Sleep Disorders Prominent Among Patients With COPD

Sleep disorders proved to be significantly prominent among patients with chronic obstructive pulmonary disease (COPD), particularly insomnia and obstructive sleep apnea (OSA), according to study findings published in Annals of Thoracic Medicine.

For patients with COPD, the researchers say the pathophysiology for disturbed sleep is complex and multifactorial, in which physiological changes, ventilatory disturbances, inflammation, and medications all play a role. With an estimated prevalence of sleep disturbance ranging from 34% to 78% in patients with COPD, knowing the potential of sleep disorders to adversely affect this patient population may prove crucial to their care.

“The presence of sleep disorders may cause a further decline in the quality of life in patients with COPD,” note the study authors. “It also predisposes already suffering COPD population to health problems, functioning, and health care expenditures.”

Although these are known consequences, the researchers highlight that sleep disorders are not typically detected or treated in those with COPD. Moreover, the use of the Pittsburgh Sleep Quality Index, a widely used tool to screen for disturbed sleep, was advised against by the researchers because its differentiation between “good sleepers” and “bad sleepers” would not be effective in assessing the complex relationship between sleep disturbance and COPD.

Seeking to better understand the prevalence of sleep disorders in COPD, the researchers conducted a prospective case–control study utilizing the Global Sleep Assessment Questionnaire (GSAQ), which they described as one of the best screening tools for the general population.

In addition to exploring the prevalence of sleep disorders, including insomnia, OSA, restless leg syndrome (RLS), and depression in patients with stable COPD (n = 100), the study authors examined the sensitivity and specificity of GSAQ and whether the screening tool’s score in COPD is high compared with a cohort of matched healthy adults (n = 50).

“The presence of sleep disorder in COPD was further confirmed based on the diagnostic criteria and polysomnography,” added the researchers.

The study authors found the GSAQ to be positive in 68% of patients with COPD compared with 16% of the healthy participant cohort (P < .001), with sleep disturbance confirmed in 66 patients with COPD. Based on the type of sleep disorder, several diagnoses were made:

• Insomnia in 39
• RLS in 30
• OSA in 13
• Depression/anxiety in 22

Thirty-one patients had an overlap of 2 or more disorders.

Overall, the GSAQ’s sensitivity was indicated as 90.9%, with a specificity of 70.58%. “The sensitivity/specificity of GSAQ for insomnia, OSA, RLS, and anxiety/depression was 87%/75%, 77%/67%, 90%/80%, and 91%/65%, respectively," the authors stated.

They note that further studies are needed to confirm their findings in a larger patient population and to adjust for variables, such as nicotine use and withdrawal.

Reference

Vaidya S, Gothi D, Patro M. Prevalence of sleep disorders in chronic obstructive pulmonary disease and utility of global sleep assessment questionnaire: An observational case–control study. Ann Thorac Med. 2020;15(4):230-237. doi:10.4103/atm.ATM_85_20