Study of Insomnia in Chronic Obstructive Pulmonary Disease Patients at a Tertiary Care Centre

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Jaspreet Singh Khandpur
Sushama Dugad
Ravindra Shinde
Nikhil Raj
Kappagantu Surya Chaitanya Neeladrirao Subbarao
Juhi Kadukar

Abstract

Background: Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities caused by significant exposure to noxious particles or gases. Aims and Objectives: 1. To estimate the proportion of insomnia in Chronic Obstructive Pulmonary Diseases patients, 2. To study the association of insomnia with severity of Chronic Obstructive Pulmonary Diseases among study participants and 3. Assessment of Quality of Life among study participants. Materials and Methods: This prospective observational study was conducted in Department of Respiratory Medicine in a tertiary care center and medical college. Written informed consent was taken from all the study participants and those who give consent were enrolled in the present study. Total 159 COPD patients were included in the study, after satisfying the eligibility criteria. The COPD patients were enrolled after satisfying the eligibility criteria given GSAQ Questionnaire to find the presence of insomnia, PSQI for quality of sleep and then SF-36 score questionnaire to assess Quality of Life. Study was conducted for duration of 2 years (August 2018 to December 2020). Observation and Results: The most common age group amongst study population was 51 to 60 years (42%) followed by 40 to 50 years (29%) and more than 60 years (29%). There was male predominance (54.5%) in the study population as compared to females (45.5%). The most common occupation amongst study population was farmer (28%) followed by Shopkeeper (23%) and Driver (19%) and most of the study population were obese (65.2%) followed by normal BMI (28.8%) and underweight (6.1%). Most of the study population were Grade 2 dyspnea (36%) followed by Grade 3 (34%) and Grade 4 (16%). Most of the study population were Moderate COPD (45.5%) followed by severe COPD (27.3%) and very severe (21.2%). Comorbidities like Diabetes and Hypertension was observed in 11% and 28% of study population. 29% of study population was ex smokers. 69.57% of ex smokers had more than 20 pack years while 30.43% had less than 20 pack years. The prevalence of insomnia in our study population was 43%. The prevalence of insomnia was most commonly observed in severe COPD (40%) followed by Very severe COPD (35%), Moderate COPD (19%) and mild COPD (6%) and the difference was statistically significant. Mean Physical health score and Mental health score was significantly lower in insomnia patients as compared to non insomnia patients. Mean PSQI was significantly higher in insomniac patients as compared to non insomnia patients. Conclusion: 40% of our patients with COPD experienced poor sleep quality. Presence of insomnia in patients with COPD is also associated with increased day time sleepiness and worse QOL.

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How to Cite
Khandpur, J. S. ., Dugad, S. ., Shinde, R. ., Raj, N., Subbarao, K. S. C. N., & Kadukar, J. (2022). Study of Insomnia in Chronic Obstructive Pulmonary Disease Patients at a Tertiary Care Centre. MVP Journal of Medical Sciences, 258–266. https://doi.org/10.18311/mvpjms/2021/v8i2/316

References

  1. Global initiative for Chronic Obstructive Lung Disease, Inc. Gold website www.goldcopd.org. Pocket guide to COPD diagnosis, management and prevention. A Guide for Health Care Professionals. 2018 report; 2.
  2. Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J, et al, eds. Harrisons principle of internal medicine. New York: McGraw-Hill Education. Pulmonology: Chronic Obstructive Pulmonary Disease. (19th ed). Section 9. 2016; 131:718.
  3. Caballero A. Torres-Duque CA. Jaramillo C. Prevalence of COPD in five Colombian cities situated at low, medium and high altitude. Chest. 2008; 133(2):343–9. PMid: 17951621. https://doi.org/10.1378/chest.07-1361 DOI: https://doi.org/10.1378/chest.07-1361
  4. Ohayon M. Epidemiological study on insomnia in the general population. Sleep. 1996; 19:S7–15. DOI: https://doi.org/10.1093/sleep/19.suppl_3.S7
  5. Riba FJ. Insomnia behavioural and cognitive intervention. Behavioural science learning modules. Division of Mental Health World Health Organization Geneva. 1993:1.
  6. Klink M, Quan SF. Prevalence of reported sleep disturbances in a general adult population and their relationship to obstructive airways diseases. Chest. 1987; 91:540–6. DOI: https://doi.org/10.1378/chest.91.4.540
  7. Bellia V, Catalano F, Scichilone N, et al. Sleep disorders in the elderly with and without chronic airflow obstruction: The SARA study. Sleep. 2003; 26:318–23. PMid: 12749552. https://doi.org/10.1093/sleep/26.3.318 DOI: https://doi.org/10.1093/sleep/26.3.318
  8. Zammit GK, Weiner J, Damato N, Sillup GP, McMillan CA. Quality of Life in people with insomnia. Sleep. 1999; 22:S379–85.
  9. Desikan R, Mason HL, Rupp MT, Skehan M. Healthrelated Quality of Life and healthcare resource utilization by COPD patients: A comparison of three instruments. Qual Life Res. 2002; 11:739–51. PMid: 12482158. https://doi.org/10.1023/A:1020836719321 DOI: https://doi.org/10.1023/A:1020836719321
  10. Kashyp R, Hock LM, Bowman TJ. Higher prevalence of smoking in patients diagnosed as having obstructive sleep apnea. Sleep Breath. 2001; 5(4):167–72. DOI: https://doi.org/10.1055/s-2001-18805
  11. Series F, Roy N, Marc I. Effects of deprivation and sleep fragmentation on upper
  12. airway collapsibility in normal subjects. Am J Respir Crit Care Med. 1994; 150(2):481–5. DOI: https://doi.org/10.1164/ajrccm.150.2.8049833
  13. Marin JM, Soariano JB, Carrizo SJ, Boldova A, Celli BR. Outcomes in patients with Chronic Obstructive Pulmonary Diseases and obstructive sleep apnea: the overlap syndrome. AM J Respir Crit Care Med. 2010: 182(3):325–31. PMid: 20378728. https://doi.org/10.1164/rccm.200912-1869OC DOI: https://doi.org/10.1164/rccm.200912-1869OC
  14. Fabbri LM, Hurd SS. Global strategy for the diagnosis, management and prevention of COPD: 2003 update. Eur Respir J. 2003; 22:1–2. DOI: https://doi.org/10.1183/09031936.03.00063703
  15. Fletcher CM. Standardised questionnaire on respiratory symptoms: A statement prepared and approved by the MRC Committee on the Aeitology of Chronic Bronchitis (MRC breathlessness score). BMJ. 1960; C2:1662.
  16. Roth T, Zammit G, Kushida C, et al. A new questionnaire to detect sleep disorders. Sleep Med. 2002; 3:99–108. https://doi.org/10.1016/S1389-9457(01)00131-9 DOI: https://doi.org/10.1016/S1389-9457(01)00131-9
  17. McHorney CA, Ware JE, Lu JFR, Sherbourne CD. The MOS 36-Item Short-Form Health Survey (SF-36): III. tests of data quality, scaling assumptions and reliability across diverse patient groups. Med Car.e1994; 32(4):40–66. PMid: 8277801. https://doi.org/10.1097/00005650-199401000-00004 DOI: https://doi.org/10.1097/00005650-199401000-00004
  18. Mollayeva T, Thurairajah P, Burton K, et al. The Pittsburgh sleep quality index as a screening tool for sleep dysfunction in clinical and non-clinical samples: A systematic review and meta-analysis. Sleep Med Rev. 2016; 25:S62. DOI: https://doi.org/10.1016/j.sleep.2015.02.156
  19. Stockley RA. Neutrophils and the pathogenesis of COPD. Chest 2002; 121 5 Suppl:151S–5S. PMid: 12010844. https://doi.org/10.1378/chest.121.5_suppl.151S DOI: https://doi.org/10.1378/chest.121.5_suppl.151S
  20. Lopez AD, Murray CC. The global burden of disease, 19902020. Nat Med. 1998; 4:1241–3. DOI: https://doi.org/10.1038/3218
  21. Hasan A, Uwais Ashraf M, Naaz S, Bhargava R, Ashraf J. A study of clinical and echocardiographic profile of patients of Chronic Obstructive Pulmonary Disease helping in early diagnosis of Corpulmonalenternational Journal of Enhanced Research in Medicines and Dental Care. 2014; 1(2):5–8.
  22. Guleria JS, et al. American Review Res Dis. 1969; 100:490. DOI: https://doi.org/10.1001/archderm.1969.01610280108028
  23. Narayana Gowda DS, Golia S, Jaiswal J, Manasa SS. A bacteriological study of acute exacerbation of Chronic Obstructive Pulmonary Disease over a period of one year. Int J Res Med Sci. 2015; 3:3141–6. DOI: https://doi.org/10.18203/2320-6012.ijrms20151152
  24. Anthonisen NR, Manfreda J, Warren CP, Hershfield ES, Harding GK, Nelson NA. Antibiotic therapy in exacerbations of Chronic Obstructive Pulmonary Disease. Ann Intern Med. 1987; 106:196–204. PMid: 3492164. https://doi.org/10.7326/0003-4819-106-2-196 DOI: https://doi.org/10.7326/0003-4819-106-2-196
  25. Dirkje PS, Huib KAM. Epidemiology and natural history of Chronic Obstructive Pulmonary Disease. Gibson G John, Geddes M Duncan, Costabel Ulrich, Sterk J Peter, Corrin Bryan, ed. Respiratory Medicine. 3rd ed. Saunders 2003; 2:1109–20
  26. Rachaiah NM, Rachaiah JM, Krishnaswamy RB. A correlative study of spirometric parameters and ECG changes in patients with Chronic Obstructive Pulmonary Disease. Int J Biol Med Res. 2012; 3(1):1322–6.
  27. Wig KL, Guleria JS, Bhasin RC, Holmes JR. E, Vasudeva YL,Singh H. Certain clinical and epidemiological aspects of chronic bronchitis as seen in Northern India. Indian J Chest Dis. 1964; 6:183–94.
  28. Sunil Babu M, Praveen N, Naik V. A study of clinical profile, radiological features, electrocardiographic and echocardiographic changes in chronic corpulmonale in a rural hospital. Journal of Evolution of Medical and Dental Sciences. 2013 Nov; 2(45):8827-–40. https://doi.org/10.14260/jemds/1532 DOI: https://doi.org/10.14260/jemds/1532
  29. Ladeira, et al., The overall impact of COPD (CAT) and BODE index on COPD male patients: Correlation? Rev Port Pneumol. 2015; 21:11–5. DOI: https://doi.org/10.1016/j.rppnen.2014.02.004
  30. Ittyachen AM, et al., Predictors of outcome in patients admitted with acute exacerbation of Chronic Obstructive Pulmonary Disease in a rural Tertiary Care Center. J Family Med Prim Care. 2016 Apr-Jun; 5(2):411–5. PMid: 27843851 PMCid: PMC5084571. https://doi.org/10.4103/22494863.192365 DOI: https://doi.org/10.4103/2249-4863.192365
  31. Budhiraja R, Parthasarathy S, Budhiraja P, Habib MP, Wendel C, Quan SF. Insomnia in patients with COPD. Sleep. 2012; 35:369–75. PMid: 22379243 PMCid: PMC3274338. https://doi.org/10.5665/sleep.1698 DOI: https://doi.org/10.5665/sleep.1698
  32. Sleep Quality in COPD. Last accessed on 2019 May 31. Available from: http://www.thoracic.org/copd-guidelines/for-healthprofessionals/management-of-stable-copd/sleep/sleep-problems-in-copd.php
  33. Gothi D. Sleep disorders in chronic obstructive pulmonary disease. Indian J Sleep Med. 2015; 10:11–21. https://doi.org/10.1017/S1431927615014439 DOI: https://doi.org/10.5005/IJSM-10-1-11
  34. Vaidya S, Sah RB, Teotiya A, Gothi D. Evaluation of sleep disorders in Chronic Obstructive Sleep Disease patients by subjective questionnaire and their correlation with FEV1, PaO2 and PaCO2. Indian J Sleep Med. 2017; 12:60–3. https://doi.org/10.5005/jp-journals-10069-0012 DOI: https://doi.org/10.5005/jp-journals-10069-0012
  35. Panda S, Taly AB, Sinha S, Gururaj G, Girish N, Nagaraja D. Sleep-related disorders among a healthy population in South India. Neurol India. 2012; 60:68–74. PMid: 22406784. https://doi.org/10.4103/0028-3886.93601 DOI: https://doi.org/10.4103/0028-3886.93601
  36. Budhiraja TA. Siddiqi, Quan SF, Sleep disorders in Chronic Obstructive Pulmonary Disease: Etiology, Impact and Management. J Clin Sleep Med. 2015 Mar 15; 11(3):259–70. PMid: 25700872 PMCid: PMC4346647. https://doi.org/10.5664/jcsm.4540 DOI: https://doi.org/10.5664/jcsm.4540
  37. Nunes DM, Mota RM, de Pontes Neto, OL, Pereira ED, de Bruin VM, de Bruin PF Impaired sleep reduces Quality of Life in Chronic Obstructive Pulmonary Disease. Lung. 2009; 187:159–63. PMid: 19399553. https://doi.org/10.1007/s00408-009-9147-5 DOI: https://doi.org/10.1007/s00408-009-9147-5
  38. Scharf SM, Maimon N, Tuval TS, Bernhard-Scharf BJ, Reuveni H, Tarasiuk A. Sleep quality predicts Quality of Life in Chronic Obstructive Pulmonary Disease. International Journal of Chronic Obstructive Pulmonary Disease. 2011; 6:1–12. DOI: https://doi.org/10.2147/COPD.S15666
  39. Akinci AC, Yildirim E. Factors affecting health status in patients with Chronic Obstructive Pulmonary Disease. International Journal of Nursing Practice. 2013; 19(1):31–8. DOI: https://doi.org/10.1111/ijn.12034
  40. Lucia Dignaniet L. Sleep and Quality of Life in people With COPD: A descriptive correlational study. Clinical Nursing Research. 2015; 1–16.
  41. Agusti A, Hedner J, Marin JM, Barbe F, Cazzola M, Rennard S. Nighttime symptoms: A forgotten dimension of COPD. European Respiratory Review. 2011; 20:183–94. DOI: https://doi.org/10.1183/09059180.00004311
  42. Price D, Small M, Milligan G, Higgins V, Gil EG, Estruch J. Impact of night-time symptoms in COPD: A real-world study in five European countries. International Journal of Chronic Obstructive Pulmonary Disease. 2013; 8:595–603. DOI: https://doi.org/10.2147/COPD.S48570