PRS60 IMPACT OF SLEEP DISTURBANCE ON HEALTH-RELATED QUALITY OF LIFE IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD): WHAT DO WE KNOW SO FAR?

Abstract

Extrapulmonary impacts of chronic obstructive pulmonary disease (COPD) often include sleep disturbance, poor sleep quality, and daytime sleepiness resulting in detrimental impact on patients' overall health-related quality of life (HRQoL). This study evaluated the impact of sleep disturbance on HRQoL in patients with COPD. Literature searches were performed in biomedical databases until March 2019. Specific search terms identified observational studies assessing HRQoL in COPD that included sleep as a patient-reported outcome (PRO) endpoint. Only full text articles published in English were included. Out of total 1247 abstracts identified for initial screening, 177 were selected for full text review. Based on the inclusion criteria, PRO-related information from 36 studies are analyzed. Sleep disturbances and poor sleep quality was on average prevalent in more than one-third, ranging from 27%-100% of COPD patients. Sleep measures such as the Pittsburgh Sleep Quality Index (PSQI), PROMIS-sleep disturbance domain, Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), and COPD and Asthma Sleep Impact Scale (CASIS) showed significant correlations (all p<0.05) with HRQoL [determined by COPD Assessment Test (CAT), 36-Item Short Form Health Survey (SF-36), the Nottingham Health Profile (NHP) and the St George's Respiratory Questionnaire (SGRQ)]. Univariate and multivariate analyses showed that sleep quality (evaluated by PSQI) is an important determinant for HRQoL in COPD. Furthermore, HRQoL is an important predictor of sleep quality, thereby establishing bidirectional relationship. “Good sleepers” (PSQI<5) have better HRQoL compared to “poor sleepers” (PSQI≥5). Increased sleep disturbance is associated with emotional impact. Both significant (all p<0.05) and non-significant (all p>0.05) results were seen for associations of sleep with disease severity. Overall, there is a bidirectional relationship of sleep quality and HRQoL in COPD. Sleep quality is an independent significant predictor of HRQoL in COPD. Hence, sleep should be considered an important HRQoL component when evaluating the health status of COPD patients.