Hirata Raquel Pastrello, Dala Pola Daniele Caroline, Schneider Lorena Paltanin, Bertoche Mariana Pereira, Furlanetto Karina Couto, Hernandes Nidia Aparecida, Mesas Arthur Eumann, Pitta Fabio
Laboratory of Research in Respiratory Physiotherapy, Dept of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil.
Research Center in Health Sciences, University of Northern Paraná (UNOPAR), Londrina, Brazil.
ERJ Open Res. 2020 Dec 21;6(4). doi: 10.1183/23120541.00370-2020. eCollection 2020 Oct.
The association between characteristics of sleep and physical activity in daily life (PADL) has not yet been investigated in depth in subjects with COPD. This study evaluated whether time spent per day in physical activity (PA) and sedentary behaviour are associated with sleep quantity and quality in this population. Sleep and PADL were objectively assessed by an activity monitor for 7 days and analysed on a minute-by-minute basis. Subjects also underwent spirometry and 6-min walking test (6MWT). Fifty-five subjects with moderate-to-severe COPD (28 male, 67±8 years) were studied. Subjects with total time in bed (TIB) per night ≥9 h had higher wake-after-sleep onset than TIB 7-9 h and TIB ≤7 h (195 (147-218) 117 (75-167) and 106 (84-156) min) and more fragmented sleep than TIB ≤7 h (8.2 (6.7-14.3) 6.3 (5.6-6.9) sleeping bouts; p<0.05 for all). Subjects with TIB ≥9 h also spent more time per day in sedentary behaviour and less time per day in PA of light and moderate-to-vigorous intensity than those with TIB 7-9 h and ≤7 h. In multiple linear regression, TIB ≥9 h was the only significant predictor of physical inactivity (β=-3.3 (-5.1, -1.6), p≤0.0001), accounting for 20% of its variation. Sleep fragmentation was frequent and more pronounced in physically inactive than active patients (7.5 (6.3-9.6) 6.4 (5.5-7.3) sleeping bouts; p=0.027). In summary, subjects with COPD with TIB ≥9 h·night have more fragmented sleep, are more sedentary and less physically active than those with <9 h·night, independently of the awake time. Sleep quality is frequently poor and even worse in patients classified as physically inactive.
慢性阻塞性肺疾病（COPD）患者睡眠特征与日常生活身体活动（PADL）之间的关联尚未得到深入研究。本研究评估了该人群每天花在身体活动（PA）和久坐行为上的时间是否与睡眠数量和质量相关。通过活动监测仪对睡眠和PADL进行了7天的客观评估，并逐分钟进行分析。受试者还接受了肺活量测定和6分钟步行试验（6MWT）。对55例中重度COPD患者（28例男性，67±8岁）进行了研究。每晚卧床总时间（TIB）≥9小时的受试者，其睡眠后觉醒时间高于TIB为7 - 9小时和TIB≤7小时的受试者（分别为195（147 - 218）、117（75 - 167）和106（84 - 156）分钟），且睡眠片段化程度高于TIB≤7小时的受试者（分别为8.2（6.7 - 14.3）、6.3（5.6 - 6.9）次睡眠发作；所有p值均<0.05）。与TIB为7 - 9小时和≤7小时的受试者相比，TIB≥9小时的受试者每天花在久坐行为上的时间更多，而花在轻度和中等到剧烈强度PA上的时间更少。在多元线性回归中，TIB≥9小时是身体活动不足的唯一显著预测因素（β=-3.3（-5.1，-1.6），p≤0.0001），解释了其20%的变异。身体活动不足的患者比活动患者睡眠片段化更频繁且更明显（分别为7.5（6.3 - 9.6）、6.4（5.5 - 7.3）次睡眠发作；p = 0.027）。总之，与夜间TIB<9小时的COPD患者相比，夜间TIB≥9小时的患者睡眠片段化更多，久坐时间更长，身体活动更少，且与清醒时间无关。身体活动不足的患者睡眠质量通常较差，甚至更差。
