Sleep Quality And Related Factors In Patients With High-risk Acute Exacerbation Of Chronic Obstructive Pulmonary Disease

Objective: To investigate the subjective and objective sleep quality and its influencing factors in patients with with high-risk acute exacerbation of chronic obstructive pulmonary disease(COPD).Methods: From October 1th,2017 to October 28 th,2018,patients with COPD hospitalized in the Department of Respiratory Medicine of our hospital were screened out for acute exacerbation ? 2 times a year or ? 1 time due to acute exacerbation and meeting the inclusion and exclusion criteria.All patients underwent overnight sleep monitoring within 1 day before being discharged.the clinical characters and spirometry results,Epworth Sleepiness Score(ESS),Pittsburgh Sleep Quality Index(PSQI),UK Medical Research Council Dyspnea Scale(mMRC),Copd Asessment Test(CAT)results were recorded.PSQI score > 5 was defined as decreased sleep quality.According to the results of sleep monitoring,the patients were divided into simple chronic obstructive pulmonary disease group(n = 12)and overlap syndrome group(n = 14).Twenty-seven patients were selected for sleep room examination in our hospital.according to the results of sleep monitoring,they were divided into control group(n = 13)and OSAHS group(n = 14).The subjective and objective sleep parameters of the four groups were compared and the correlation analysis was carried out.Results: Sleep quality decreased in 23 of 26 patients with high-risk acute exacerbation of COPD.The total score of PSQI,the score of ESS,the number of awakening and wake time after sleep onset were significantly increased in patients with high-risk acute exacerbation of copd,but the total sleep time(TST)and objective sleep efficiency were significantly lower than those in the control group.The total score of PSQI,objective sleep latency and awakening times in patients with overlap syndrome were significantly higher than those in OSAHS group(P < 0.05),and compared with those in patients with high-risk acute exacerbation of copd alone,the total score,objective sleep latency and awakening times in patients with overlap syndrome were significantly higher than those in patients with COPD alone.Slow wave sleep(SWS)was significantly decreased in patients with overlap syndrome(P < 0.05).The results of correlation analysis showed that the times of acute exacerbation in the past year,dyspnea index and ESS score were positively correlated with the total score of PSQI,and the wake time after sleep onset was positively correlated with the scores of CAT and mMRC.The percentage of REM sleep to TST was positively correlated with FEF25-75% and PEF%,while the percentage of SWS to TST was negatively correlated with AHI.Conclusion: The subjective and objective sleep quality of patients with igh-risk acute exacerbation of copd was poor.The sleep quality of patients with overlap syndrome was worse than that of patients with a single disease.PSQI was correlated with the number of acute exacerbation,dyspnea index and ESS score in the past year.the objective sleep parameters were correlated with the degree of airflow obstruction,CAT score and mMRC score.