire-based data from 2745 women aged 18-64 years were analyzed regarding comorbid CPD status (severe bronchitis, emphysema, asthma). Pain status was assessed according to symptoms reflecting severity (Visual Analogue Scale, VAS rating 0-10) and duration and spreading (limited spread or widespread) of pain. A diagnosis of RLS was defined by four validated diagnostic criteria. Anthropometrics and co-morbidities were assessed as covariates in univariate and multivariate analyses. RESULTS Widespread pain was overrepresented in women with CPD (44.6 vs. 24.6%, p < 0.001). The odds ratio for widespread pain in women with CPD was 1.6 (95% confidence interval (CI) 1.2-2.2, p < 0.001) in the fully adjusted model. Severe pain (VAS rating ≥ 7) was more prevalent in females with known CPD (28.8 vs. 15.4%, p < 0.001, odd ratio 1.4 (95% CI 1.0-1.9, p = 0.029)). The prevalence of RLS was 37.4 and 23.8% in subjects with or without CPD, respectively (p < 0.001). In multivariate analysis, CPD was associated with a 30% risk increase for RLS (odds ratio 1.3 (95% CI 1.0-1.7, p = 0.04)). CONCLUSION This population-based study identified CPD as an independent risk factor for severe and widespread pain as well as for RLS. Further research addressing pathophysiological mechanisms linking CPD and chronic pain conditions/RLS is warranted.
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Affiliation(s)
- Zou Ding
- Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
| | - Romana Stehlik
- Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
- Pain Center, Akademiska University Hospital, Uppsala, Sweden
| | - Jan Hedner
- Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
- Sleep Disorders Center, Department for Respiratory Disease, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Ludger Grote
- Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden.
- Sleep Disorders Center, Department for Respiratory Disease, Sahlgrenska University Hospital, Gothenburg, Sweden.
- Respiratory Medicine, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden.
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Gupta R, Ulfberg J, Allen RP, Goel D. High prevalence of restless legs syndrome/Willis Ekbom Disease (RLS/WED) among people living at high altitude in the Indian Himalaya. Sleep Med 2017; 35:7-11. [DOI: 10.1016/j.sleep.2017.02.031] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/02/2017] [Accepted: 02/06/2017] [Indexed: 11/30/2022]
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To what extent and why are COPD and Willis-Ekbom disease associated? Sleep Breath 2016; 20:1021-7. [DOI: 10.1007/s11325-016-1359-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 04/21/2016] [Accepted: 05/10/2016] [Indexed: 11/27/2022]
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Goldstein C. Management of Restless Legs Syndrome/Willis-Ekbom Disease in Hospitalized and Perioperative Patients. Sleep Med Clin 2015; 10:303-10, xiv. [PMID: 26329440 DOI: 10.1016/j.jsmc.2015.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Restless legs syndrome (RLS) is a sensorimotor disorder that can cause significant discomfort, impaired quality of life, poor mood, and disturbed sleep. Because the disorder is chronic and associated with multiple comorbidities, RLS can be seen in an inpatient or perioperative setting. Certain characteristics of the hospitalized or surgical context can exacerbate or unmask RLS. Importantly, RLS and the associated discomfort and insomnia can prolong hospital stay and negatively impact outcomes. RLS medications should be continued during the hospital admission when possible. Avoidance of excessive phlebotomy and medications known to trigger RLS is helpful. Patients should increase activity when acceptable.
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Affiliation(s)
- Cathy Goldstein
- Department of Neurology, University of Michigan Sleep Disorders Center, C728 Med Inn Building, SPC 5845, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5845, USA.
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Budhiraja R, Siddiqi TA, Quan SF. Sleep disorders in chronic obstructive pulmonary disease: etiology, impact, and management. J Clin Sleep Med 2015; 11:259-70. [PMID: 25700872 DOI: 10.5664/jcsm.4540] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 12/21/2014] [Indexed: 01/18/2023]
Abstract
ABSTRACT Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality and may frequently be complicated by sleep disorders. Insomnia and obstructive sleep apnea are commonly encountered in patients with COPD. Nocturnal hypoxemia is also prevalent in COPD may occur despite adequate awake oxygenation and can be especially severe in rapid eye movement sleep. Additionally, several factors--some of them unique to COPD--can contribute to sleep-related hypoventilation. Recognition of hypoventilation can be vital as supplemental oxygen therapy itself can acutely worsen hypoventilation and lead to disastrous consequences. Finally, accruing data establish an association between restless leg syndrome and COPD--an association that may be driven by hypoxemia and/or hypercapnia. Comorbid sleep disorders portend worse sleep quality, diminished quality of life, and multifarious other adverse consequences. The awareness and knowledge regarding sleep comorbidities in COPD has continued to evolve over past many years. There are still several lacunae, however, in our understanding of the etiologies, impact, and therapies of sleep disorders, specifically in patients with COPD. This review summarizes the latest concepts in prevalence, pathogenesis, diagnosis, and management of diverse sleep disorders in COPD.
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Affiliation(s)
- Rohit Budhiraja
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Tufts Medical Center, Boston, MA
| | - Tauseef A Siddiqi
- Division of Allergy, Critical Care, Pulmonary and Sleep Medicine, Department of Medicine, University of Arizona College of Medicine, Tucson, AZ
| | - Stuart F Quan
- Division of Allergy, Critical Care, Pulmonary and Sleep Medicine, Department of Medicine, University of Arizona College of Medicine, Tucson, AZ.,Divisions of Sleep Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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Garrow AP, Yorke J, Khan N, Vestbo J, Singh D, Tyson S. Systematic literature review of patient-reported outcome measures used in assessment and measurement of sleep disorders in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2015; 10:293-307. [PMID: 25709424 PMCID: PMC4330032 DOI: 10.2147/copd.s68093] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Sleep problems are common in patients with chronic obstructive pulmonary disease (COPD), but the validity of patient-reported outcome measures (PROMs) that measure sleep dysfunction has not been evaluated. We have reviewed the literature to identify disease-specific and non-disease-specific sleep PROMs that have been validated for use in COPD patients. The review also examined the psychometric properties of identified sleep outcome measures and extracted point and variability estimates of sleep instruments used in COPD studies. METHODS The online EMBASE, MEDLINE, PsycINFO, and SCOPUS databases for all years to May 2014 were used to source articles for the review. The review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Criteria from the Medical Outcomes Trust Scientific Advisory Committee guidelines were used to evaluate the psychometric properties of all sleep PROMs identified. RESULTS One COPD-specific and six non-COPD-specific sleep outcome measures were identified and 44 papers met the review selection criteria. We only identified one instrument, the COPD and Asthma Sleep Impact Scale, which was developed specifically for use in COPD populations. Ninety percent of the identified studies used one of two non-disease-specific sleep scales, ie, the Pittsburgh Sleep Quality Index and/or the Epworth Sleep Scale, although neither has been tested for reliability or validity in people with COPD. CONCLUSION The results highlight a need for existing non-disease-specific instruments to be validated in COPD populations and also a need for new disease-specific measures to assess the impact of sleep problems in COPD.
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Affiliation(s)
- Adam P Garrow
- University of Manchester Medicines Evaluation Unit, University Hospital of South Manchester Foundation Trust, Manchester, UK
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Janelle Yorke
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Naimat Khan
- University of Manchester Medicines Evaluation Unit, University Hospital of South Manchester Foundation Trust, Manchester, UK
| | - Jørgen Vestbo
- The University of Manchester Academic Health Science Centre, University Hospital South Manchester NHS Foundation Trust, Manchester, UK
| | - Dave Singh
- University of Manchester Medicines Evaluation Unit, University Hospital of South Manchester Foundation Trust, Manchester, UK
| | - Sarah Tyson
- University of Manchester Medicines Evaluation Unit, University Hospital of South Manchester Foundation Trust, Manchester, UK
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Insomnia in chronic obstructive pulmonary disease: breathless and sleepless. Sleep Med 2013; 14:1233-4. [DOI: 10.1016/j.sleep.2013.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 09/26/2013] [Indexed: 11/22/2022]
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