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

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• 作者：Theodore A. Omachi^a ; ^{omachi@ucsf.edu} ; Paul D. Blanc^b ; ^{paul.blanc@ucsf.edu} ; David M. Claman^a ; ^{david.claman@ucsf.edu} ; Hubert Chen^a ; ^{hubert.chen@ucsf.edu} ; Edward H. Yelin^c ; ^d ; ^{ed.yelin@ucsf.edu} ; Laura Julian^d ; ^{laura.julian@ucsf.edu} ; Patricia P. Katz^c ; ^d ; ^{patti.katz@ucsf.edu}
• 关键词：BMI ; body mass index ; COPD ; chronic obstructive pulmonary disease ; DKEFS ; Delis Kaplan Executive Function System ; ED ; emergency department ; HR ; hazard ratio ; HVLT ; Hopkins Verbal Learning Test ; FEV1 ; forced expiratory volume in one second ; FVC ; forced vit
• 刊名：Sleep Medicine
• 出版年：2012
• 期刊代码：241_13899457
• 类别：med
• 出版时间：May, 2012
• 卷：13
• 期：5
• 页码：476-483
• 文件大小：230 K

摘要

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: FEV₁ 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 FEV₁. In multivariable logistic regression, controlling for sociodemographics and body-mass index, sleep disturbance longitudinally predicted both incident COPD exacerbations (OR = 4.7; <em>pem> = 0.018) and respiratory-related emergency utilization (OR = 11.5; <em>pem> = 0.004). In Cox proportional hazards analysis, controlling for the same covariates, sleep disturbance predicted poorer survival (HR = 5.0; <em>pem> = 0.013). For all outcomes, these relationships persisted after also controlling for baseline FEV₁ 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.