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Subjective sleep quality is associated with disease status in COPD patients. The cross-sectional Greek UNLOCK study

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

The association of chronic obstructive pulmonary disease (COPD) severity and related health status with sleep quality remains unclear. We aimed to investigate the association between COPD and sleep quality in the Greek national branch of the UNLOCK cohort.

Methods

A sample of 257 COPD patients enrolled cross-sectionally from primary care in Greece. Sleep quality was assessed by the COPD and Asthma Sleep Impact Scale (CASIS-7 items) questionnaire (higher score indicates worse sleep quality). We tested for associations of sleep impairment with health status (CAT and mMRC scores), exacerbations, hospitalizations, GOLD 2018 ABCD status, inhaler adherence, frailty, and sense of coherence, adjusting for age, gender, smoking status, and comorbidities.

Results

The majority of patients reported uncontrolled symptoms (91% with ≥ 10 CAT or 61% with ≥ 2 mMRC). Mean (SD) age was 65 (12.3) with 79% males. CASIS-7 mean (SD) score was 37.7 (12.9). After adjustments, CASIS was significantly associated with worse health status (e.g., CASIS increased with CAT ≥ 10 [β = 12.53, (95% CI, 6.82, 18.25); p < 0.001], mMRC ≥ 2 [β = 4.96, (95% CI, 1.56, 8.34); p = 0.004]), COPD severity (CAT-based GOLD BD [β = 8.88 (95% CI, 2.50, 15.26); p = 0.007]), frailty [β = 8.85 (95% CI 4.45,13.25); p < 0.001], and sense of coherence [β = −0.14 (95% CI −0.21, −0.06), p < 001]. When using a CASIS cut-off score of 30 as indicator of sleep impairment, additional to the aforementioned associations, we found increased risk for sleep impairment with ≥ 2 exacerbations/year and poor inhaler adherence (p value < 0.05).

Conclusions

Our study suggests that worse health status and COPD severity are associated with poor sleep quality in COPD patients.

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Acknowledgements

Greek UNLOCK team

Maria Kampouraki (Primary care practice, Health Center of Moires, Heraklion, Crete, Greece); Despo Ierodiakonou (Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece; Department of Public Health, Heraklion University Hospital, Heraklion, Crete, Greece); Ioanna Tsiligianni (Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece); Eleftheria Lintovoi (Primary care practice, Corfu, Greece); Dimitris Karanassos (Primary care practice, Akraifnio, Boeotia, Greece); Polyvios Papadokostakis (Garipa primary care practice, Health Center of Arcalohori, Heraklion, Crete, Greece); Ioannis Poulorinakis (Primary care practice, Health Center of Agia Varvara, Heraklion, Crete, Greece); Kyriakos Maltezis (Primary care practice, Akraifnio, Boeotia, Greece); Maria Chorti (Primary care practice, Attica, Greece.); EvangelosPetrovitsos (Primary care practice, Attica, Greece); Sofia Dimopoulou (Primary care practice, Chalkidiki, Greece); Sam Hamind (Primary care practice, Santorini, Cyclades Islands, Greece); Ioannis Gialamas (Primary care practice, Health Center of Sitia, Sitia General Hospital, Lasithi, Crete, Greece); Polyxeni Athanasiou (Department of Public Health, Heraklion University Hospital, Heraklion, Crete, Greece); Vasiliki Bempi (Heraklion University Hospital, Heraklion, Crete, Greece); Irene Lampraki (Department of Public Health, Heraklion University Hospital, Heraklion, Crete, Greece).

Author information

Author notes

  1. Despo Ierodiakonou and Izolde Bouloukaki contributed equally to this work.

Authors and Affiliations

  1. Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Voutes Campus, GR-71003, Heraklion, Crete, Greece

    Despo Ierodiakonou, Izolde Bouloukaki & Ioanna Tsiligianni

  2. Department of Public Health, Heraklion University Hospital, Heraklion, Crete, Greece

    Despo Ierodiakonou, Irene Lampraki & Polyxeni Athanasiou

  3. Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, Voutes Campus, GR-71003, Heraklion, Crete, Greece

    Izolde Bouloukaki & Sophia Schiza

  4. Primary care practice, Health Center of Moires, Heraklion, Crete, Greece

    Maria Kampouraki

  5. Garipa primary care practice, Health Center of Arcalohori, Heraklion, Crete, Greece

    Polyvios Papadokostakis

  6. Primary care practice, Health Center of Agia Varvara, Heraklion, Crete, Greece

    Ioannis Poulorinakis

Authors
  1. Despo Ierodiakonou
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Consortia

On behalf of the Greek UNLOCK Group

  • Maria Kampouraki
  • , Despo Ierodiakonou
  • , Ioanna Tsiligianni
  • , Eleftheria Lintovoi
  • , Dimitris Karanassos
  • , Polyvios Papadokostakis
  • , Ioannis Poulorinakis
  • , Kyriakos Maltezis
  • , Maria Chorti
  • , Evangelos Petrovitsos
  • , Sam Hamind
  • , Ioannis Gialamas
  • , Polyxeni Athanasiou
  • , Vasiliki Bempi
  •  & Irene Lampraki

Corresponding authors

Correspondence to Izolde Bouloukaki or Ioanna Tsiligianni.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Ierodiakonou, D., Bouloukaki, I., Kampouraki, M. et al. Subjective sleep quality is associated with disease status in COPD patients. The cross-sectional Greek UNLOCK study. Sleep Breath 24, 1599–1605 (2020). https://doi.org/10.1007/s11325-020-02039-8

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  • DOI: https://doi.org/10.1007/s11325-020-02039-8

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