1 Veterans Affairs Puget Sound Healthcare System, Seattle, Washington.
2 University of Washington, Seattle, Washington.
Ann Am Thorac Soc. 2017 Dec;14(12):1836-1843. doi: 10.1513/AnnalsATS.201706-453OC.
Sleep disturbance frequently affects patients with chronic obstructive pulmonary disease (COPD), and is associated with reduced quality of life and poorer outcomes. Data indicate that smokers with preserved pulmonary function have clinical symptoms similar to those meeting spirometric criteria for COPD, but little is known about the driving factors for sleep disturbance in this population of emerging interest.
To compare the magnitude and correlates of sleep disturbance between smokers with preserved pulmonary function and those with airflow obstruction.
Using cross-sectional data from the COPD Outcomes-Based Network for Clinical Effectiveness and Research Translation multicenter registry, we identified participants clinically identified as having COPD with a smoking history of at least 20 pack-years and either preserved pulmonary function or airflow obstruction. We quantified sleep disturbance by T-score measured in the sleep disturbance domain of the Patient-Reported Outcomes Information System questionnaire, and defined a minimum important difference as a T-score difference of two points. We performed univariate and multivariable linear regression to evaluate correlates within each group.
We identified 100 smokers with preserved pulmonary function and 476 with airflow obstruction. The sleep disturbance T-score was 4.1 points greater among individuals with preserved pulmonary function (95% confidence interval [CI], 2.0-6.3). In adjusted analyses, depression symptom T-score was associated with sleep disturbance in both groups (airflow obstruction: β, 0.61 points; 95% CI, 0.27-0.94; preserved pulmonary function: β, 0.25 points; 95% CI, 0.12-0.38). Of note, lower percent predicted FEV was associated with greater sleep disturbance among those with preserved pulmonary function (β, -0.19 points; 95% CI, -0.31 to -0.07), whereas higher FEV was associated with greater sleep disturbance among individuals with airflow obstruction (β, 0.06 points; 95% CI, 0.01-0.10).
Among smokers with clinically identified COPD, the severity of sleep disturbance is greater among those with preserved pulmonary function compared with those with airflow obstruction. Nonrespiratory symptoms, such as depression, were associated with sleep disturbance in both groups, whereas the relationship of sleep disturbance with FEV differed.
睡眠障碍常影响慢性阻塞性肺疾病（COPD）患者，与生活质量降低和预后较差相关。数据表明，肺功能保留的吸烟者有类似符合 COPD 肺功能标准的临床症状，但对于这一新兴人群睡眠障碍的驱动因素知之甚少。
比较肺功能保留和气流受限的吸烟者睡眠障碍的严重程度和相关因素。
使用 COPD 基于结果的网络临床有效性和研究转化多中心注册中心的横断面数据，我们确定了临床诊断为 COPD 的参与者，这些参与者有至少 20 包年的吸烟史，且有肺功能保留或气流受限。我们使用患者报告结局信息系统问卷的睡眠障碍域中的 T 评分来量化睡眠障碍，并将两点的 T 评分差异定义为最小有意义差异。我们进行了单变量和多变量线性回归，以评估每组内的相关因素。
我们确定了 100 名肺功能保留的吸烟者和 476 名气流受限的吸烟者。肺功能保留者的睡眠障碍 T 评分高 4.1 分（95%置信区间 [CI]，2.0-6.3）。在调整分析中，抑郁症状 T 评分与两组的睡眠障碍相关（气流受限：β，0.61 分；95%CI，0.27-0.94；肺功能保留：β，0.25 分；95%CI，0.12-0.38）。值得注意的是，肺功能保留者较低的预计 FEV%与睡眠障碍更严重相关（β，-0.19 分；95%CI，-0.31 至-0.07），而气流受限者较高的 FEV 与睡眠障碍更严重相关（β，0.06 分；95%CI，0.01-0.10）。
在临床诊断为 COPD 的吸烟者中，与气流受限者相比，肺功能保留者的睡眠障碍更严重。两组的非呼吸症状，如抑郁，与睡眠障碍相关，而睡眠障碍与 FEV 的关系不同。
