ABSTRACT

Objective:

The purpose of this study is to evaluate the subjective sleep quality, factors affecting sleep quality, and the risk of Obstructive Sleep Apnea syndrome (OSAS) in the patients with stable Chronic Obstructive Pulmonary disease (COPD).

Materials and Methods:

We included the patients who were admitted to our chest diseases clinic and evaluated as stable COPD in the study. Pittsburgh Sleep Quality index (PSQI) and STOP-Bang survey were applied to the patients to evaluate the sleep quality and the risk for OSA.

Results:

We included 75 patients (67 males and 8 females) in this study. In total, 38.7% of the patients had a PSQI >5, whereas 61.3% of them had a PSQI ≤5. The comparison of groups revealed a significant difference in terms of diagnosis of hypertension, excessive daytime sleepiness, and sleep efficiency (p=0.005, p=0.049, p<0.001, respectively). There was no significant difference regarding the COPD stages between the groups (p=0.141). The question “to go to the toilet at night” from PSQI was the question had the highest score. According to the STOP-Bang score, 15 (20%) patients were identified at a low risk, 27 (36%) were at a medium risk, and 33 (44%) at a high risk for OSA.

Conclusion:

We determined that 37.8% of patients with stable COPD had a poor sleep quality and 44% of them were at a high risk for OSA. Patients with a poor sleep quality were more hypertensive and had lower subjective sleep efficacy. “To go to the toilet at night” was one of the factors that negatively affect sleep quality. Questioning patients with COPD at an advanced age in terms of nocturia can help in revealing an underlying co-morbid condition. Moreover, it is also important to implement measures that may lead to an increase in sleep quality.

Keywords: Chronic Obstructive Pulmonary disease, Pittsburgh Sleep Quality index, Obstructive sleep apnea (OSA), STOP-Bang

References

GOLD 2019-Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2019 update. Available from: http: //goldcopd.org.

Erdinç E, Polatlı M, Kocabaş A, et al. Türk Toraks Derneği Kronik Obstrüktif Akciğer Hastalığı Tanı Ve Tedavi Uzlaşı Raporu. Turk Thorac J 2010;11(Suppl 1):1-66.

Rennard S, Decramer M, Calverley PM, Pride NB, Soriano JB, Vermeire PA, Vestbo J. Impact of COPD in North America and Europe in 2000: Subjects’ perspective of Confronting COPD International Survey. Eur Respir J 2002;20:799-805.

Stege G, Vos PJ, van den Elshout FJ, Richard Dekhuijzen PN, van de Ven MJ, Heijdra YF. Sleep, hypnotics and chronic obstructive pulmonary disease. Respir Med 2008;102:801-14.

Mohsenin V. Sleep in chronic obstructive pulmonary disease. Semin Respir Crit Care Med 2005;26:109-16.

Öztürk Ö. Kronik Obstrüktif Akciğer Hastalığı ve Uyku. Solunum Derg 2011;13:67-77.

McNicholas WT, Verbraecken J, Marin JM. Sleep disorders in COPD: The forgotten dimension. Eur Respir Rev 2013;22:365-75.

Crinion SJ, McNicholas WT. Sleep-related disorders in chronic obstructive pulmonary disease. Expert Rev Respir Med 2014;8:79-88.

Bülbül Y. Kronik Obstrüktif Akciğer Hastalığında Uyku Sorunları. Güncel Göğüs Hastalıkları Serisi 2013;1:80-5.

Sanders MH, Newman AB, Haggerty CL, Redline S, Lebowitz M, Samet J, O’Connor GT, Punjabi NM, Shahar E; Sleep Heart Health Study. Sleep and sleep-disordered breathing in adults with predominantly mild obstructive airway disease. Am J Respir Crit Care Med 2003;167:7-14.

Owens RL, Malhotra A. Sleep-disordered breathing and COPD: The overlap syndrome. Respir Care 2010;55:1333-46.

Örsal Ö, Eren H, Duru P. Psikiyatri hastalarının uyku kalitesini etkileyen faktörlerin yapısal eşitlik modeli ile incelenmesi. J Psychiatr Nurs 2019;10:55-64.

Johns MW. A new method for measuring daytime sleepiness: The Epworth sleepiness scale. Sleep 1991;14:540-5.

Buysse DJ, Hall ML, Strollo PJ, Kamarck TW, Owens J, Lee L, Reis SE, Matthews KA. Relationships between the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and clinical/polysomnographic measures in a community sample. J Clin Sleep Med 2008;4:563-71.

Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, Khajehdehi A, Shapiro CM. STOP questionnaire: A tool to screen patients for obstructive sleep apnea. Anesthesiology 2008;108:812-21.

Chung F, Yang Y, Brown R, Liao P. Alternative scoring models of STOP-Bang questionnaire improve specificity to detect undiagnosed obstructive sleep apnea. J Clin Sleep Med 2014;10:951-8.

Izci B, Ardic S, Firat H, Sahin A, Altinors M, Karacan I. Reliability and validity studies of the Turkish version of the Epworth Sleepiness Scale. Sleep Breath 2008;12:161-8.

Ağargün MY, Kara H, Anlar Ö. Pittsburgh Uyku Kalitesi İndeksi’nin Geçerliği ve Güvenirliği. Türk Psikiyatr Derg 1996;7:107-15.

Acar HV, Kaya A, Yücel F, Erdem M, Eruyar Günal S, Özgen F, Dikmen B. Validation of the STOP-Bang Questionnaire: an Obstructive Sleep Apnoea Screening Tool in Turkish Population. Turkish J Anesth Reanim 2013;41:115-20.

Valipour A, Lavie P, Lothaller H, Mikulic I, Burghuber OC. Sleep profile and symptoms of sleep disorders in patients with stable mild to moderate chronic obstructive pulmonary disease. Sleep Med 2011;12:367-72.

Nunes DM, Mota RM, de Pontes Neto OL, Pereira ED, de Bruin VM, de Bruin PF. Impaired sleep reduces quality of life in chronic obstructive pulmonary disease. Lung 2009;187:159-63.

Chen R, Tian JW, Zhou LQ, Chen X, Yan HY, Zeng B, Zhang MS. The relationship between sleep quality and functional exercise capacity in COPD. Clin Respir J 2016;10:477-85.

Incalzi RA, Bellia V, Catalano F, Scichilone N, Imperiale C, Maggi S, Rengo F; Salute Respiratoria nell-Anziano (Sa.R.A.) Study. Evaluation of health outcomes in elderly patients with asthma and COPD using disease-specific and generic instruments: the Salute Respiratoria nell’Anziano (Sa.R.A.) Study. Chest 2001;120:734-42.

Vukoja M, Kopitovic I, Milicic D, Maksimovic O, Pavlovic-Popovic Z, Ilic M. Sleep quality and daytime sleepiness in patients with COPD and asthma. Clin Respir J 2018;12:398-403.

Batum M, Batum Ö, Can H, Kısabay A, Götalay T, Yılmaz H. Kronik obstrüktif akciğer hastalığında evrelere göre uyku yakınmalarının değerlendirilmesi. J Turkish Sleep Med 2015;3:59-64.

B Budhiraja R, Parthasarathy S, Budhiraja P, Habib MP, Wendel C, Quan SF. Insomnia in Patients with COPD. Sleep 2012;35:369-75.

Yoshimura K, Terada N, Matsui Y, Terai A, Kinukawa N, Arai Y. Prevalence of and risk factors for nocturia: Analysis of a health screening program. Int J Urol 2004;11:282-7.

Hillas G, Perlikos F, Tsiligianni I, Tzanakis N. Managing comorbidities in COPD. Int J Chron Obstruct Pulmon Dis 2015;10:95-109.

Barnes PJ, Celli BR. Systemic manifestations and comorbidities of COPD. Eur Respir J 2009;33:1165-85.

Ayik S, Bal K, Akhan G. The association of nocturia with sleep disorders and metabolic and chronic pulmonary conditions: Data derived from the polysomnographic evaluations of 730 patients. Turkish J Med Sci 2014;44:249-54.

Loke YK, Singh S. Risk of acute urinary retention associated with inhaled anticholinergics in patients with chronic obstructive lung disease: Systematic review. Ther Adv Drug Saf 2013;4:19-26.

Afonso ASM, Verhamme KMC, Stricker BHC, Sturkenboom MCJM, Brusselle GGO. Inhaled anticholinergic drugs and risk of acute urinary retention. BJU Int 2011;107:1265-72.

Miyazaki H, Suda T, Otsuka A, Nagata M, Ozono S, Hashimoto D, Nakamura Y, Inui N, Nakamura H, Chida K. Tiotropium does not affect lower urinary tract functions in COPD patients with benign prostatic hyperplasia. Pulm Pharmacol Ther 2008;21:879-83.

Marin JM, Soriano JB, Carrizo SJ, Boldova A, Celli BR. Outcomes in patients with chronic obstructive pulmonary disease and obstructive sleep apnea: The overlap syndrome. Am J Respir Crit Care Med 2010;182:325-31.

Kopp G, Lador F, Adler D. Overlap syndrome in chronic obstructive pulmonary disease patient. Rev Med Suisse 2019;15:2087-9.

Evaluation of the Sleep Quality and the Risk of Obstructive Sleep Apnea in Patients with Stable Chronic Obstructive Pulmonary Disease

ABSTRACT

References