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Pulmonary rehabilitation and sleep quality: a before and after controlled study of patients with chronic obstructive pulmonary disease

2014; Nature Portfolio; Volume: 24; Issue: 1 Linguagem: Inglês

10.1038/npjpcrm.2014.28

2055-1010

Lucy McDonnell, Lauren Hogg, Lynn McDonnell, Patrick White,

Obstructive Sleep Apnea Research

Poor sleep quality is common in chronic obstructive pulmonary disease (COPD). It is associated with poor quality of life. Pulmonary rehabilitation (PR) improves quality of life, exercise capacity, and anxiety and depression. Its effect on sleep quality is uncertain. To determine whether PR improves sleep quality in COPD. A prospective controlled ‘before and after’ study of sleep quality in COPD patients attending a community PR programme was conducted. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). Lung function, disease-specific quality of life (COPD assessment test—CAT), exercise capacity (incremental shuttle walk test—ISWT), and anxiety and depression (Hospital Anxiety and Depression Scale—HADS) were measured. Change in sleep quality was compared with a COPD control group. Twenty-eight participants completed PR. The control group comprised 24 patients. Prevalence of poor sleep quality (PSQI ⩾5) was 78%. There were no differences between observation and control groups in sleep quality, age or severity. Quality of life was strongly correlated with quality of sleep (r=0.64, P<0.001). PR improved the quality of life (CAT change 3.0; 95% CI, 0.7–5.3), exercise capacity (ISWT change (metres) 81.0; 15.3–146.6), anxiety (HADS score ⩾8: change 2.33; 0.45–4.22), and depression (HADS score ⩾8: change 2.90; 1.92–3.88). PR did not improve sleep quality (PSQI mean change 0.79; −0.35 to 1.93). PR did not improve sleep quality in COPD despite improving quality of life, exercise capacity, anxiety and depression. New strategies, independent of PR, are required to improve sleep quality in COPD. Pulmonary rehabilitation (PR) does not improve sleep quality in patients with chronic obstrutive pulmonary disease (COPD). Sleep quality is compromised in up to 70% of patients with the disease but the underlying cause is unclear. A study led by Patrick White at King's College London, UK, and colleagues assessed sleep quality in 28 patients with COPD before and after completing an 8-week PR programme. Although the programme had positive effects on exercise capacity and mood, no improvements in sleep quality,as measured using the Pittsburgh Sleep Quality Index,were observed compared with a control group. PR has been shown to improve the quality of life of patients with COPD but specific strategies other than PR, for example, cognitive behavioural therapy for insomnia, are needed to improve the quality of their sleep.