title: Pulmonary rehabilitation improves subjective sleep quality in COPD.
abstract: BACKGROUND
  Poor sleep quality is often reported among patients with COPD. Pulmonary rehabilitation (PR) is beneficial in improving exercise capacity and health-related quality of life (HRQOL). However, its benefit in terms of sleep quality in patients with COPD remains unclear. This study aimed to investigate the effects of PR on sleep quality of patients with COPD.
  
  
  METHODS
  Thirty-four subjects with COPD were studied. All subjects participated in a 12-week (2 sessions/week) hospital-based out-patient PR study. Baseline and post-PR status were evaluated by spirometry, a sleep questionnaire (Pittsburgh Sleep Quality Index [PSQI]), a disease-specific questionnaire of HRQOL (St George Respiratory Questionnaire [SGRQ]), cardiopulmonary exercise testing, respiratory muscle strength, and the Borg dyspnea scale.
  
  
  RESULTS
  Mean FEV1/FVC in the subjects was 0.49 ± 0.13, and the mean FEV1 was 1.06 ± 0.49 L/min (49.7 ± 18.0% of predicted). After PR, the PSQI score decreased from 9.41 ± 4.33 to 7.82 ± 3.90 (P < .001). The number of subjects with a PSQI score > 5 also decreased (85.3-64.7%, P = .006). There were significant improvements in HRQOL (SGRQ, P = .003), exercise capacity (peak oxygen uptake, P < .001; and work rate, P < .001), dyspnea score (P < .001), and respiratory muscle strength (inspiratory muscle strength, P = .005; and expiratory muscle strength, P = .004) after PR. There were no significant changes in pulmonary function test results (FEV1, P = .77; FVC, P = .90; FEV1/FVC, P = .90).
  
  
  CONCLUSIONS
  PR results in significant improvement in sleep quality, along with concurrent improvements in HRQOL and exercise capacity. PR is an effective nonpharmacologic treatment to improve sleep quality in patients with COPD and should be part of their clinical management.
authors.affiliation: Division of Pulmonary Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan and the School of Medicine, Tzu Chi University, Hualien, Taiwan.
authors.forename: Chou-Chin
authors.initials: CC
authors.lastname: Lan
authors.affiliation: Department of Nursing, Cardinal Tien College of Healthcare and Management, New Taipei City, Taiwan.
authors.forename: Hui-Chuan
authors.initials: HC
authors.lastname: Huang
authors.affiliation: Division of Pulmonary Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan and the School of Medicine, Tzu Chi University, Hualien, Taiwan.
authors.forename: Mei-Chen
authors.initials: MC
authors.lastname: Yang
authors.affiliation: Division of Pulmonary Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan and the School of Medicine, Tzu Chi University, Hualien, Taiwan.
authors.forename: Chih-Hsin
authors.initials: CH
authors.lastname: Lee
authors.affiliation: Division of Pulmonary Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan and the School of Medicine, Tzu Chi University, Hualien, Taiwan.
authors.forename: Chun-Yao
authors.initials: CY
authors.lastname: Huang
authors.affiliation: Division of Pulmonary Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan and the School of Medicine, Tzu Chi University, Hualien, Taiwan drbfci@yahoo.com.tw.
authors.forename: Yao-Kuang
authors.initials: YK
authors.lastname: Wu
mesh_terms: D000368:Aged; D002681:China; D004417:Dyspnea / Q000503:physiopathology; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000503:physiopathology / Q000534:rehabilitation*; D011788:Quality of Life; D015656:Respiratory Mechanics / Q000502:physiology; D012893:Sleep Wake Disorders / Q000209:etiology* / Q000517:prevention & control*; D013147:Spirometry; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: COPD; health-related quality of life; pulmonary rehabilitation; sleep quality