Predictors of Increased Daytime Sleepiness in Patients with Chronic Obstructive Pulmonary Disease: A Cross-Sectional Study

Abstract

Background. Patients with Chronic Obstructive Pulmonary Disease (COPD) suffer from increased daytime sleepiness. The aim of this study was to identify potential predictors of subjective daytime sleepiness with special regard to sleep-related breathing disorder and nocturnal activity. Methods. COPD patients were recruited at the University Hospital Basel, Switzerland. COPD risk groups A–D were determined according to spirometry and COPD Assessment Test (CAT). Breathing disorder evaluation was performed with the ApneaLink device. Nocturnal energy expenditure was measured with the SenseWear Mini Armband. Subjective daytime sleepiness was recorded using the Epworth Sleepiness Scale (ESS). Results. Twenty-two patients (36%) were in COPD risk group A, 28 patients (45%) in risk group B, and 12 patients (19%) in risk groups C + D (n = 62). Eleven patients (18%) had a pathological ESS ≥ 10/24. ESS correlated positively with CAT (r = 0.386, p < 0.01) and inversely with age (r = −0.347, p < 0.01). In multiple linear regression age (β = −0.254, p < 0.05), AHI (β = 0.287, p < 0.05) and CAT score (β = 0.380, p < 0.01) were independent predictors of ESS, while nocturnal energy expenditure showed no significant association (p = 0.619). Conclusion. These findings provide evidence that daytime sleepiness in COPD patients may partly be attributable to nocturnal respiratory disturbances and it seems to mostly affect younger patients with more severe COPD symptoms.

The Epidemiology of Patient‐Reported Hypersomnia in Persons With Advanced Age

“…Our results did not show advancing age, medical conditions other than arthritis, or cognitive impairment as having statistically significant associations with the ESS. With respect to the effect of age, results from CHS also showed no association between age and higher scores, while other studies found lower ESS scores in older as compared to middle‐aged persons . We again posit that a higher tolerance for hypersomnia, the paradox of well‐being, or reduced awareness of symptom severity may explain the lack of association of age with patient‐reported hypersomnia.…”

“…With respect to the effect of age, results from CHS also showed no association between age and higher scores, while other studies found lower ESS scores in older as compared to middleaged persons. 7,43,44 We again posit that a higher tolerance for hypersomnia, the paradox of well-being, or reduced awareness of symptom severity may explain the lack of association of age with patient-reported hypersomnia. Additionally, the adverse effect of aging on sleep architecture occurs predominantly in middle age.…”

Stability of distinct symptom experiences in patients with chronic obstructive pulmonary disease (COPD)

“…Linked to lack of energy is also feeling drowsy, and in the present study, the probability of occurrence of feeling drowsy was high in all three classes at 12 months compared to baseline [13]. Drowsiness, or daytime sleepiness, may be caused by nocturnal respiratory disturbances in patients with more severe COPD symptoms [46] and is reported as a common symptom in COPD [47,48]. Difficulty sleeping was rated considerably lower, which may suggest that the symptom of drowsiness may occur due to the total burden and the high number of symptoms.…”

Evaluation of sleep quality and daytime somnolence in patients with chronic obstructive pulmonary disease in pulmonary rehabilitation

“…Studies have verified that, as the disease is chronic, COPD patients have a susceptibility to daytime somnolence [31]. Thus, the more severe the COPD, the greater the daytime somnolence [32].…”