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. 2012 May;13(5):476-83.
doi: 10.1016/j.sleep.2011.12.007. Epub 2012 Mar 18.

Disturbed sleep among COPD patients is longitudinally associated with mortality and adverse COPD outcomes

Theodore A Omachi  1 , Paul D Blanc, David M Claman, Hubert Chen, Edward H Yelin, Laura Julian, Patricia P Katz
Affiliations

Disturbed sleep among COPD patients is longitudinally associated with mortality and adverse COPD outcomes

Theodore A Omachi et al. Sleep Med. 2012 May.

Abstract

Objective: To investigate the cross-sectional association between COPD severity and disturbed sleep and the longitudinal association between disturbed sleep and poor health outcomes.

Methods: Ninety eight adults with spirometrically-confirmed COPD were recruited through population-based, random-digit telephone dialing. Sleep disturbance was evaluated using a 4-item scale assessing insomnia symptoms as: difficulty falling asleep, nocturnal awakening, morning tiredness, and sleep duration adequacy. COPD severity was quantified by: FEV(1) and COPD Severity Score, which incorporates COPD symptoms, requirement for COPD medications and oxygen, and hospital-based utilization. Subjects were assessed one year after baseline to determine longitudinal COPD exacerbations and emergency utilization and were followed for a median 2.4 years to assess all-cause mortality.

Results: Sleep disturbance was cross-sectionally associated with cough, dyspnea, and COPD Severity Score, but not FEV(1). In multivariable logistic regression, controlling for sociodemographics and body-mass index, sleep disturbance longitudinally predicted both incident COPD exacerbations (OR=4.7; p=0.018) and respiratory-related emergency utilization (OR=11.5; p=0.004). In Cox proportional hazards analysis, controlling for the same covariates, sleep disturbance predicted poorer survival (HR=5.0; p=0.013). For all outcomes, these relationships persisted after also controlling for baseline FEV(1) and COPD Severity Score.

Conclusions: Disturbed sleep is cross-sectionally associated with worse COPD and is longitudinally predictive of COPD exacerbations, emergency health care utilization, and mortality.

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Conflict of interest statement

No authors have any conflicts of interest to disclose

Figures

Figure 1
Figure 1
The study addressed questions of cross-sectional associations (Pathways #1 and #2), questions of longitudinal associations (Pathway #3), and questions of cognitive deficits or psychological factors as potential mediators in longitudinal associations (Pathway #4).
See this image and copyright information in PMC

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