Impaired Sleep Quality in COPD Is Associated With Exacerbations: The CanCOLD Cohort Study

Canadian Respiratory Research Network; CanCOLD Collaborative Research group

doi:10.1016/j.chest.2019.04.132

Impaired Sleep Quality in COPD Is Associated With Exacerbations: The CanCOLD Cohort Study

Canadian Respiratory Research Network, CanCOLD Collaborative Research group

Medicine

Résultat de recherche: Article › examen par les pairs

62 Citations (Scopus)

Résumé

Background: COPD increases susceptibility to sleep disturbances, which may in turn predispose to increased respiratory symptoms. The objective of this study was to evaluate, in a population-based sample, the relationship between subjective sleep quality and risk of COPD exacerbations. Methods: Data were obtained from the Canadian Cohort Obstructive Lung Disease (CanCOLD) study. Participants with COPD who had completed 18 months of follow-up were included. Sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI) and a three-factor analysis. Symptom-based (dyspnea or sputum change ≥ 48 h) and event-based (symptoms plus medication or unscheduled health services use) exacerbations were assessed. Association of PSQI with exacerbation rate was assessed by using negative binomial regression. Exacerbation-free survival was also assessed. Results: A total of 480 participants with COPD were studied, including 185 with one or more exacerbations during follow-up and 203 with poor baseline sleep quality (PSQI score > 5). Participants with subsequent symptom-based exacerbations had higher median baseline PSQI scores than those without (6.0 [interquartile range, 3.0-8.0] vs 5.0 [interquartile range, 2.0-7.0]; P = .01), and they were more likely to have baseline PSQI scores > 5 (50.3% vs 37.3%; P = .01). Higher PSQI scores were associated with increased symptom-based exacerbation risk (adjusted rate ratio, 1.09; 95% CI, 1.01-1.18; P = .02) and event-based exacerbation risk (adjusted rate ratio, 1.10; 95% CI, 1.00-1.21; P = .048). The association occurred mainly in those with undiagnosed COPD. Strongest associations were with Factor 3 (sleep disturbances and daytime dysfunction). Time to symptom-based exacerbation was shorter in participants with poor sleep quality (adjusted hazard ratio, 1.49; 95% CI, 1.09-2.03). Conclusions: Higher baseline PSQI scores were associated with increased risk of COPD exacerbation over 18 months’ prospective follow-up.

Langue d'origine	English
Pages (de-à)	852-863
Nombre de pages	12
Journal	Chest
Volume	156
Numéro de publication	5
DOI	https://doi.org/10.1016/j.chest.2019.04.132
Statut de publication	Published - nov. 2019

Note bibliographique

Funding Information:
FUNDING/SUPPORT: The Canadian Cohort Obstructive Lung Disease (CanCOLD) study is currently funded by the Canadian Respiratory Research Network (CRRN); industry partners: Astra Zeneca Canada Ltd; Boehringer Ingelheim Canada Ltd; GlaxoSmithKline Canada Ltd; Novartis. Researchers at RI-MUHC Montreal and Icapture Centre Vancouver lead the project. Previous funding partners are the CIHR (CIHR/ Rx&D Collaborative Research Program Operating Grants- 93326); the Respiratory Health Network of the FRQS; industry partners: Almirall; Merck Nycomed; Pfizer Canada Ltd; and Theratechnologies.

Funding Information:
Author contributions: M. K. served as the guarantor and takes responsibility for the content of the manuscript, including the data and analysis. M. S. R. J. A. M. M. K. J. B. J. K. and N.A. designed the current study, including the objective and analysis methods. M. S. M. K. J. B. and J. K. interpreted data and participated in drafting of the manuscript. J. B. W. C. T. S. D. A. D. D. S. J. R. K. R. C. D. E. O. F. M. P. H. B. L. W. and D. M. participated in the design of the parent cohort, and coordination and supervision of data collection at their respective sites. Financial/nonfinancial disclosures: The authors have reported to CHEST the following: J. B. reports grants from the Canadian Institutes of Health Research (CIHR), Canadian Respiratory Research Network, GlaxoSmithKline, Grifols, Aerocrine, Boehringer Ingelheim, Foundation of the MUHC, Novartis, and AstraZeneca, during the conduct of the study; and personal fees from GlaxoSmithKline, Grifols, Boehringer Ingelheim, Novartis, AstraZeneca, and Trudell, outside the submitted work. J. K. reports grants from CIHR, the Canadian Respiratory Research Network, GlaxoSmithKline, Grifols, Aerocrine, Boehringer Ingelheim, Foundation of the MUHC, Novartis, and AstraZeneca, during the conduct of the study; and grants from the Multiple Sclerosis Society of Canada, Philips Respironics, ResMed, and Fonds de Recherche du Québec-Santé, outside the submitted work. A. M. is funded by the National Institutes of Health; does some work with the Alfred E. Mann Foundation, which is a nonprofit; and ResMed provided a philanthropic donation to UC San Diego. W. C. T. reports personal fees from Teva and GlaxoSmithKline, outside the submitted work. D. D. S. reports grants and personal fees from AstraZeneca and Boehringer Ingelheim, grants from Merck Frosst, and personal fees from Novartis, outside the submitted work. K. R. C. reports grants and personal fees from AstraZeneca, Boehringer Ingelheim, CSL Behring, Grifols, Sanofi, Genentech, Kamada, Roche, Novartis, and Merck; grants from Baxter, GlaxoSmithKline, and Amgen; and personal fees from the CIHR-GSK Research Chair in Respiratory Health Care Delivery, UHN, during the conduct of the study. F. M. reports grants from GlaxoSmithKline, Boehringer Ingelheim, Novartis, AstraZeneca, and Grifols; personal fees from Novartis, Boehringer Ingelheim, and Grifols; and personal fees from Boehringer Ingelheim and Novartis outside the submitted work. P. H. reports grants from CIHR, during the conduct of the study; personal fees from Actelion, AstraZeneca, Bayer, GlaxoSmithKline, Roche, Teva and Trudell, outside the submitted work; grants and personal fees from Boehringer Ingelheim, grants from CSL Behring, Grifols, and Prometic; and service as Secretary of Executive Committee of the Canadian Thoracic Society. B. L. W. reports grants from CIHR, AstraZeneca Canada Ltd, Boehringer Ingelheim Canada, GlaxoSmithKline Canada, and Novartis, during the conduct of the study; grants from Respiratory Health Strategic Clinical Network Alberta and personal fees from AstraZeneca, GlaxoSmithKline, and Novartis, outside the submitted work. D. M. reports grants from CIHR during the conduct of the study; grants from Boehringer-Ingelheim, GlaxoSmithKline, the Lung Association of Saskatchewan, Novartis, AstraZeneca, Canada Health Infoway, CIHR, Schering-Plough; and other from Canadian Foundation for Healthcare Improvement, AstraZeneca, Boehringer-Ingelheim, GlaxoSmithKline, Novartis, Saskatoon Health Region, Health Canada, University of Saskatchewan, outside the submitted work. M. K. reports grants from AstraZeneca Canada, Boehringer Ingelheim Canada Ltd. GlaxoSmithKline Canada Ltd. Almirall, Merck Nycomed, Pfizer Canada Ltd. Theratechnologies, Canadian Respiratory Research Network, CIHR, and Respiratory Health Network of the FRQS, during the conduct of the study; nonfinancial support from Philips Respironics and VitalAire; and grants from ResMed Corp, Fisher & Paykel, CIHR, and Weston Brain Institute outside the submitted work. None declared (M. S. R. J. N. A. S. D. A. J. R. D. E. O.). Role of sponsors: The funders had no role in the study design, data collection and analysis, or preparation of the manuscript. Other contributions: The authors thank the men and women who participated in the study and individuals in the CanCOLD Collaborative Research Group: Executive Committee: Jean Bourbeau, (Mcgill University, Montreal, QC, Canada); Wan C. Tan, J. Mark FitzGerald; D. D. Sin (UBC, Vancouver, BC, Canada); D. D. Marciniuk (University of Saskatoon, Saskatoon, SASK, Canada) D. E. O'Donnell (Queen's University, Kingston, ON, Canada); Paul Hernandez (University of Halifax, Halifax, NS, Canada); Kenneth R. Chapman (University of Toronto, Toronto, ON, Canada); Robert Cowie (University of Calgary, Calgary, AB, Canada); Shawn Aaron (University of Ottawa, Ottawa, ON, Canada); F. Maltais (University of Laval, Quebec City, QC, Canada); International Advisory Board: Jonathon Samet (the Keck School of Medicine of USC, CA); Milo Puhan (John Hopkins School of Public Health, Baltimore, MD); Qutayba Hamid (McGill University, Montreal, QC, Canada); James C. Hogg (UBC James Hogg Research Center, Vancouver, BC, Canada). Operations Center: Jean Bourbeau (PI), Carole Baglole, Carole Jabet, Palmina Mancino, Yvan Fortier, (University of McGill, Montreal, QC, Canada); Wan C. Tan (co-PI), Don Sin, Sheena Tam, Jeremy Road, Joe Comeau, Adrian Png, Harvey Coxson, Miranda Kirby, Jonathon Leipsic, Cameron Hague (University of British Columbia James Hogg Research Center, Vancouver, BC, Canada); Economic Core: Mohsen Sadatsafavi (University of British Columbia, Vancouver, BC, Canada); Public Health core: Teresa To, Andrea Gershon (University of Toronto, Toronto, ON, Canada); Data management and Quality Control: Wan C. Tan, Harvey Coxson (UBC, Vancouver, BC, Canada); Jean Bourbeau, Pei-Zhi Li, Jean-Francois Duquette, Yvan Fortier, Andrea Benedetti, Denis Jensen (Mcgill University, Montreal, QC, Canada), Denis O'Donnell (Queen's University, Kingston, ON, Canada; Field Centers: Wan C. Tan (PI), Christine Lo, Sarah Cheng, Cindy Fung, Nancy Ferguson, Nancy Haynes, Junior Chuang, Licong Li, Selva Bayat, Amanda Wong, Zoe Alavi, Catherine Peng, Bin Zhao, Nathalie Scott-Hsiung, Tasha Nadirshaw (UBC James Hogg Research Center, Vancouver, BC, Canada); Jean Bourbeau (PI), Palmina Mancino, David Latreille, Jacinthe Baril, Laura Labonte (McGill University, Montreal, QC, Canada); Kenneth Chapman (PI), Patricia McClean, Nadeen Audisho (University of Toronto, Toronto, ON, Canada); Brandie Walker, Robert Cowie (PI), Ann Cowie, Curtis Dumonceaux, Lisette Machado (University of Calgary, Calgary, AB, Canada); Paul Hernandez (PI), Scott Fulton, Kristen Osterling (University of Halifax, Halifax, NS, Canada); Shawn Aaron (PI), Kathy Vandemheen, Gay Pratt, Amanda Bergeron (University of Ottawa, Ottawa, ON, Canada); Denis O'Donnell (PI), Matthew McNeil, Kate Whelan (Queen's University, Kingston, ON, Canada); Francois Maltais (PI), Cynthia Brouillard (University of Laval, Quebec City, QC, Canada); Darcy Marciniuk (PI), Ron Clemens, Janet Baran (University of Saskatoon, Saskatoon, SK, Canada). The authors also thank Pei Zhi Li, MSc, for her expert data analysis. FUNDING/SUPPORT: The Canadian Cohort Obstructive Lung Disease (CanCOLD) study is currently funded by the Canadian Respiratory Research Network (CRRN); industry partners: Astra Zeneca Canada Ltd; Boehringer Ingelheim Canada Ltd; GlaxoSmithKline Canada Ltd; Novartis. Researchers at RI-MUHC Montreal and Icapture Centre Vancouver lead the project. Previous funding partners are the CIHR (CIHR/ Rx&D Collaborative Research Program Operating Grants- 93326); the Respiratory Health Network of the FRQS; industry partners: Almirall; Merck Nycomed; Pfizer Canada Ltd; and Theratechnologies.

Funding Information:
Financial/nonfinancial disclosures: The authors have reported to CHEST the following: J. B. reports grants from the Canadian Institutes of Health Research (CIHR), Canadian Respiratory Research Network, GlaxoSmithKline, Grifols, Aerocrine, Boehringer Ingelheim, Foundation of the MUHC, Novartis, and AstraZeneca, during the conduct of the study; and personal fees from GlaxoSmithKline, Grifols, Boehringer Ingelheim, Novartis, AstraZeneca, and Trudell, outside the submitted work. J. K. reports grants from CIHR, the Canadian Respiratory Research Network, GlaxoSmithKline, Grifols, Aerocrine, Boehringer Ingelheim, Foundation of the MUHC, Novartis, and AstraZeneca, during the conduct of the study; and grants from the Multiple Sclerosis Society of Canada, Philips Respironics, ResMed, and Fonds de Recherche du Québec-Santé, outside the submitted work. A. M. is funded by the National Institutes of Health; does some work with the Alfred E. Mann Foundation, which is a nonprofit; and ResMed provided a philanthropic donation to UC San Diego. W. C. T. reports personal fees from Teva and GlaxoSmithKline, outside the submitted work. D. D. S. reports grants and personal fees from AstraZeneca and Boehringer Ingelheim, grants from Merck Frosst, and personal fees from Novartis, outside the submitted work. K. R. C. reports grants and personal fees from AstraZeneca, Boehringer Ingelheim, CSL Behring, Grifols, Sanofi, Genentech, Kamada, Roche, Novartis, and Merck; grants from Baxter, GlaxoSmithKline, and Amgen; and personal fees from the CIHR-GSK Research Chair in Respiratory Health Care Delivery, UHN, during the conduct of the study. F. M. reports grants from GlaxoSmithKline, Boehringer Ingelheim, Novartis, AstraZeneca, and Grifols; personal fees from Novartis, Boehringer Ingelheim, and Grifols; and personal fees from Boehringer Ingelheim and Novartis outside the submitted work. P. H. reports grants from CIHR, during the conduct of the study; personal fees from Actelion, AstraZeneca, Bayer, GlaxoSmithKline, Roche, Teva and Trudell, outside the submitted work; grants and personal fees from Boehringer Ingelheim, grants from CSL Behring, Grifols, and Prometic; and service as Secretary of Executive Committee of the Canadian Thoracic Society. B. L. W. reports grants from CIHR, AstraZeneca Canada Ltd, Boehringer Ingelheim Canada, GlaxoSmithKline Canada, and Novartis, during the conduct of the study; grants from Respiratory Health Strategic Clinical Network Alberta and personal fees from AstraZeneca, GlaxoSmithKline, and Novartis, outside the submitted work. D. M. reports grants from CIHR during the conduct of the study; grants from Boehringer-Ingelheim, GlaxoSmithKline, the Lung Association of Saskatchewan, Novartis, AstraZeneca, Canada Health Infoway, CIHR, Schering-Plough; and other from Canadian Foundation for Healthcare Improvement, AstraZeneca, Boehringer-Ingelheim, GlaxoSmithKline, Novartis, Saskatoon Health Region, Health Canada, University of Saskatchewan, outside the submitted work. M. K. reports grants from AstraZeneca Canada, Boehringer Ingelheim Canada Ltd., GlaxoSmithKline Canada Ltd., Almirall, Merck Nycomed, Pfizer Canada Ltd., Theratechnologies, Canadian Respiratory Research Network, CIHR, and Respiratory Health Network of the FRQS, during the conduct of the study; nonfinancial support from Philips Respironics and VitalAire; and grants from ResMed Corp, Fisher & Paykel, CIHR, and Weston Brain Institute outside the submitted work. None declared (M. S., R. J., N. A., S. D. A., J. R., D. E. O.).

Publisher Copyright:
© 2019

ASJC Scopus Subject Areas

Pulmonary and Respiratory Medicine
Critical Care and Intensive Care Medicine
Cardiology and Cardiovascular Medicine

PubMed: MeSH publication types

Journal Article
Research Support, N.I.H., Extramural

Accès au document

10.1016/j.chest.2019.04.132

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Citer

@article{a62aeb812d38494b87e515a36723fd7b,

title = "Impaired Sleep Quality in COPD Is Associated With Exacerbations: The CanCOLD Cohort Study",

abstract = "Background: COPD increases susceptibility to sleep disturbances, which may in turn predispose to increased respiratory symptoms. The objective of this study was to evaluate, in a population-based sample, the relationship between subjective sleep quality and risk of COPD exacerbations. Methods: Data were obtained from the Canadian Cohort Obstructive Lung Disease (CanCOLD) study. Participants with COPD who had completed 18 months of follow-up were included. Sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI) and a three-factor analysis. Symptom-based (dyspnea or sputum change ≥ 48 h) and event-based (symptoms plus medication or unscheduled health services use) exacerbations were assessed. Association of PSQI with exacerbation rate was assessed by using negative binomial regression. Exacerbation-free survival was also assessed. Results: A total of 480 participants with COPD were studied, including 185 with one or more exacerbations during follow-up and 203 with poor baseline sleep quality (PSQI score > 5). Participants with subsequent symptom-based exacerbations had higher median baseline PSQI scores than those without (6.0 [interquartile range, 3.0-8.0] vs 5.0 [interquartile range, 2.0-7.0]; P = .01), and they were more likely to have baseline PSQI scores > 5 (50.3% vs 37.3%; P = .01). Higher PSQI scores were associated with increased symptom-based exacerbation risk (adjusted rate ratio, 1.09; 95% CI, 1.01-1.18; P = .02) and event-based exacerbation risk (adjusted rate ratio, 1.10; 95% CI, 1.00-1.21; P = .048). The association occurred mainly in those with undiagnosed COPD. Strongest associations were with Factor 3 (sleep disturbances and daytime dysfunction). Time to symptom-based exacerbation was shorter in participants with poor sleep quality (adjusted hazard ratio, 1.49; 95% CI, 1.09-2.03). Conclusions: Higher baseline PSQI scores were associated with increased risk of COPD exacerbation over 18 months{\textquoteright} prospective follow-up.",

author = "{Canadian Respiratory Research Network} and {CanCOLD Collaborative Research group} and Matthew Shorofsky and Jean Bourbeau and John Kimoff and Rachel Jen and Atul Malhotra and Najib Ayas and Tan, {Wan C.} and Aaron, {Shawn D.} and Sin, {Don D.} and Jeremy Road and Chapman, {Kenneth R.} and O'Donnell, {Denis E.} and Fran{\c c}ois Maltais and Paul Hernandez and Walker, {Brandie L.} and Darcy Marciniuk and Marta Kaminska and FitzGerald, {J. Mark} and Marciniuk, {D. D.} and O'Donnell, {D. E.} and Robert Cowie and Shawn Aaron and F. Maltais and Jonathon Samet and Milo Puhan and Qutayba Hamid and Hogg, {James C.} and Carole Baglole and Carole Jabet and Palmina Mancino and Yvan Fortier and Sheena Tam and Joe Comeau and Adrian Png and Harvey Coxson and Miranda Kirby and Jonathon Leipsic and Cameron Hague and Mohsen Sadatsafavi and Andrea Gershon and Li, {Pei Zhi} and Duquette, {Jean Francois} and Andrea Benedetti and Denis Jensen and Denis O'Donnell and Christine Lo and Sarah Cheng and Cindy Fung and Nancy Ferguson and Nancy Haynes",

note = "Funding Information: FUNDING/SUPPORT: The Canadian Cohort Obstructive Lung Disease (CanCOLD) study is currently funded by the Canadian Respiratory Research Network (CRRN); industry partners: Astra Zeneca Canada Ltd; Boehringer Ingelheim Canada Ltd; GlaxoSmithKline Canada Ltd; Novartis. Researchers at RI-MUHC Montreal and Icapture Centre Vancouver lead the project. Previous funding partners are the CIHR (CIHR/ Rx&D Collaborative Research Program Operating Grants- 93326); the Respiratory Health Network of the FRQS; industry partners: Almirall; Merck Nycomed; Pfizer Canada Ltd; and Theratechnologies. Funding Information: Author contributions: M. K. served as the guarantor and takes responsibility for the content of the manuscript, including the data and analysis. M. S. R. J. A. M. M. K. J. B. J. K. and N.A. designed the current study, including the objective and analysis methods. M. S. M. K. J. B. and J. K. interpreted data and participated in drafting of the manuscript. J. B. W. C. T. S. D. A. D. D. S. J. R. K. R. C. D. E. O. F. M. P. H. B. L. W. and D. M. participated in the design of the parent cohort, and coordination and supervision of data collection at their respective sites. Financial/nonfinancial disclosures: The authors have reported to CHEST the following: J. B. reports grants from the Canadian Institutes of Health Research (CIHR), Canadian Respiratory Research Network, GlaxoSmithKline, Grifols, Aerocrine, Boehringer Ingelheim, Foundation of the MUHC, Novartis, and AstraZeneca, during the conduct of the study; and personal fees from GlaxoSmithKline, Grifols, Boehringer Ingelheim, Novartis, AstraZeneca, and Trudell, outside the submitted work. J. K. reports grants from CIHR, the Canadian Respiratory Research Network, GlaxoSmithKline, Grifols, Aerocrine, Boehringer Ingelheim, Foundation of the MUHC, Novartis, and AstraZeneca, during the conduct of the study; and grants from the Multiple Sclerosis Society of Canada, Philips Respironics, ResMed, and Fonds de Recherche du Qu{\'e}bec-Sant{\'e}, outside the submitted work. A. M. is funded by the National Institutes of Health; does some work with the Alfred E. Mann Foundation, which is a nonprofit; and ResMed provided a philanthropic donation to UC San Diego. W. C. T. reports personal fees from Teva and GlaxoSmithKline, outside the submitted work. D. D. S. reports grants and personal fees from AstraZeneca and Boehringer Ingelheim, grants from Merck Frosst, and personal fees from Novartis, outside the submitted work. K. R. C. reports grants and personal fees from AstraZeneca, Boehringer Ingelheim, CSL Behring, Grifols, Sanofi, Genentech, Kamada, Roche, Novartis, and Merck; grants from Baxter, GlaxoSmithKline, and Amgen; and personal fees from the CIHR-GSK Research Chair in Respiratory Health Care Delivery, UHN, during the conduct of the study. F. M. reports grants from GlaxoSmithKline, Boehringer Ingelheim, Novartis, AstraZeneca, and Grifols; personal fees from Novartis, Boehringer Ingelheim, and Grifols; and personal fees from Boehringer Ingelheim and Novartis outside the submitted work. P. H. reports grants from CIHR, during the conduct of the study; personal fees from Actelion, AstraZeneca, Bayer, GlaxoSmithKline, Roche, Teva and Trudell, outside the submitted work; grants and personal fees from Boehringer Ingelheim, grants from CSL Behring, Grifols, and Prometic; and service as Secretary of Executive Committee of the Canadian Thoracic Society. B. L. W. reports grants from CIHR, AstraZeneca Canada Ltd, Boehringer Ingelheim Canada, GlaxoSmithKline Canada, and Novartis, during the conduct of the study; grants from Respiratory Health Strategic Clinical Network Alberta and personal fees from AstraZeneca, GlaxoSmithKline, and Novartis, outside the submitted work. D. M. reports grants from CIHR during the conduct of the study; grants from Boehringer-Ingelheim, GlaxoSmithKline, the Lung Association of Saskatchewan, Novartis, AstraZeneca, Canada Health Infoway, CIHR, Schering-Plough; and other from Canadian Foundation for Healthcare Improvement, AstraZeneca, Boehringer-Ingelheim, GlaxoSmithKline, Novartis, Saskatoon Health Region, Health Canada, University of Saskatchewan, outside the submitted work. M. K. reports grants from AstraZeneca Canada, Boehringer Ingelheim Canada Ltd. GlaxoSmithKline Canada Ltd. Almirall, Merck Nycomed, Pfizer Canada Ltd. Theratechnologies, Canadian Respiratory Research Network, CIHR, and Respiratory Health Network of the FRQS, during the conduct of the study; nonfinancial support from Philips Respironics and VitalAire; and grants from ResMed Corp, Fisher & Paykel, CIHR, and Weston Brain Institute outside the submitted work. None declared (M. S. R. J. N. A. S. D. A. J. R. D. E. O.). Role of sponsors: The funders had no role in the study design, data collection and analysis, or preparation of the manuscript. Other contributions: The authors thank the men and women who participated in the study and individuals in the CanCOLD Collaborative Research Group: Executive Committee: Jean Bourbeau, (Mcgill University, Montreal, QC, Canada); Wan C. Tan, J. Mark FitzGerald; D. D. Sin (UBC, Vancouver, BC, Canada); D. D. Marciniuk (University of Saskatoon, Saskatoon, SASK, Canada) D. E. O'Donnell (Queen's University, Kingston, ON, Canada); Paul Hernandez (University of Halifax, Halifax, NS, Canada); Kenneth R. Chapman (University of Toronto, Toronto, ON, Canada); Robert Cowie (University of Calgary, Calgary, AB, Canada); Shawn Aaron (University of Ottawa, Ottawa, ON, Canada); F. Maltais (University of Laval, Quebec City, QC, Canada); International Advisory Board: Jonathon Samet (the Keck School of Medicine of USC, CA); Milo Puhan (John Hopkins School of Public Health, Baltimore, MD); Qutayba Hamid (McGill University, Montreal, QC, Canada); James C. Hogg (UBC James Hogg Research Center, Vancouver, BC, Canada). Operations Center: Jean Bourbeau (PI), Carole Baglole, Carole Jabet, Palmina Mancino, Yvan Fortier, (University of McGill, Montreal, QC, Canada); Wan C. Tan (co-PI), Don Sin, Sheena Tam, Jeremy Road, Joe Comeau, Adrian Png, Harvey Coxson, Miranda Kirby, Jonathon Leipsic, Cameron Hague (University of British Columbia James Hogg Research Center, Vancouver, BC, Canada); Economic Core: Mohsen Sadatsafavi (University of British Columbia, Vancouver, BC, Canada); Public Health core: Teresa To, Andrea Gershon (University of Toronto, Toronto, ON, Canada); Data management and Quality Control: Wan C. Tan, Harvey Coxson (UBC, Vancouver, BC, Canada); Jean Bourbeau, Pei-Zhi Li, Jean-Francois Duquette, Yvan Fortier, Andrea Benedetti, Denis Jensen (Mcgill University, Montreal, QC, Canada), Denis O'Donnell (Queen's University, Kingston, ON, Canada; Field Centers: Wan C. Tan (PI), Christine Lo, Sarah Cheng, Cindy Fung, Nancy Ferguson, Nancy Haynes, Junior Chuang, Licong Li, Selva Bayat, Amanda Wong, Zoe Alavi, Catherine Peng, Bin Zhao, Nathalie Scott-Hsiung, Tasha Nadirshaw (UBC James Hogg Research Center, Vancouver, BC, Canada); Jean Bourbeau (PI), Palmina Mancino, David Latreille, Jacinthe Baril, Laura Labonte (McGill University, Montreal, QC, Canada); Kenneth Chapman (PI), Patricia McClean, Nadeen Audisho (University of Toronto, Toronto, ON, Canada); Brandie Walker, Robert Cowie (PI), Ann Cowie, Curtis Dumonceaux, Lisette Machado (University of Calgary, Calgary, AB, Canada); Paul Hernandez (PI), Scott Fulton, Kristen Osterling (University of Halifax, Halifax, NS, Canada); Shawn Aaron (PI), Kathy Vandemheen, Gay Pratt, Amanda Bergeron (University of Ottawa, Ottawa, ON, Canada); Denis O'Donnell (PI), Matthew McNeil, Kate Whelan (Queen's University, Kingston, ON, Canada); Francois Maltais (PI), Cynthia Brouillard (University of Laval, Quebec City, QC, Canada); Darcy Marciniuk (PI), Ron Clemens, Janet Baran (University of Saskatoon, Saskatoon, SK, Canada). The authors also thank Pei Zhi Li, MSc, for her expert data analysis. FUNDING/SUPPORT: The Canadian Cohort Obstructive Lung Disease (CanCOLD) study is currently funded by the Canadian Respiratory Research Network (CRRN); industry partners: Astra Zeneca Canada Ltd; Boehringer Ingelheim Canada Ltd; GlaxoSmithKline Canada Ltd; Novartis. Researchers at RI-MUHC Montreal and Icapture Centre Vancouver lead the project. Previous funding partners are the CIHR (CIHR/ Rx&D Collaborative Research Program Operating Grants- 93326); the Respiratory Health Network of the FRQS; industry partners: Almirall; Merck Nycomed; Pfizer Canada Ltd; and Theratechnologies. Funding Information: Financial/nonfinancial disclosures: The authors have reported to CHEST the following: J. B. reports grants from the Canadian Institutes of Health Research (CIHR), Canadian Respiratory Research Network, GlaxoSmithKline, Grifols, Aerocrine, Boehringer Ingelheim, Foundation of the MUHC, Novartis, and AstraZeneca, during the conduct of the study; and personal fees from GlaxoSmithKline, Grifols, Boehringer Ingelheim, Novartis, AstraZeneca, and Trudell, outside the submitted work. J. K. reports grants from CIHR, the Canadian Respiratory Research Network, GlaxoSmithKline, Grifols, Aerocrine, Boehringer Ingelheim, Foundation of the MUHC, Novartis, and AstraZeneca, during the conduct of the study; and grants from the Multiple Sclerosis Society of Canada, Philips Respironics, ResMed, and Fonds de Recherche du Qu{\'e}bec-Sant{\'e}, outside the submitted work. A. M. is funded by the National Institutes of Health; does some work with the Alfred E. Mann Foundation, which is a nonprofit; and ResMed provided a philanthropic donation to UC San Diego. W. C. T. reports personal fees from Teva and GlaxoSmithKline, outside the submitted work. D. D. S. reports grants and personal fees from AstraZeneca and Boehringer Ingelheim, grants from Merck Frosst, and personal fees from Novartis, outside the submitted work. K. R. C. reports grants and personal fees from AstraZeneca, Boehringer Ingelheim, CSL Behring, Grifols, Sanofi, Genentech, Kamada, Roche, Novartis, and Merck; grants from Baxter, GlaxoSmithKline, and Amgen; and personal fees from the CIHR-GSK Research Chair in Respiratory Health Care Delivery, UHN, during the conduct of the study. F. M. reports grants from GlaxoSmithKline, Boehringer Ingelheim, Novartis, AstraZeneca, and Grifols; personal fees from Novartis, Boehringer Ingelheim, and Grifols; and personal fees from Boehringer Ingelheim and Novartis outside the submitted work. P. H. reports grants from CIHR, during the conduct of the study; personal fees from Actelion, AstraZeneca, Bayer, GlaxoSmithKline, Roche, Teva and Trudell, outside the submitted work; grants and personal fees from Boehringer Ingelheim, grants from CSL Behring, Grifols, and Prometic; and service as Secretary of Executive Committee of the Canadian Thoracic Society. B. L. W. reports grants from CIHR, AstraZeneca Canada Ltd, Boehringer Ingelheim Canada, GlaxoSmithKline Canada, and Novartis, during the conduct of the study; grants from Respiratory Health Strategic Clinical Network Alberta and personal fees from AstraZeneca, GlaxoSmithKline, and Novartis, outside the submitted work. D. M. reports grants from CIHR during the conduct of the study; grants from Boehringer-Ingelheim, GlaxoSmithKline, the Lung Association of Saskatchewan, Novartis, AstraZeneca, Canada Health Infoway, CIHR, Schering-Plough; and other from Canadian Foundation for Healthcare Improvement, AstraZeneca, Boehringer-Ingelheim, GlaxoSmithKline, Novartis, Saskatoon Health Region, Health Canada, University of Saskatchewan, outside the submitted work. M. K. reports grants from AstraZeneca Canada, Boehringer Ingelheim Canada Ltd., GlaxoSmithKline Canada Ltd., Almirall, Merck Nycomed, Pfizer Canada Ltd., Theratechnologies, Canadian Respiratory Research Network, CIHR, and Respiratory Health Network of the FRQS, during the conduct of the study; nonfinancial support from Philips Respironics and VitalAire; and grants from ResMed Corp, Fisher & Paykel, CIHR, and Weston Brain Institute outside the submitted work. None declared (M. S., R. J., N. A., S. D. A., J. R., D. E. O.). Publisher Copyright: {\textcopyright} 2019",

year = "2019",

month = nov,

doi = "10.1016/j.chest.2019.04.132",

language = "English",

volume = "156",

pages = "852--863",

journal = "Chest",

issn = "0012-3692",

publisher = "American College of Chest Physicians",

number = "5",

}

TY - JOUR

T1 - Impaired Sleep Quality in COPD Is Associated With Exacerbations

T2 - The CanCOLD Cohort Study

AU - Canadian Respiratory Research Network

AU - CanCOLD Collaborative Research group

AU - Shorofsky, Matthew

AU - Bourbeau, Jean

AU - Kimoff, John

AU - Jen, Rachel

AU - Malhotra, Atul

AU - Ayas, Najib

AU - Tan, Wan C.

AU - Aaron, Shawn D.

AU - Sin, Don D.

AU - Road, Jeremy

AU - Chapman, Kenneth R.

AU - O'Donnell, Denis E.

AU - Maltais, François

AU - Hernandez, Paul

AU - Walker, Brandie L.

AU - Marciniuk, Darcy

AU - Kaminska, Marta

AU - FitzGerald, J. Mark

AU - Marciniuk, D. D.

AU - O'Donnell, D. E.

AU - Cowie, Robert

AU - Aaron, Shawn

AU - Maltais, F.

AU - Samet, Jonathon

AU - Puhan, Milo

AU - Hamid, Qutayba

AU - Hogg, James C.

AU - Baglole, Carole

AU - Jabet, Carole

AU - Mancino, Palmina

AU - Fortier, Yvan

AU - Tam, Sheena

AU - Comeau, Joe

AU - Png, Adrian

AU - Coxson, Harvey

AU - Kirby, Miranda

AU - Leipsic, Jonathon

AU - Hague, Cameron

AU - Sadatsafavi, Mohsen

AU - Gershon, Andrea

AU - Li, Pei Zhi

AU - Duquette, Jean Francois

AU - Benedetti, Andrea

AU - Jensen, Denis

AU - O'Donnell, Denis

AU - Lo, Christine

AU - Cheng, Sarah

AU - Fung, Cindy

AU - Ferguson, Nancy

AU - Haynes, Nancy

N1 - Funding Information: FUNDING/SUPPORT: The Canadian Cohort Obstructive Lung Disease (CanCOLD) study is currently funded by the Canadian Respiratory Research Network (CRRN); industry partners: Astra Zeneca Canada Ltd; Boehringer Ingelheim Canada Ltd; GlaxoSmithKline Canada Ltd; Novartis. Researchers at RI-MUHC Montreal and Icapture Centre Vancouver lead the project. Previous funding partners are the CIHR (CIHR/ Rx&D Collaborative Research Program Operating Grants- 93326); the Respiratory Health Network of the FRQS; industry partners: Almirall; Merck Nycomed; Pfizer Canada Ltd; and Theratechnologies. Funding Information: Author contributions: M. K. served as the guarantor and takes responsibility for the content of the manuscript, including the data and analysis. M. S. R. J. A. M. M. K. J. B. J. K. and N.A. designed the current study, including the objective and analysis methods. M. S. M. K. J. B. and J. K. interpreted data and participated in drafting of the manuscript. J. B. W. C. T. S. D. A. D. D. S. J. R. K. R. C. D. E. O. F. M. P. H. B. L. W. and D. M. participated in the design of the parent cohort, and coordination and supervision of data collection at their respective sites. Financial/nonfinancial disclosures: The authors have reported to CHEST the following: J. B. reports grants from the Canadian Institutes of Health Research (CIHR), Canadian Respiratory Research Network, GlaxoSmithKline, Grifols, Aerocrine, Boehringer Ingelheim, Foundation of the MUHC, Novartis, and AstraZeneca, during the conduct of the study; and personal fees from GlaxoSmithKline, Grifols, Boehringer Ingelheim, Novartis, AstraZeneca, and Trudell, outside the submitted work. J. K. reports grants from CIHR, the Canadian Respiratory Research Network, GlaxoSmithKline, Grifols, Aerocrine, Boehringer Ingelheim, Foundation of the MUHC, Novartis, and AstraZeneca, during the conduct of the study; and grants from the Multiple Sclerosis Society of Canada, Philips Respironics, ResMed, and Fonds de Recherche du Québec-Santé, outside the submitted work. A. M. is funded by the National Institutes of Health; does some work with the Alfred E. Mann Foundation, which is a nonprofit; and ResMed provided a philanthropic donation to UC San Diego. W. C. T. reports personal fees from Teva and GlaxoSmithKline, outside the submitted work. D. D. S. reports grants and personal fees from AstraZeneca and Boehringer Ingelheim, grants from Merck Frosst, and personal fees from Novartis, outside the submitted work. K. R. C. reports grants and personal fees from AstraZeneca, Boehringer Ingelheim, CSL Behring, Grifols, Sanofi, Genentech, Kamada, Roche, Novartis, and Merck; grants from Baxter, GlaxoSmithKline, and Amgen; and personal fees from the CIHR-GSK Research Chair in Respiratory Health Care Delivery, UHN, during the conduct of the study. F. M. reports grants from GlaxoSmithKline, Boehringer Ingelheim, Novartis, AstraZeneca, and Grifols; personal fees from Novartis, Boehringer Ingelheim, and Grifols; and personal fees from Boehringer Ingelheim and Novartis outside the submitted work. P. H. reports grants from CIHR, during the conduct of the study; personal fees from Actelion, AstraZeneca, Bayer, GlaxoSmithKline, Roche, Teva and Trudell, outside the submitted work; grants and personal fees from Boehringer Ingelheim, grants from CSL Behring, Grifols, and Prometic; and service as Secretary of Executive Committee of the Canadian Thoracic Society. B. L. W. reports grants from CIHR, AstraZeneca Canada Ltd, Boehringer Ingelheim Canada, GlaxoSmithKline Canada, and Novartis, during the conduct of the study; grants from Respiratory Health Strategic Clinical Network Alberta and personal fees from AstraZeneca, GlaxoSmithKline, and Novartis, outside the submitted work. D. M. reports grants from CIHR during the conduct of the study; grants from Boehringer-Ingelheim, GlaxoSmithKline, the Lung Association of Saskatchewan, Novartis, AstraZeneca, Canada Health Infoway, CIHR, Schering-Plough; and other from Canadian Foundation for Healthcare Improvement, AstraZeneca, Boehringer-Ingelheim, GlaxoSmithKline, Novartis, Saskatoon Health Region, Health Canada, University of Saskatchewan, outside the submitted work. M. K. reports grants from AstraZeneca Canada, Boehringer Ingelheim Canada Ltd. GlaxoSmithKline Canada Ltd. Almirall, Merck Nycomed, Pfizer Canada Ltd. Theratechnologies, Canadian Respiratory Research Network, CIHR, and Respiratory Health Network of the FRQS, during the conduct of the study; nonfinancial support from Philips Respironics and VitalAire; and grants from ResMed Corp, Fisher & Paykel, CIHR, and Weston Brain Institute outside the submitted work. None declared (M. S. R. J. N. A. S. D. A. J. R. D. E. O.). Role of sponsors: The funders had no role in the study design, data collection and analysis, or preparation of the manuscript. Other contributions: The authors thank the men and women who participated in the study and individuals in the CanCOLD Collaborative Research Group: Executive Committee: Jean Bourbeau, (Mcgill University, Montreal, QC, Canada); Wan C. Tan, J. Mark FitzGerald; D. D. Sin (UBC, Vancouver, BC, Canada); D. D. Marciniuk (University of Saskatoon, Saskatoon, SASK, Canada) D. E. O'Donnell (Queen's University, Kingston, ON, Canada); Paul Hernandez (University of Halifax, Halifax, NS, Canada); Kenneth R. Chapman (University of Toronto, Toronto, ON, Canada); Robert Cowie (University of Calgary, Calgary, AB, Canada); Shawn Aaron (University of Ottawa, Ottawa, ON, Canada); F. Maltais (University of Laval, Quebec City, QC, Canada); International Advisory Board: Jonathon Samet (the Keck School of Medicine of USC, CA); Milo Puhan (John Hopkins School of Public Health, Baltimore, MD); Qutayba Hamid (McGill University, Montreal, QC, Canada); James C. Hogg (UBC James Hogg Research Center, Vancouver, BC, Canada). Operations Center: Jean Bourbeau (PI), Carole Baglole, Carole Jabet, Palmina Mancino, Yvan Fortier, (University of McGill, Montreal, QC, Canada); Wan C. Tan (co-PI), Don Sin, Sheena Tam, Jeremy Road, Joe Comeau, Adrian Png, Harvey Coxson, Miranda Kirby, Jonathon Leipsic, Cameron Hague (University of British Columbia James Hogg Research Center, Vancouver, BC, Canada); Economic Core: Mohsen Sadatsafavi (University of British Columbia, Vancouver, BC, Canada); Public Health core: Teresa To, Andrea Gershon (University of Toronto, Toronto, ON, Canada); Data management and Quality Control: Wan C. Tan, Harvey Coxson (UBC, Vancouver, BC, Canada); Jean Bourbeau, Pei-Zhi Li, Jean-Francois Duquette, Yvan Fortier, Andrea Benedetti, Denis Jensen (Mcgill University, Montreal, QC, Canada), Denis O'Donnell (Queen's University, Kingston, ON, Canada; Field Centers: Wan C. Tan (PI), Christine Lo, Sarah Cheng, Cindy Fung, Nancy Ferguson, Nancy Haynes, Junior Chuang, Licong Li, Selva Bayat, Amanda Wong, Zoe Alavi, Catherine Peng, Bin Zhao, Nathalie Scott-Hsiung, Tasha Nadirshaw (UBC James Hogg Research Center, Vancouver, BC, Canada); Jean Bourbeau (PI), Palmina Mancino, David Latreille, Jacinthe Baril, Laura Labonte (McGill University, Montreal, QC, Canada); Kenneth Chapman (PI), Patricia McClean, Nadeen Audisho (University of Toronto, Toronto, ON, Canada); Brandie Walker, Robert Cowie (PI), Ann Cowie, Curtis Dumonceaux, Lisette Machado (University of Calgary, Calgary, AB, Canada); Paul Hernandez (PI), Scott Fulton, Kristen Osterling (University of Halifax, Halifax, NS, Canada); Shawn Aaron (PI), Kathy Vandemheen, Gay Pratt, Amanda Bergeron (University of Ottawa, Ottawa, ON, Canada); Denis O'Donnell (PI), Matthew McNeil, Kate Whelan (Queen's University, Kingston, ON, Canada); Francois Maltais (PI), Cynthia Brouillard (University of Laval, Quebec City, QC, Canada); Darcy Marciniuk (PI), Ron Clemens, Janet Baran (University of Saskatoon, Saskatoon, SK, Canada). The authors also thank Pei Zhi Li, MSc, for her expert data analysis. FUNDING/SUPPORT: The Canadian Cohort Obstructive Lung Disease (CanCOLD) study is currently funded by the Canadian Respiratory Research Network (CRRN); industry partners: Astra Zeneca Canada Ltd; Boehringer Ingelheim Canada Ltd; GlaxoSmithKline Canada Ltd; Novartis. Researchers at RI-MUHC Montreal and Icapture Centre Vancouver lead the project. Previous funding partners are the CIHR (CIHR/ Rx&D Collaborative Research Program Operating Grants- 93326); the Respiratory Health Network of the FRQS; industry partners: Almirall; Merck Nycomed; Pfizer Canada Ltd; and Theratechnologies. Funding Information: Financial/nonfinancial disclosures: The authors have reported to CHEST the following: J. B. reports grants from the Canadian Institutes of Health Research (CIHR), Canadian Respiratory Research Network, GlaxoSmithKline, Grifols, Aerocrine, Boehringer Ingelheim, Foundation of the MUHC, Novartis, and AstraZeneca, during the conduct of the study; and personal fees from GlaxoSmithKline, Grifols, Boehringer Ingelheim, Novartis, AstraZeneca, and Trudell, outside the submitted work. J. K. reports grants from CIHR, the Canadian Respiratory Research Network, GlaxoSmithKline, Grifols, Aerocrine, Boehringer Ingelheim, Foundation of the MUHC, Novartis, and AstraZeneca, during the conduct of the study; and grants from the Multiple Sclerosis Society of Canada, Philips Respironics, ResMed, and Fonds de Recherche du Québec-Santé, outside the submitted work. A. M. is funded by the National Institutes of Health; does some work with the Alfred E. Mann Foundation, which is a nonprofit; and ResMed provided a philanthropic donation to UC San Diego. W. C. T. reports personal fees from Teva and GlaxoSmithKline, outside the submitted work. D. D. S. reports grants and personal fees from AstraZeneca and Boehringer Ingelheim, grants from Merck Frosst, and personal fees from Novartis, outside the submitted work. K. R. C. reports grants and personal fees from AstraZeneca, Boehringer Ingelheim, CSL Behring, Grifols, Sanofi, Genentech, Kamada, Roche, Novartis, and Merck; grants from Baxter, GlaxoSmithKline, and Amgen; and personal fees from the CIHR-GSK Research Chair in Respiratory Health Care Delivery, UHN, during the conduct of the study. F. M. reports grants from GlaxoSmithKline, Boehringer Ingelheim, Novartis, AstraZeneca, and Grifols; personal fees from Novartis, Boehringer Ingelheim, and Grifols; and personal fees from Boehringer Ingelheim and Novartis outside the submitted work. P. H. reports grants from CIHR, during the conduct of the study; personal fees from Actelion, AstraZeneca, Bayer, GlaxoSmithKline, Roche, Teva and Trudell, outside the submitted work; grants and personal fees from Boehringer Ingelheim, grants from CSL Behring, Grifols, and Prometic; and service as Secretary of Executive Committee of the Canadian Thoracic Society. B. L. W. reports grants from CIHR, AstraZeneca Canada Ltd, Boehringer Ingelheim Canada, GlaxoSmithKline Canada, and Novartis, during the conduct of the study; grants from Respiratory Health Strategic Clinical Network Alberta and personal fees from AstraZeneca, GlaxoSmithKline, and Novartis, outside the submitted work. D. M. reports grants from CIHR during the conduct of the study; grants from Boehringer-Ingelheim, GlaxoSmithKline, the Lung Association of Saskatchewan, Novartis, AstraZeneca, Canada Health Infoway, CIHR, Schering-Plough; and other from Canadian Foundation for Healthcare Improvement, AstraZeneca, Boehringer-Ingelheim, GlaxoSmithKline, Novartis, Saskatoon Health Region, Health Canada, University of Saskatchewan, outside the submitted work. M. K. reports grants from AstraZeneca Canada, Boehringer Ingelheim Canada Ltd., GlaxoSmithKline Canada Ltd., Almirall, Merck Nycomed, Pfizer Canada Ltd., Theratechnologies, Canadian Respiratory Research Network, CIHR, and Respiratory Health Network of the FRQS, during the conduct of the study; nonfinancial support from Philips Respironics and VitalAire; and grants from ResMed Corp, Fisher & Paykel, CIHR, and Weston Brain Institute outside the submitted work. None declared (M. S., R. J., N. A., S. D. A., J. R., D. E. O.). Publisher Copyright: © 2019

PY - 2019/11

Y1 - 2019/11

N2 - Background: COPD increases susceptibility to sleep disturbances, which may in turn predispose to increased respiratory symptoms. The objective of this study was to evaluate, in a population-based sample, the relationship between subjective sleep quality and risk of COPD exacerbations. Methods: Data were obtained from the Canadian Cohort Obstructive Lung Disease (CanCOLD) study. Participants with COPD who had completed 18 months of follow-up were included. Sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI) and a three-factor analysis. Symptom-based (dyspnea or sputum change ≥ 48 h) and event-based (symptoms plus medication or unscheduled health services use) exacerbations were assessed. Association of PSQI with exacerbation rate was assessed by using negative binomial regression. Exacerbation-free survival was also assessed. Results: A total of 480 participants with COPD were studied, including 185 with one or more exacerbations during follow-up and 203 with poor baseline sleep quality (PSQI score > 5). Participants with subsequent symptom-based exacerbations had higher median baseline PSQI scores than those without (6.0 [interquartile range, 3.0-8.0] vs 5.0 [interquartile range, 2.0-7.0]; P = .01), and they were more likely to have baseline PSQI scores > 5 (50.3% vs 37.3%; P = .01). Higher PSQI scores were associated with increased symptom-based exacerbation risk (adjusted rate ratio, 1.09; 95% CI, 1.01-1.18; P = .02) and event-based exacerbation risk (adjusted rate ratio, 1.10; 95% CI, 1.00-1.21; P = .048). The association occurred mainly in those with undiagnosed COPD. Strongest associations were with Factor 3 (sleep disturbances and daytime dysfunction). Time to symptom-based exacerbation was shorter in participants with poor sleep quality (adjusted hazard ratio, 1.49; 95% CI, 1.09-2.03). Conclusions: Higher baseline PSQI scores were associated with increased risk of COPD exacerbation over 18 months’ prospective follow-up.

AB - Background: COPD increases susceptibility to sleep disturbances, which may in turn predispose to increased respiratory symptoms. The objective of this study was to evaluate, in a population-based sample, the relationship between subjective sleep quality and risk of COPD exacerbations. Methods: Data were obtained from the Canadian Cohort Obstructive Lung Disease (CanCOLD) study. Participants with COPD who had completed 18 months of follow-up were included. Sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI) and a three-factor analysis. Symptom-based (dyspnea or sputum change ≥ 48 h) and event-based (symptoms plus medication or unscheduled health services use) exacerbations were assessed. Association of PSQI with exacerbation rate was assessed by using negative binomial regression. Exacerbation-free survival was also assessed. Results: A total of 480 participants with COPD were studied, including 185 with one or more exacerbations during follow-up and 203 with poor baseline sleep quality (PSQI score > 5). Participants with subsequent symptom-based exacerbations had higher median baseline PSQI scores than those without (6.0 [interquartile range, 3.0-8.0] vs 5.0 [interquartile range, 2.0-7.0]; P = .01), and they were more likely to have baseline PSQI scores > 5 (50.3% vs 37.3%; P = .01). Higher PSQI scores were associated with increased symptom-based exacerbation risk (adjusted rate ratio, 1.09; 95% CI, 1.01-1.18; P = .02) and event-based exacerbation risk (adjusted rate ratio, 1.10; 95% CI, 1.00-1.21; P = .048). The association occurred mainly in those with undiagnosed COPD. Strongest associations were with Factor 3 (sleep disturbances and daytime dysfunction). Time to symptom-based exacerbation was shorter in participants with poor sleep quality (adjusted hazard ratio, 1.49; 95% CI, 1.09-2.03). Conclusions: Higher baseline PSQI scores were associated with increased risk of COPD exacerbation over 18 months’ prospective follow-up.

UR - http://www.scopus.com/inward/record.url?scp=85071726261&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85071726261&partnerID=8YFLogxK

U2 - 10.1016/j.chest.2019.04.132

DO - 10.1016/j.chest.2019.04.132

M3 - Article

C2 - 31150638

AN - SCOPUS:85071726261

SN - 0012-3692

VL - 156

SP - 852

EP - 863

JO - Chest

JF - Chest

IS - 5

ER -

Impaired Sleep Quality in COPD Is Associated With Exacerbations: The CanCOLD Cohort Study

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