Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK.
Adelphi Real World, Adelphi Mill, Bollington, UK.
Int J Chron Obstruct Pulmon Dis. 2013;8:595-603. doi: 10.2147/COPD.S48570. Epub 2013 Nov 27.
Sleep quality is often poor in patients with chronic obstructive pulmonary disease (COPD). A cross-sectional European survey investigated the prevalence of night-time symptoms in COPD to evaluate the level of disconnect between physician and patient perceptions of the presence of night-time symptoms, and to compare the characteristics of patients with and without night-time symptoms.
A total of 251 primary care physicians and 251 respiratory specialists completed record forms on 2,807 patients with COPD. The forms captured information on patient demographics, lung function, COPD severity, and symptoms. Patients completed questionnaires on the time of day when their COPD symptoms bothered them, and the impact of COPD on their ability to get up in the morning and on sleep. Data were compared between groups (those with and without night-time symptoms) using t-tests or Wilcoxon signed rank tests. The kappa statistic was used to assess the level of disconnect between physician and patient perceptions of the impact of night-time symptoms.
Most patients (78%) reported night-time disturbance. Patients with night-time symptoms experienced more daytime breathlessness (mean modified Medical Research Council dyspnea scale score 2.4 versus 1.1) and exacerbations in the previous 12 months (mean 1.7 versus 0.4), and received more maintenance therapy (mean of 2.8 versus 2.3 products) than those without. Concordance between the frequency of physician-reported (67.9% of patients) and patient-reported (68.5% of patients) night-time symptoms was good. Physicians significantly underestimated the impact of COPD on the patient's ability to get up in the morning and on sleep (fair-moderate agreement). Physician-reported night-time symptoms were present for 41.2% of patients who could be categorized by Global initiative for chronic Obstructive Lung Disease (GOLD) group (n=937), increasing from 20.9% of those in the low-risk group to 77.4% of those in the high-riskgroup.
Patients with COPD experience night-time symptoms regardless of GOLD group, that impact on their ability to get up in the morning and on their sleep quality.
慢性阻塞性肺疾病（COPD）患者的睡眠质量往往较差。一项欧洲横断面调查研究了 COPD 患者夜间症状的患病率，以评估医生和患者对夜间症状存在的认知之间的脱节程度，并比较有和无夜间症状患者的特征。
251 名初级保健医生和 251 名呼吸科专家对 2807 名 COPD 患者填写记录表格。表格中记录了患者的人口统计学资料、肺功能、COPD 严重程度和症状。患者填写问卷，回答他们的 COPD 症状在一天中的哪个时间困扰他们，以及 COPD 对他们早晨起床和睡眠质量的影响。使用 t 检验或 Wilcoxon 符号秩检验比较组间（有和无夜间症状组）的数据差异。使用 Kappa 统计评估医生和患者对夜间症状影响的认知之间的脱节程度。
大多数患者（78%）报告夜间有干扰。有夜间症状的患者白天呼吸困难更严重（改良医学研究委员会呼吸困难量表评分均值 2.4 比 1.1），过去 12 个月内加重更频繁（均值 1.7 比 0.4），接受的维持治疗更多（均值 2.8 比 2.3 种产品）。医生报告的夜间症状（67.9%的患者）和患者报告的夜间症状（68.5%的患者）之间的一致性较好。医生明显低估了 COPD 对患者早晨起床和睡眠质量的影响（中等程度的一致性）。根据全球慢性阻塞性肺疾病倡议（GOLD）分组（n=937），有 41.2%的可分类患者存在医生报告的夜间症状，从低危组的 20.9%到高危组的 77.4%。
无论 GOLD 分组如何，COPD 患者都经历夜间症状，这些症状影响他们早晨起床和睡眠质量。
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