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Impaired Sleep Quality in COPD Is Associated With Exacerbations

2019; Elsevier BV; Volume: 156; Issue: 5 Linguagem: Inglês

10.1016/j.chest.2019.04.132

1931-3543

Matthew Shorofsky, Jean Bourbeau, John Kimoff, Rachel Jen, Atul Malhotra, Najib Ayas, Wan C. Tan, Shawn D. Aaron, Don D. Sin, Jeremy Road, Kenneth R. Chapman, Denis E. O’Donnell, François Maltais, Paul Hernandez, Brandie Walker, Darcy Marciniuk, Marta Kamińska, Jean Bourbeau, Wan C. Tan, J. Mark FitzGerald, Don D. Sin, Darcy Marciniuk, Denis E. O’Donnell, Paul Hernandez, Kenneth R. Chapman, Robert Cowie, Shawn D. Aaron, François Maltais, Jonathon Samet, Milo A. Puhan, Qutayba Hamid, James C. Hogg, Jean Bourbeau, Carole Baglole, Carole Jabet, Palmina Mancino, Yvan Fortier, Wan C. Tan, Don D. Sin, Sheena Tam, Jeremy Road, Joe Comeau, Adrian Png, Harvey O. Coxson, Miranda Kirby, Jonathon Leipsic, Cameron Hague, Mohsen Sadatsafavi, Andrea S. Gershon, Wan C. Tan, Harvey O. Coxson, Jean Bourbeau, Peizhi Li, Jean-Francois Duquette, Yvan Fortier, Andrea Benedetti, Denis Jensen, Denis E. O’Donnell, Wan C. Tan, Christine Lo, Sarah Cheng, Cindy Fung, Nancy Ferguson, Nancy Haynes, Junior Chuang, Licong Li, Selva Bayat, Amanda Wong, Zoe Alavi, Catherine C. Peng, Bin Zhao, Nathalie Scott-Hsiung, Tasha Nadirshaw, Jean Bourbeau, Palmina Mancino, David Latreille, Jacinthe Baril, Laura Labonté, Kenneth R. Chapman, Patricia McClean, Nadeen Audisho, Brandie Walker, Robert Cowie, Ann Cowie, Curtis Dumonceaux, Lisette Machado, Paul Hernandez, Scott Fulton, Kristen Osterling, Shawn D. Aaron, Kathy Vandemheen, Gay Pratt, Amanda Bergeron, Denis E. O’Donnell, Matthew McNeil, Kate Whelan, François Maltais, Cynthia Brouillard, Darcy Marciniuk, Ron Clemens, Janet Baran,

Obstructive Sleep Apnea Research

COPD increases susceptibility to sleep disturbances, which may in turn predispose to increased respiratory symptoms. The objective of this study was to evaluate, in a population-based sample, the relationship between subjective sleep quality and risk of COPD exacerbations.Data were obtained from the Canadian Cohort Obstructive Lung Disease (CanCOLD) study. Participants with COPD who had completed 18 months of follow-up were included. Sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI) and a three-factor analysis. Symptom-based (dyspnea or sputum change ≥ 48 h) and event-based (symptoms plus medication or unscheduled health services use) exacerbations were assessed. Association of PSQI with exacerbation rate was assessed by using negative binomial regression. Exacerbation-free survival was also assessed.A total of 480 participants with COPD were studied, including 185 with one or more exacerbations during follow-up and 203 with poor baseline sleep quality (PSQI score > 5). Participants with subsequent symptom-based exacerbations had higher median baseline PSQI scores than those without (6.0 [interquartile range, 3.0-8.0] vs 5.0 [interquartile range, 2.0-7.0]; P = .01), and they were more likely to have baseline PSQI scores > 5 (50.3% vs 37.3%; P = .01). Higher PSQI scores were associated with increased symptom-based exacerbation risk (adjusted rate ratio, 1.09; 95% CI, 1.01-1.18; P = .02) and event-based exacerbation risk (adjusted rate ratio, 1.10; 95% CI, 1.00-1.21; P = .048). The association occurred mainly in those with undiagnosed COPD. Strongest associations were with Factor 3 (sleep disturbances and daytime dysfunction). Time to symptom-based exacerbation was shorter in participants with poor sleep quality (adjusted hazard ratio, 1.49; 95% CI, 1.09-2.03).Higher baseline PSQI scores were associated with increased risk of COPD exacerbation over 18 months' prospective follow-up.