Pulmonary Rehabilitation Improves Subjective Sleep Quality in COPD

BACKGROUND: Poor sleep quality is often reported among patients with COPD. Pulmonary rehabilitation (PR) is beneficial in improving exercise capacity and health-related quality of life (HRQOL). However, its benefit in terms of sleep quality in patients with COPD remains unclear. This study aimed to investigate the effects of PR on sleep quality of patients with COPD. METHODS: Thirty-four subjects with COPD were studied. All subjects participated in a 12-week (2 sessions/week) hospital-based out-patient PR study. Baseline and post-PR status were evaluated by spirometry, a sleep questionnaire (Pittsburgh Sleep Quality Index [PSQI]), a disease-specific questionnaire of HRQOL (St George Respiratory Questionnaire [SGRQ)], cardiopulmonary exercise testing, respiratory muscle strength, and the Borg dyspnea scale. RESULTS: Mean FEV1/FVC in the subjects was 0.49 +/- 0.13, and the mean FEV1 was 1.06 +/- 0.49 L/min (49.7 +/- 18.0% of predicted). After PR, the PSQI score decreased from 9.41 +/- 4.33 to 7.82 +/- 3.90 (P < .001). The number of subjects with a PSQI score > 5 also decreased (85.3-64.7%, P = .006). There were significant improvements in HRQOL (SGRQ, P = .003), exercise capacity (peak oxygen uptake, P < .001; and work rate, P < .001), dyspnea score (P < .001), and respiratory muscle strength (inspiratory muscle strength, P = .005; and expiratory muscle strength, P = .004) after PR. There were no significant changes in pulmonary function test results (FEV1, P = .77; FVC, P = .90; FEV1/FVC, P = .90). CONCLUSIONS: PR results in significant improvement in sleep quality, along with concurrent improvements in HRQOL and exercise capacity. PR is an effective nonpharmacologic treatment to improve sleep quality in patients with COPD and should be part of their clinical management.