A longitudinal assessment of sleep variables during exacerbations of chronic obstructive pulmonary disease

Abstract

Although sleep disturbance is common in chronic obstructive pulmonary disease (COPD), relatively little is known on the effect of the exacerbation on sleep quality. Accordingly, we longitudinally assessed sleep variables during exacerbations and clinical stability. This is a sub-study of a larger observational analysis. Inclusion criteria were clinically stable COPD and two or more clinical exacerbations in the preceding 12 months. Patients were followed for approximately 6 months and during this time the following were recorded daily: (1) COPD exacerbations, which were determined in two ways, clinically and symptom defined using the exacerbations of chronic pulmonary disease tool (EXACT); (2) daytime sleepiness, which was measured using the Stanford Sleepiness Scale; (3) subjective awakenings, which was measured from a sleep diary; and (4) sleep duration, efficiency, and objective awakenings, which was measured from actigraphy. These variables for exacerbation and non-exacerbation days were compared. Seventeen patients (9 male, age 63 + 12 years, forced expiratory volume in 1 second 52 + 20%) entered data over 135 + 18 days. During this time, 15 patients had 27 symptom-defined exacerbations and 8 had 9 clinically reported exacerbations. Symptom-defined exacerbation days were 26% of the total study days. More daytime sleepiness, decreased total sleep time (TST), and decreased sleep efficiency (SE) were present during exacerbations compared with clinical stability (p < 0.001). These disturbances tended to be greater during clinically reported exacerbations than during unreported events (p < 0.05). Increased daytime sleepiness, less TST, and poorer SE are present during COPD exacerbations.

Sleep problems in breast cancer survivors 1–10 years posttreatment

“…Although the relationship between daytime sleepiness and sleep quality has not been well-studied in cancer survivors (Forsythe et al, 2012), a similar lack of association has been found in studies of other medical populations (Lu et al, 2015; Setthawatcharawanich et al, 2014). The populations in which a relationship has been found include newly diagnosed lung cancer patients (Le Guen et al, 2007) and individuals with such breathing-related sleep disorders as sleep apnea (Vanaparthy et al, 2015), suggesting that a more complex relationship may exist between sleep quality and daytime sleepiness that should be examined in future research.…”

Understanding the impact of chronic obstructive pulmonary disease exacerbations on patient health and quality of life

“…A global patient survey revealed that the majority of patients with COPD felt that exacerbations prevented them from making plans for the future and impacted daily activities such as walking, sleeping, and speaking [39]. Consistent with this, increased daytime sleepiness, decreased total sleep time, decreased sleep efficiency, and levels of fatigue have been reported during an exacerbation [54,55]. In addition, COPD has previously been associated with sexual dysfunction in males, particularly erectile dysfunction, with most patients dissatisfied with their current and expected sexual function [56,57].…”

The Case for Using Actigraphy Generated Sleep and Activity Endpoints in Alzheimer’s Disease Clinical Trials

“…There is potential to identify new and exploratory endpoints with clinical relevance in specific populations using actigraphy data. Exploratory work in other theraputic areas such as pain, autism and COPD has identified endpoints that have value in subtyping patients who show differential responses to therapy (autism)15or who show increased sensivity (pain) (16) or who are at risk of exacerbation (COPD) (17). While it is not feasible to compare one patient population with another, and the current research is limited, activity and sleep patterns can provide signficant insight into patients and their theraputic response with very little patient burden.…”