Introduction: Previous studies have reported associations between sleep problems and chronic obstructive lung diseases (COPD, and/or asthma), but little is known about the impact of sleep disturbances on the management of these diseases or on the quality of life for older patients. This pilot study was designed to evaluate the feasibility of identifying sleep disturbances, obtain estimates of the prevalence of disrupted sleep in this population, and demonstrate sleep’s possible impact on clinical outcomes.
Methods: Subjects 70 years of age or older with an established diagnosis of COPD or asthma were sequentially asked to participate during their regular clinic visit. Study subjects were asked to complete a survey composed of previously validated instruments that addressed sleep quality, disease related quality of life and general health. Lung function was objectively measured by spirometry per national standards. Medications prescribed in the 12 months prior to enrollment and 6 months following enrollment were obtained through pharmacy databases and medical records. Hospitalizations, emergency room visits, and unscheduled clinic visits were obtained through administrative databases. Sleep disturbance was objectively measured by overnight oximetry and ten days of continuous actigraphy data with concurrent sleep logs.
Results: A total of 42 subjects were recruited for participation in this study (63.3% females, mean age 77 years). Average sleep efficiency was 65.3%. Average total sleep time was 5.8 hours. Mean Pittsburg Sleep Quality Score was 6.29. Mean St. Georges Respiratory Questionnaire total score was 41.36. Mean SF8 score physical domain was 42.28 and mental domain was 51.37. Mean low nocturnal oxygen saturation was 86%. There were a total of 28 hospitalizations, 15 emergency room visits, 9 urgent care visits, and 415 clinic visits in the study period. A multivariate model including age, FEV1, lowest oxygen saturation, general health and sleep efficiency accounted for 38.4% of the variance in predicting an unscheduled clinic visit. Low nocturnal oxygen saturation and age were the greatest predictors of increased clinic visits. Objective lung function did not correlate with either sleep quality or predict healthcare use.
Conclusions: Sleep quality was poor in this population with obstructive lung disease. Addressing this population's poor sleep quality may potentially improve quality of life and decrease healthcare demands. This pilot study supports further investigation into the relationship between obstructive lung disease and sleep.