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Multimorbidity in COPD, does sleep matter?

  • Lowie EGW Vanfleteren
    Affiliations
    COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden

    COPD Center, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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  • Bianca Beghe
    Affiliations
    Section of Respiratory Diseases, Department of Medicine, University of Modena and Reggio Emilia, Modena, Italy
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  • Anders Andersson
    Affiliations
    COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden

    COPD Center, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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  • Daniel Hansson
    Affiliations
    Sleep Disorders Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden

    Center for Sleep and Wake Disorders, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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  • Leonardo M Fabbri
    Correspondence
    Corresponding author. Viale Verdi 59, 41121 Modena, Italy.
    Affiliations
    COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden

    Eminent Scholar, Department of Medicine, University of Ferrara, Italy
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  • Ludger Grote
    Affiliations
    Sleep Disorders Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden

    Center for Sleep and Wake Disorders, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Published:January 21, 2020DOI:https://doi.org/10.1016/j.ejim.2019.12.032

      Highlights

      • Patients with COPD commonly have comorbid conditions, including sleep disorders.
      • Most frequent sleep disorders in COPD include sleep disordered breathing, insomnia and restless legs.
      • The coexistence of sleep disorders and COPD impacts a range of clinical outcomes.
      • Sleep disorders should be actively diagnosed and treated in patients with COPD.

      Abstract

      A good night's sleep is a prerequisite for sustainable mental and physical health. Sleep disorders, including sleep disordered breathing, insomnia and sleep related motor dysfunction (e.g., restless legs syndrome), are common in patients with chronic obstructive pulmonary disease (COPD), especially in more severe disease. COPD is commonly associated with multimorbidity, and sleep disorders as a component of this multimorbidity spectrum have a further negative impact on COPD-related comorbidities. Indeed, concomitant diseases in COPD and in obstructive sleep apnea (OSA) are similar, suggesting that the combination of COPD and OSA, the so called OSA-COPD overlap syndrome (OVS), affects patient outcomes. Potential clinically important interactions of OVS exist in cardiovascular and metabolic disease, arthritis, anxiety, depression, neurocognitive disorder and the fatigue syndrome. Correct diagnosis for recognition and treatment of sleep-related disorders in COPD is recommended. However, surprisingly limited information is available and further research and improved diagnostic tools are needed. In the absence of clear evidence, we agree with the recommendation of the Global Initiative on Chronic Obstructive Lung Disease that sleep disorders should be actively searched for and treated in patients with COPD. We believe that both aspects are important components of the holistic approach required in patients with chronic multimorbid conditions.

      Keywords

      Abbreviations:

      AHI (Apnea-Hypopnea Index), APAP (auto-adjusting continuous positive airway pressure), ATS (American Thoracic Society), BPAP (BiLevel positive airway pressure), CBTi (cognitive behavioral therapy for insomnia), COPD (chronic obstructive pulmonary disease), CPAP fixed pressure (continuous positive airway pressure), CSA (central sleep apnea), EDS (excessive daytime sleepiness), ERS (European Respiratory Society), ESRS (European Sleep Research Society), ESS (Epworth Sleepiness Scale), HSAT (home sleep apnea test), LTOT (long term oxygen therapy), NHF (nasal high flow treatment), NICE (National Institute for Health and Care Excellence), NIM (neck inspiratory muscle), NIV (non-invasive ventilation), OSA (obstructive sleep apnea), OVS (OSA-COPD overlap syndrome), PAP (positive airway pressure), PSG (polysomnography), RCT (randomized controlled trial), REM (rapid eye movement), RERA (respiratory effort related arousal), RLS (restless legs syndrome), SDB (sleep disordered breathing)
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