Miravitlles Marc, Worth Heinrich, Soler Cataluña Juan José, Price David, De Benedetto Fernando, Roche Nicolas, Godtfredsen Nina Skavlan, van der Molen Thys, Löfdahl Claes-Göran, Padullés Laura, Ribera Anna
Pneumology Department, Hospital Universitari Vall d'Hebron, Ciber de Enfermedades Respiratorias (CIBERES), P. de la Vall d'Hebron, 119-129, Barcelona, Spain.
Medical Department I, Fürth Hospital, Fürth, Germany.
Respir Res. 2014 Oct 21;15(1):122. doi: 10.1186/s12931-014-0122-1.
Few studies have investigated the 24-hour symptom profile in patients with COPD or how symptoms during the 24-hour day are inter-related. This observational study assessed the prevalence, severity and relationship between night-time, early morning and daytime COPD symptoms and explored the relationship between 24-hour symptoms and other patient-reported outcomes.
The study enrolled patients with stable COPD in clinical practice. Baseline night-time, early morning and daytime symptoms (symptom questionnaire), severity of airflow obstruction (FEV1), dyspnoea (modified Medical Research Council Dyspnoea Scale), health status (COPD Assessment Test), anxiety and depression levels (Hospital Anxiety and Depression Scale), sleep quality (COPD and Asthma Sleep Impact Scale) and physical activity level (sedentary, moderately active or active) were recorded.
The full analysis set included 727 patients: 65.8% male, mean ± standard deviation age 67.2 ± 8.8 years, % predicted FEV1 52.8 ± 20.5%. In each part of the 24-hour day, >60% of patients reported experiencing ≥1 symptom in the week before baseline. Symptoms were more common in the early morning and daytime versus night-time (81.4%, 82.7% and 63.0%, respectively). Symptom severity was comparable for each period assessed. Overall, in the week before baseline, 56.7% of patients had symptoms throughout the whole 24-hour day (3 parts of the day); 79.9% had symptoms in ≥2 parts of the 24-hour day. Symptoms during each part of the day were inter-related, irrespective of disease severity (all p < 0.001). Early morning and daytime symptoms were associated with the severity of airflow obstruction (p < 0.05 for both). Night-time, early morning and daytime symptoms were all associated with worse dyspnoea, health status and sleep quality, and higher anxiety and depression levels (all p < 0.001 versus patients without symptoms in each corresponding period). In each part of the 24-hour day, there was also an association between symptoms and a patient's physical activity level (p < 0.05 for each period).
More than half of patients experienced COPD symptoms throughout the whole 24-hour day. There was a significant relationship between night-time, early morning and daytime symptoms. In each period, symptoms were associated with worse patient-reported outcomes, suggesting that improving 24-hour symptoms should be an important consideration in the management of COPD.
很少有研究调查慢性阻塞性肺疾病（COPD）患者的24小时症状概况，或者一天中24小时的症状之间是如何相互关联的。这项观察性研究评估了夜间、清晨和白天COPD症状的患病率、严重程度及相互关系，并探讨了24小时症状与其他患者报告结局之间的关系。
该研究纳入了临床实践中病情稳定的COPD患者。记录基线时的夜间、清晨和白天症状（症状问卷）、气流阻塞严重程度（第一秒用力呼气容积[FEV1]）、呼吸困难程度（改良医学研究委员会呼吸困难量表）、健康状况（慢性阻塞性肺疾病评估测试）、焦虑和抑郁水平（医院焦虑抑郁量表）、睡眠质量（慢性阻塞性肺疾病和哮喘睡眠影响量表）以及身体活动水平（久坐、中度活动或活跃）。
完整分析集包括727例患者：男性占65.8%，平均年龄±标准差为67.2±8.8岁，FEV1预测值百分比为52.8±20.5%。在一天的24小时中的每个时间段，超过60%的患者报告在基线前一周内经历过≥1种症状。症状在清晨和白天比夜间更常见（分别为81.4%、82.7%和63.0%）。各评估时间段的症状严重程度相当。总体而言，在基线前一周，56.7%的患者在整个24小时（一天的3个时间段）都有症状；79.9%的患者在24小时中的≥2个时间段有症状。一天中每个时间段的症状都是相互关联的，与疾病严重程度无关（所有p<0.001）。清晨和白天症状与气流阻塞严重程度相关（两者p均<0.05）。夜间、清晨和白天症状均与更严重的呼吸困难、健康状况和睡眠质量相关，以及更高的焦虑和抑郁水平相关（与各相应时间段无症状的患者相比，所有p<0.001）。在一天的24小时中的每个时间段，症状与患者的身体活动水平之间也存在关联（每个时间段p<0.05）。
超过一半的患者在整个24小时内都经历过COPD症状。夜间、清晨和白天症状之间存在显著关系。在每个时间段，症状都与更差的患者报告结局相关，这表明改善24小时症状应是COPD管理中的一个重要考虑因素。
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