Indian Journal of Sleep Medicine

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VOLUME 12 , ISSUE 4 ( October-December, 2017 ) > List of Articles

ORIGINAL ARTICLE

Evaluation of Sleep Disorders in Chronic Obstructive Pulmonary Disease Patients by Subjective Questionnaire and Their Correlation with FEV1, PaO2, and PaCO2

Ram B Sah, Anchal Teotiya

Keywords : Global sleep assessment questionnaire, Partial pressure of arterial carbon dioxide, Partial pressure of arterial oxygen, Patient health quality 4.,Forced vital capacity in 1 second

Citation Information : Sah RB, Teotiya A. Evaluation of Sleep Disorders in Chronic Obstructive Pulmonary Disease Patients by Subjective Questionnaire and Their Correlation with FEV1, PaO2, and PaCO2. Indian Sleep Med 2017; 12 (4):60-63.

DOI: 10.5005/jp-journals-10069-0012

License: CC BY-SA 4.0

Published Online: 00-12-2017

Copyright Statement:  Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction/objectives: Sleep disorders are common in chronic obstructive pulmonary disease (COPD). The commonly seen sleep disorders in COPD that can worsen the quality of sleep are insomnia, restless leg syndrome (RLS), obstructive sleep apnea (OSA), and nocturnal oxygen desaturation (NOD). However, these sleep disorders have not been studied in India. Aim: (1) To determine the prevalence of sleep disorder in COPD patients with global sleep assessment questionnaire (GSAQ). (2) To confirm the presence of insomnia, depression, and RLS. (3) To assess the sensitivity and specificity of GSAQ with respect to insomnia, depression, and RLS. (4) Correlation of GSAQ with age, body mass index (BMI), forced expiratory volume in 1 second (FEV1), and partial pressure of arterial oxygen (PaO2) and carbon dioxide (PaCO2). Materials and methods: A prospective study of 60 clinically stable COPD patients was undertaken. Patients were screened for sleep disturbances with the help of the GSAQ. All participants were further assessed with the insomnia, Unpleasant Sensation, Rest induced, Gets relieved on movement, Evening (URGE), and patient health quality 4 (PHQ4) questionnaire. Spirometry and arterial blood gas (ABG) analysis were done in all the patients. Results: In the enrolled 60 patients, male:female ratio was 53:7. 33 (55%) and the patients were found to have positive GSAQ. Among them, 22 (66.67.%), 17 (57.57%), and 23 (69.69%) patients were suspected to have insomnia, RLS, and depression respectively. Some of them had overlap of two disorders. The overall sensitivity and specificity of GSAQ obtained by confirmatory questionnaire were 84.61 and 95.23% respectively. The difference in the mean age, BMI, PaO2, and PaCO2 among GSAQ-positive and egative patients was nonsignificant (p > 0.05). Though low BMI was present, hypercapnea and hypoxia were more commonly present in the GSAQ-positive group. The mean FEV1 (absolute value) in GSAQ-positive group was: 1.23 ± 0.53 L/min, while in the GSAQ-negative group, it was 1.68 ± 0.62 L/min. The difference was statistically significant (p – 0.0003) for FEV1 and its low value was found correlating with high chances of sleep disorders (GSAQ positive). Conclusion: Sleep disorders are commonly seen in COPD patients. The majority of the patients had sleep disturbance due to insomnia. Patients with lower FEV1 have higher chances of sleep disturbance.


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  1. American Thoracic Society. Sleep quality in COPD. New York: ATS; [cited 2017 Nov 1]. Available from: http://www.thoracic. org/copd-guidelines/for-health-professionals/managementof- stable-copd/sleep/sleep-problems-in-copd.php.
  2. Klink M, Quan SF. Prevalence of reported sleep disturbances in a general adult population and their relationship to obstructive airways diseases. Chest 1987 Apr;91(4):540-546.
  3. Klink ME, Dodge R, Quan SF. The relation of sleep complaints to respiratory symptoms in a general population. Chest 1994 Jan;105(1):151-154.
  4. Lewis CA, Fergusson W, Eaton T, Zeng I, Kolbe. Isolated nocturnal desaturation in COPD: prevalence and impact on quality of life and sleep. Thorax 2009 Feb;64(2):133-138.
  5. Cormick W, Olson LG, Hensley MJ, Saunders NA. Nocturnal hypoxaemia and quality of sleep in patients with chronic obstructive lung disease. Thorax 1986 Nov;41(11):846-854.
  6. 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 Apr;12(4):367-372.
  7. Kinsman RA, Yaroush RA, Fernandez E, Dirks JF, Schocket M, Fukuhara J. Symptoms and experiences in chronic bronchitis and emphysema. Chest 1983 May;83(5):755-761.
  8. Anzueto A, Ferguson GT, Feldman G, Chinsky K, Seibert A, Emmett A, Knobil K, O'Dell D, Kalberg C, Crater G. Effect of fluticasone propionate/salmeterol (250/50) on COPD exacerbations and impact on patient outcomes. COPD 2009 Oct;6(5):320-329.
  9. Tashkin DP, Rennard SI, Martin P, Ramachandran S, Martin UJ, Silkoff PE, Goldman M. Efficacy and safety of budesonide and formoterol in one pressurized metered-dose inhaler in patients with moderate to very severe chronic obstructive pulmonary disease: results of a 6-month randomized clinical trial. Drugs 2008 Oct;68(14):1975-2000.
  10. Price D, Small M, Milligan G, Higgins V, Gil EG, Estruch J. The prevalence and impact of nighttime symptoms in COPD patients—a real-world study in five European countries. Int J Chron Obstruct Pulmon Dis 2013 Nov;8:595-603.
  11. Roth T, Zammit G, Kushida C, Doghramji K, Mathias SD, Wong JM, Buysse DJ. A new questionnaire to detect sleep disorders. Sleep Med 2002 Mar;3(2):99-108.
  12. American Association of Sleep Medicine. International classification of sleep disorders. 3rd ed. Darien (IL): American Association of Sleep Medicine; 2014.
  13. International Restless Legs Study Group. IRLSSG diagnostic criteria for RLS. Rochester (MN): IRLSSG; 2012. [cited 2012 Jun 7]. Available from: www.irlssg.org.
  14. Kroenke K, Spitzer RL, Williams JB, Lowe B. An ultra brief screening scale for anxiety and depression : the PHQ-4. Psychosomatics 2009 Nov-Dec;50(6):613-621.
  15. Budhiraja R, Parthasarathy S, Budhiraja P, Habib MP, Wendel C, Quan SF. Insomnia in patients with COPD. Sleep 2012 Mar;35(3):369-375.
  16. Fleetham J, West P, Mezon B, Conway W, Roth T, Kryger M. Sleep, arousals, and oxygen desaturation in chronic obstructive pulmonary disease. The effect of oxygen therapy. Am Rev Respir Dis 1982 Sep;126(3):429-433.
  17. Budhiraja R, Siddiqi TA, Quan SF. Sleep disorders in chronic obstructive pulmonary disease: etiology, impact, and management. J Clin Sleep Med 2015 Mar;11(3):259-270.
  18. Lacasse Y, Sériès F, Vujovic-Zotovic N, Goldstein R, Bourbeau J, Lecours R, Aaron SD, Maltais F. Evaluating nocturnal oxygen desaturation in COPD revised. Respir Med 2011 Sep;105(9):1331-1337.
  19. Aras G, Kadakal F, Purisa S, Kanmaz D, Aynaci A, Isik E. Are we aware of restless legs syndrome in COPD patients who are in an exacerbation period? Frequency and probable factors related to underlying mechanism. COPD 2011 Dec;8(6): 437-443.
  20. Innes KE, Selfe TK, Agarwal P. Restless legs syndrome and conditions associated with metabolic dysregulation, sympathoadrenal dysfunction, and cardiovascular disease risk: a systematic review. Sleep Med Rev 2012 Aug;16(4):309-339.
  21. Eisner MD, Blanc PD, Yelin EH, Katz PP, Sanchez G, Iribarren C, Omachi TA. Influence of anxiety on health outcomes in COPD. Thorax 2010 Mar;65(3):229-234.
  22. Gothi D. Restless legs syndrome: common yet an under recognized entity. Indian J Sleep Med 2014;9(2):41-49.
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