title: Sleep quality, daytime sleepiness and fasting insulin levels in women with chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  To test the clinical observations that patients with chronic obstructive pulmonary disease (COPD) have impaired sleep quality without excessive daytime sleepiness (EDS), and to analyse the aetiological factors.
  
  
  METHODS
  Fifteen non-diabetic postmenopausal women with moderate to severe COPD and 20 community dwelling age-matched control women.
  
  
  RESULTS
  Patients completed questionnaires, had a polysomnography and blood tests. Controls filled in the questionnaires. In the Basic Nordic Sleep Questionnaire, the average (+/-sd) scores for sleepiness (9.9+/-3.0 in patients vs. 7.6+/-3.2 in controls, P = 0.025, test range 4-20) and insomnia (18.3+/-3.4 vs. 16.6+/-4.4, P = 123, test range 7-35) were low. Although 53% had a good night's sleep seldom or never and 70% slept restlessly, only 33% felt tired in the mornings. Controls reported better sleep quality, less tiredness and sleepiness. With polysomnography, the total sleep time was 4h 41 min +/-1h 20 min in patients. Sleep was fragmented, the proportion of stage 1 sleep high and rapid eye movement (REM) latency delayed. Sleepiness correlated with fasting serum insulin levels (r = 0.59, P = 0.027) and body movements (r = 0.52, P = 0.047). In stepwise linear regression analyses, sleepiness was positively associated with insulin levels (P = 0.025) but not with body movements. Insulin explained 38.0% of the variance in the sleepiness score, when adjusted for body mass index (BMI).
  
  
  CONCLUSIONS
  Despite short and fragmented sleep, non-diabetic patients with COPD did not have marked EDS. An association between fasting insulin and sleepiness suggests that insulin resistance is involved in EDS.
authors.affiliation: Sleep Research Unit at the Department of Physiology, University of Turku, Dentalia, Lemminkaisenkatu 2, 20520 Turku, Finland. tarja.saaresranta@tyks.fi
authors.forename: Tarja
authors.initials: T
authors.lastname: Saaresranta
authors.forename: Kerttu
authors.initials: K
authors.lastname: Irjala
authors.forename: Tero
authors.initials: T
authors.lastname: Aittokallio
authors.forename: Olli
authors.initials: O
authors.lastname: Polo
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D006970:Disorders of Excessive Somnolence / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology; D005215:Fasting / Q000097:blood; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D006935:Hypercapnia / Q000209:etiology; D000860:Hypoxia / Q000209:etiology; D007328:Insulin / Q000378:metabolism*; D017286:Polysomnography; D017698:Postmenopause; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000378:metabolism / Q000503:physiopathology; D012044:Regression Analysis; D014797:Vital Capacity / Q000502:physiology
chemical_list: D007328:Insulin