Department of Primary Care and Public Health Sciences, King's College London, King's Health Partners, London, UK.
Department of Physiotherapy, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK.
NPJ Prim Care Respir Med. 2014 Jul 10;24:14028. doi: 10.1038/npjpcrm.2014.28.
Poor sleep quality is common in chronic obstructive pulmonary disease (COPD). It is associated with poor quality of life. Pulmonary rehabilitation (PR) improves quality of life, exercise capacity, and anxiety and depression. Its effect on sleep quality is uncertain.
To determine whether PR improves sleep quality in COPD.
A prospective controlled 'before and after' study of sleep quality in COPD patients attending a community PR programme was conducted. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). Lung function, disease-specific quality of life (COPD assessment test--CAT), exercise capacity (incremental shuttle walk test--ISWT), and anxiety and depression (Hospital Anxiety and Depression Scale--HADS) were measured. Change in sleep quality was compared with a COPD control group.
Twenty-eight participants completed PR. The control group comprised 24 patients. Prevalence of poor sleep quality (PSQI ≥5) was 78%. There were no differences between observation and control groups in sleep quality, age or severity. Quality of life was strongly correlated with quality of sleep (r=0.64, P<0.001). PR improved the quality of life (CAT change 3.0; 95% CI, 0.7-5.3), exercise capacity (ISWT change (metres) 81.0; 15.3-146.6), anxiety (HADS score ≥8: change 2.33; 0.45-4.22), and depression (HADS score ≥8: change 2.90; 1.92-3.88). PR did not improve sleep quality (PSQI mean change 0.79; -0.35 to 1.93).
PR did not improve sleep quality in COPD despite improving quality of life, exercise capacity, anxiety and depression. New strategies, independent of PR, are required to improve sleep quality in COPD.
慢性阻塞性肺疾病（COPD）患者常存在睡眠质量差的情况，且与较差的生活质量相关。肺康复（PR）可改善生活质量、运动能力以及焦虑和抑郁。但 PR 对睡眠质量的影响尚不确定。
确定 PR 是否能改善 COPD 患者的睡眠质量。
对参加社区 PR 计划的 COPD 患者进行前瞻性对照“前后”研究，以匹兹堡睡眠质量指数（PSQI）评估睡眠质量。还测量了肺功能、疾病特异性生活质量（COPD 评估测试--CAT）、运动能力（递增式穿梭步行测试--ISWT）以及焦虑和抑郁（医院焦虑和抑郁量表--HADS）。与 COPD 对照组比较睡眠质量的变化。
28 名参与者完成了 PR，对照组包括 24 名患者。睡眠质量差（PSQI≥5）的患病率为 78%。观察组和对照组在睡眠质量、年龄或严重程度方面无差异。生活质量与睡眠质量密切相关（r=0.64，P<0.001）。PR 提高了生活质量（CAT 变化 3.0；95%CI，0.7-5.3）、运动能力（ISWT 变化（米）81.0；15.3-146.6）、焦虑（HADS 评分≥8：变化 2.33；0.45-4.22）和抑郁（HADS 评分≥8：变化 2.90；1.92-3.88）。PR 未改善睡眠质量（PSQI 平均变化 0.79；-0.35 至 1.93）。
尽管 PR 改善了生活质量、运动能力、焦虑和抑郁，但并未改善 COPD 患者的睡眠质量。需要新的策略，独立于 PR，来改善 COPD 患者的睡眠质量。
