title: Pulmonary rehabilitation and sleep quality: a before and after controlled study of patients with chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Poor sleep quality is common in chronic obstructive pulmonary disease (COPD). It is associated with poor quality of life. Pulmonary rehabilitation (PR) improves quality of life, exercise capacity, and anxiety and depression. Its effect on sleep quality is uncertain.
  
  
  OBJECTIVE
  To determine whether PR improves sleep quality in COPD.
  
  
  METHODS
  A prospective controlled 'before and after' study of sleep quality in COPD patients attending a community PR programme was conducted. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). Lung function, disease-specific quality of life (COPD assessment test--CAT), exercise capacity (incremental shuttle walk test--ISWT), and anxiety and depression (Hospital Anxiety and Depression Scale--HADS) were measured. Change in sleep quality was compared with a COPD control group.
  
  
  RESULTS
  Twenty-eight participants completed PR. The control group comprised 24 patients. Prevalence of poor sleep quality (PSQI ≥5) was 78%. There were no differences between observation and control groups in sleep quality, age or severity. Quality of life was strongly correlated with quality of sleep (r=0.64, P<0.001). PR improved the quality of life (CAT change 3.0; 95% CI, 0.7-5.3), exercise capacity (ISWT change (metres) 81.0; 15.3-146.6), anxiety (HADS score ≥8: change 2.33; 0.45-4.22), and depression (HADS score ≥8: change 2.90; 1.92-3.88). PR did not improve sleep quality (PSQI mean change 0.79; -0.35 to 1.93).
  
  
  CONCLUSIONS
  PR did not improve sleep quality in COPD despite improving quality of life, exercise capacity, anxiety and depression. New strategies, independent of PR, are required to improve sleep quality in COPD.
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, King's Health Partners, London, UK.
authors.forename: Lucy M
authors.initials: LM
authors.lastname: McDonnell
authors.affiliation: Department of Physiotherapy, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK.
authors.forename: Lauren
authors.initials: L
authors.lastname: Hogg
authors.affiliation: Department of Physiotherapy, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK.
authors.forename: Lynn
authors.initials: L
authors.lastname: McDonnell
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, King's Health Partners, London, UK.
authors.forename: Patrick
authors.initials: P
authors.lastname: White
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D001007:Anxiety / Q000453:epidemiology / Q000209:etiology; D003863:Depression / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000534:rehabilitation*; D011788:Quality of Life; D012893:Sleep Wake Disorders / Q000453:epidemiology / Q000209:etiology*; D011795:Surveys and Questionnaires