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Sleep quality and physical activity

Analysis of nocturnal actigraphic sleep measures in patients with COPD and their association with daytime physical activity.

Spina G et al. - Thorax 2017

  • Sleep disturbances are common in COPD patients. However, despite the high prevalence of disturbed sleep in COPD, night-time symptoms are often underestimated and not a focus in current disease management.
  • Factors associated with measures of sleep in daily life or the association between sleep and the ability to engage in physical activity have not been investigated before. 
  • This study aims to provide insights into the relationship between actigraphic sleep measures and disease severity, dyspnoea, gender and parts of the week; and to investigate the association between sleep measures and next day physical activity.
  • In this retrospective, cross-sectional study, data from previous studies were obtained from research groups in 10 countries: Europe (the Netherlands, the UK, Switzerland, Germany, Italy, Ireland and Spain), North America, South America and Oceania.
  • Inclusion criteria were stable COPD, post-bronchodilator ratio FEV1 to FVC <0.70; no COPD exacerbations in the last 30 days; and availability of sleep and daytime physical activity data.  Data from 1.384 patients were available. In total 932 COPD patients were eligible for analysis.
  • Participants had sleep and physical activity continuously monitored using a multisensory activity monitor for a median of 6 days.

Sleep measures evaluation in patients with COPD

  • Patients with the most severe airflow limitation and exertional dyspnoea had significantly more fragmented sleep than patients with the lowest GOLD grade (p<0.01) and mMRC score (p<0.05).
  • Patients with the most severe airflow limitation had significantly shorter sleeping bouts (p<0.05) and lower sleep efficiency (p<0.01) than patients classified as GOLD 3.
  • Patients reporting the highest mMRC score had significantly shorter sleeping bouts (p<0.05) and lower sleep efficiency (p<0.01) compared with patients with lower mMRC scores.
  • The time spent awake after the first sleep onset increased both with disease severity and dyspnoea, being worst in patients with GOLD grade 4 (p<0.05) and mMRC score 4 (p<0.01).

Association between objective sleep measures and daytime physical activity

  • The number of steps performed during the day was inversely related to the number of sleeping bouts and the minutes spent awake after the sleep onset.
  • Patients who had their sleep characterised by 1 sleeping bout, long sleeping bouts (≥225min), high sleep efficiency (≥91%) and low time spent awake after the sleep onset (<57min) performed 600 steps more on the following day versus patients who had more
    fragmented sleep (≥4 bouts), lower sleep efficiency (<71%), lower sleeping bout durations (<86min) and higher time spent awake after the sleep onset (≥165min) (p<0.001 for all).
  • Patients with the smallest number of sleeping bouts per night, longest sleeping bouts, highest sleep efficiency and shortest time awake during the night spent more time in light and moderate-to-vigorous physical activities on the following day (p<0.01 for all).
  • Sleep impairment in COPD patients tends to be more pronounced in patients with severe airflow limitation and with worse exertional dyspnoea. Moreover, nocturnal sleep impairment appears to be an important factor associated with the capability to engage in physical activity on a day-to-day basis.
  • The fact that poor sleep quality was associated with reduced physical activity levels may have important consequences with regard to current clinical practice.

Spina et al., Thorax. 2017; 0: 1-8. doi: 10.1136/thoraxjnl-2016-208900

NS Approval ID 1033337 Revision Date 02/2017