Hospitalized Patients With COPD at Greater Risk of OSA, Insomnia

July 7, 2020

Hospitalized patients with chronic obstructive pulmonary disease (COPD) were shown to be at greater risk of obstructive sleep apnea (OSA) and insomnia than those without COPD, with worse outcomes for in-hospital sleep quality and quantity also observed, according to study findings.

Hospitalized patients with chronic obstructive pulmonary disease (COPD) were shown to be at greater risk of obstructive sleep apnea (OSA) and insomnia than those without COPD, with worse outcomes for in-hospital sleep quality and quantity also observed, according to study findings published in the Journal of Clinical Sleep Medicine.

Comorbidities, such as sleep apnea, chronic respiratory failure, and heart failure, have all been linked with COPD. In addressing these risks, positive airway pressure (PAP) therapy, which is primarily given to those with sleep apnea, has been shown to decrease hospitalizations for patients with the condition. However, as noted in that prior study, a majority of patients with COPD did not receive PAP therapy despite its effectiveness.

Researchers of the current study sought to better understand the implications of sleep in patients with COPD. They conducted a prospective cohort study, including hospitalized medical ward patients both with and without COPD (n = 572), of which both groups did not have a known sleep disorder.

On admission, each group was screened for sleep disorders such as OSA and insomnia via validated questionnaires. Additionally, wrist actigraphy measured participants’ daily sleep duration and efficiency in the hospital. Patient data was collected from March 2010 to July 2015.

When examining both groups at admission, no differences were found for sleep quality or excess sleepiness between both groups. However, patients with COPD exhibited a greater adjusted risk of OSA (adjusted odds ratio [aOR] = 1.82; 95% CI, 1.12-2.96; P = .015) and clinically significant insomnia (aOR = 2.07; 95% CI, 1.12-3.83; P = .021) compared with those without the disease.

After examining sleep quality and duration data via wrist actigraphy, patients with COPD were shown to average 34 fewer minutes of nightly sleep (95% CI 4.2-64.0 minutes; P = .026) and were 22.5% less likely to exhibit normal sleep efficiency while admitted (95% CI 3.3%-37.9%; P = .024), compared with those without the disease.

There were no statistically significant differences observed for in-hospital sleep quality, soundness, or ease of falling asleep, noted the study authors.

As patients with COPD exhibited significantly greater risk of sleep disorders at admission, and subsequent impaired sleep duration after being hospitalized, study findings highlight the often overlooked and undiagnosed sleep disorder implications in patients with COPD.

Reference

Stewart NH, Waters RW, Mokhlesi B, et al. Sleep in hospitalized patients with chronic obstructive pulmonary disease: an observational study. J Clin Sleep Med. Published online June 29, 2020. doi:10.5664/jcsm.8646