睡眠质量受损对慢性阻塞性肺疾病症状变化和未来恶化的影响。
The impact of impaired sleep quality on symptom change and future exacerbation of chronic obstructive pulmonary disease.
机构信息
Department of Respiratory and Critical Care Medicine, Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, Hunan, 410011, China.
Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China.
出版信息
Respir Res. 2023 Mar 30;24(1):98. doi: 10.1186/s12931-023-02405-6.
PURPOSE
Study the impact of impaired sleep quality on symptom change and future exacerbation of chronic obstructive pulmonary disease (COPD) patients.
METHODS
This was a prospective study. Patients with COPD were recruited into the study and followed up for one year. Pittsburgh sleep quality index (PSQI) was collected at baseline. Symptom change was assessed with Minimum clinically important difference (MCID) in COPD Assessment Test (CAT) at 6-month visit, which is an indicator to assess symptom improvement. Exacerbation was recorded during the one-year visit. PSQI score > 5 was defined as poor sleep quality, whereas PSQI score ≤ 5 was defined as good sleep quality. MCID was defined as attaining a CAT decrease ≥ 2.
RESULTS
A total of 461 patients were enrolled for final analysis. Two hundred twenty-eight (49.4%) patients had poor sleep quality. Overall, 224 (48.6%) patients attained MCID at 6-month visit and the incidence of exacerbation during the one-year visit was 39.3%. Fewer patients with impaired sleep quality achieved MCID than patients with good sleep quality. Good sleepers were significantly more likely to attain MCID (OR: 3.112, p < 0.001) than poor sleepers. Fewer poor sleepers in GOLD A and D groups attained MCID with ICS/LABA, and fewer poor sleepers in the GOLD D group attained MCID with ICS/LABA/LAMA than good sleepers. Poor sleep quality was a greater risk factor of future exacerbation in Cox regression analysis. The ROC curves showed that PSQI score had a predictive capacity for future exacerbation. More patients with poor sleep quality experienced future exacerbation in GOLD B and D group with treatment of ICS/LABA/LAMA compared to good sleepers.
CONCLUSIONS
COPD patients with impaired sleep quality were less likely to achieve symptom improvement and were at increased risk of future exacerbation compared to patients with good sleep quality. Besides, sleep disturbance may affect the symptom improvement and future exacerbation of patients with different inhaled medication or in different GOLD groups.
目的
研究睡眠质量受损对慢性阻塞性肺疾病（COPD）患者症状变化和未来加重的影响。
方法
这是一项前瞻性研究。将 COPD 患者纳入研究并随访一年。在基线时收集匹兹堡睡眠质量指数（PSQI）。在 6 个月的访视时，采用 COPD 评估测试（CAT）的最小临床重要差异（MCID）评估症状变化，这是评估症状改善的指标。在一年的访视期间记录加重情况。PSQI 评分>5 定义为睡眠质量差，而 PSQI 评分≤5 定义为睡眠质量好。MCID 定义为 CAT 降低≥2。
结果
共纳入 461 例患者进行最终分析。228 例（49.4%）患者睡眠质量差。总体而言，224 例（48.6%）患者在 6 个月时达到 MCID，一年时的加重发生率为 39.3%。睡眠质量差的患者达到 MCID 的比例低于睡眠质量好的患者。睡眠好的患者明显更有可能达到 MCID（OR：3.112，p<0.001）。在 GOLD A 和 D 组中，使用 ICS/LABA 的患者中，睡眠质量差的患者达到 MCID 的比例较低，在 GOLD D 组中，使用 ICS/LABA/LAMA 的患者中，睡眠质量差的患者达到 MCID 的比例低于睡眠质量好的患者。在 Cox 回归分析中，睡眠质量差是未来加重的一个更大的危险因素。ROC 曲线显示 PSQI 评分对未来加重具有预测能力。在 GOLD B 和 D 组中，与睡眠质量好的患者相比，使用 ICS/LABA/LAMA 治疗的患者中，睡眠质量差的患者未来加重的发生率更高。
结论
与睡眠质量好的患者相比，睡眠质量差的 COPD 患者更不可能实现症状改善，并且未来加重的风险更高。此外，睡眠障碍可能会影响不同吸入药物或不同 GOLD 组患者的症状改善和未来加重。
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