The impact of sleep disorders on the therapeutic effects of different inhaled medications in patients with chronic obstructive pulmonary disease
Objective To explore the impact of sleep disorders on the therapeutic effects of different inhaled medications in patients with chronic obstructive pulmonary disease(COPD).Methods A prospective observational study was conducted on 393 patients with stable COPD who visited the Department of Respiratory and Critical Care Medicine,the Second Xiangya Hospital,Central South University from December 2020 to September 2021.The Pittsburgh Sleep Quality Index(PSQI)was used to evaluate the sleep quality of patients with chronic obstructive pulmonary disease,and patients were divided into a non sleep disorder group and a sleep disorder group.The Berlin questionnaire was used to assess the risk of obstructive sleep apnea syndrome(OSAS)in patients,and the hospital anxiety and depression questionnaire(HADS)was used to assess the presence of anxiety and depression in patients.The improvement of symptoms[minimum clinically significant difference(MCID)]and the deterioration of symptoms[clinical significant symptom deterioration(CID)]within six months of patient follow-up were evaluated.The moderate to severe acute exacerbation of the patient was recorded during the one-year follow-up period.The clinical characteristics of two groups of patients were compared,and multiple regression analysis was used to evaluate the relationship between sleep quality and the prognosis of chronic obstructive pulmonary disease,as well as the impact of sleep disorders on the treatment efficacy of different inhaled drugs.Results The average age of 393 patients with chronic obstructive pulmonary disease was(62.9±8.3)years old,with a median percentage of forced expiratory volume in the first second(FEV1％)of 53.7％(30.7％)and a mean PSQI score of(5.7±3.4)points.186 cases(47.3％)of patients had sleep disorders.Compared with patients in the non sleep disorder group,patients in the sleep disorder group had a higher proportion of middle school education and below,lower FEV1 and FEV1/forced vital capacity(FVC),higher baseline COPD Assessment Test(CAT),modified Medical Research Council(mMRC)and Clinical COPD Questionnaire(CCQ)scores,and a higher proportion of comorbid anxiety(all P＜0.05).Compared with patients without sleep disorders,patients with sleep disorders had a lower incidence of MCID(P=0.030)and a higher incidence of CID(P=0.005).During the one-year follow-up period,patients with sleep disorders experienced a higher proportion of moderate to severe acute exacerbation(P=0.001),severe acute exacerbation(P=0.003),and frequent acute exacerbation(P=0.009).The results of multiple regression analysis showed that patients with sleep disorders had a lower likelihood of developing MCID(OR:0.288,95％CI:0.145-0.379,P＜0.001),and an increased risk of developing CID(OR:3.150,95％CI:2.011-4.388,P＜0.001)and acute exacerbation(OR:1.659,95％CI:1.162-2.368,P=0.005).Compared with patients using long-acting muscarinic antagonist(LAMA)or inhaled corticosteroids(ICS)+long-acting β2-agonist(LABA),patients in the sleep disorder group who used LABA+LABA were more likely to develop MCID(OR:1.420,95％CI:1.021-2.751,P=0.010;OR:1.976,95％CI:1.123-2.227,P=0.023).Conclusions Compared with patients without sleep disorders,COPD patients with sleep disorders have a lower likelihood of symptom improvement,and a higher risk of symptom deterioration and acute exacerbation.Patients with COPD with sleep disorders are more likely to achieve symptom improvement by using LABA+LAMA.
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