Impaired Sleep Quality in COPD Is Associated With Exacerbations The CanCOLD Cohort Study

被引：55

作者：

Shorofsky, Matthew ^{[1
]}

Bourbeau, Jean ^{[1
,15
,25
]}

Kimoff, John ^{[1
]}

Jen, Rachel ^{[2
]}

Malhotra, Atul ^{[6
]}

Ayas, Najib ^{[3
]}

Tan, Wan ^{[4
,16
,26
]}

Aaron, Shawn ^{[7
,20
]}

Sin, Don ^{[5
,16
,26
]}

Road, Jeremy ^{[4
,26
]}

Chapman, Kenneth ^{[8
,9
]}

O'Donnell, Denis ^{[10
,18
]}

Maltais, Francois ^{[11
]}

Hernandez, Paul ^{[12
,19
]}

Walker, Brandie ^{[13
]}

Marciniuk, Darcy ^{[14
]}

Kaminska, Marta ^{[1
]}

FitzGerald, J. ^{[16
]}

Marciniuk, D. ^{[17
]}

ODonnell, D. ^{[18
]}

Cowie, Robert ^{[13
]}

Aaron, Shawn ^{[7
,20
]}

Maltais, F. ^{[21
]}

Samet, Jonathon ^{[22
]}

Puhan, Milo ^{[23
]}

Hamid, Qutayba ^{[15
]}

Hogg, James ^{[24
]}

Baglole, Carole ^{[25
]}

Jabet, Carole ^{[25
]}

Mancino, Palmina ^{[15
,25
]}

Fortier, Yvan ^{[15
,25
]}

Sin, Don ^{[5
,16
,26
]}

Tam, Sheena ^{[26
]}

Comeau, Joe ^{[26
]}

Png, Adrian ^{[26
]}

Coxson, Harvey ^{[16
,26
]}

Kirby, Miranda ^{[26
]}

Leipsic, Jonathon ^{[26
]}

Hague, Cameron ^{[26
]}

Sadatsafavi, Mohsen ^{[4
]}

To, Teresa ^{[9
]}

Gershon, Andrea ^{[9
]}

Li, Pei-Zhi ^{[15
]}

Duquette, Jean-Francois ^{[15
]}

Benedetti, Andrea ^{[15
]}

Jensen, Denis ^{[15
]}

O'Donnell, Denis ^{[10
,18
]}

Lo, Christine ^{[24
]}

Cheng, Sarah ^{[24
]}

Fung, Cindy ^{[24
]}

机构：

[1] McGill Univ, Res Inst, Resp Epidemiol & Clin Res Unit, Hlth Ctr, 5252 De Maisonneuve,Room 3D-64, Montreal, PQ H4A 3S5, Canada

[2] Univ British Columbia, Div Resp Med, Vancouver, BC, Canada

[3] Univ British Columbia, Dept Med, Vancouver, BC, Canada

[4] Univ British Columbia, Vancouver, BC, Canada

[5] Univ British Columbia, St Pauls Hosp, Ctr Heart Lung Innovat, Vancouver, BC, Canada

[6] Univ Calif San Diego, Pulm & Crit Care, San Diego, CA 92103 USA

[7] Ottawa Hosp Res Inst, Ottawa, ON, Canada

[8] Univ Hlth Network, Asthma & Airway Ctr, Toronto, ON, Canada

[9] Univ Toronto, Toronto, ON, Canada

[10] Queens Univ, Dept Med Physiol, Kingston, ON, Canada

[11] Univ Laval, Inst Univ Cardiol & Pneumol Quebec, Quebec City, PQ, Canada

[12] Dalhousie Univ, Fac Med, Div Respirol, Halifax, NS, Canada

[13] Univ Calgary, Calgary, AB, Canada

[14] Univ Saskatchewan, Resp Res Ctr, Saskatoon, SK, Canada

[15] Mcgill Univ, Montreal, PQ, Canada

[16] Univ British Columbia, Vancouver, BC, Canada

[17] Univ Saskatoon, Saskatoon, SK, Canada

[18] Queens Univ, Kingston, ON, Canada

[19] Univ Halifax, Halifax, NS, Canada

[20] Univ Ottawa, Ottawa, ON, Canada

[21] Univ Laval, Quebec City, PQ, Canada

[22] USC, Keck Sch Med, Los Angeles, CA USA

[23] Johns Hopkins Sch Publ Hlth, Baltimore, MD USA

[24] UBC James Hogg Res Ctr, Vancouver, BC, Canada

[25] McGill Univ, Montreal, PQ, Canada

[26] Univ British Columbia, James Hogg Res Ctr, Vancouver, BC, Canada

来源：

CHEST | 2019年 / 156卷 / 05期

关键词：

acute exacerbation of chronic bronchitis; COPD; sleep medicine; OBSTRUCTIVE PULMONARY-DISEASE; OF-LIFE; DEFINITIONS; INDEX; APNEA;

D O I：

10.1016/j.chest.2019.04.132

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

BACKGROUND: COPD increases susceptibility to sleep disturbances, which may in turn predispose to increased respiratory symptoms. The objective of this study was to evaluate, in a population-based sample, the relationship between subjective sleep quality and risk of COPD exacerbations. METHODS: Data were obtained from the Canadian Cohort Obstructive Lung Disease (CanCOLD) study. Participants with COPD who had completed 18 months of follow-up were included. Sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI) and a three-factor analysis. Symptom-based (dyspnea or sputum change >= 48 h) and event-based (symptoms plus medication or unscheduled health services use) exacerbations were assessed. Association of PSQI with exacerbation rate was assessed by using negative binomial regression. Exacerbation-free survival was also assessed. RESULTS: A total of 480 participants with COPD were studied, including 185 with one or more exacerbations during follow-up and 203 with poor baseline sleep quality (PSQI score > 5). Participants with subsequent symptom-based exacerbations had higher median baseline PSQI scores than those without (6.0 [interquartile range, 3.0-8.0] vs 5.0 [interquartile range, 2.0-7.0]; P = .01), and they were more likely to have baseline PSQI scores > 5 (50.3% vs 37.3%; P = .01). Higher PSQI scores were associated with increased symptombased exacerbation risk (adjusted rate ratio, 1.09; 95% CI, 1.01-1.18; P = .02) and event-based exacerbation risk (adjusted rate ratio, 1.10; 95% CI, 1.00-1.21; P = .048). The association occurred mainly in those with undiagnosed COPD. Strongest associations were with Factor 3 (sleep disturbances and daytime dysfunction). Time to symptom-based exacerbation was shorter in participants with poor sleep quality (adjusted hazard ratio, 1.49; 95% CI, 1.09-2.03). CONCLUSION: Higher baseline PSQI scores were associated with increased risk of COPD exacerbation over 18 months' prospective follow-up.

引用

页码：852 / 863

页数：12

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