title: A cross-sectional survey of night-time symptoms and impact of sleep disturbance on symptoms and health status in patients with COPD.
abstract: BACKGROUND
  Sleep disturbance has been termed the forgotten dimension of chronic obstructive pulmonary disease (COPD), but it is clinically important as most patients are affected. This study examined the incremental burden of illness associated with sleep disturbance in COPD, with reference to health status and disease impact, and the degree of concordance between physicians and patients in reporting night-time COPD symptoms.
  
  
  METHODS
  Real-world data from >2,500 patients with COPD consulting for routine care were derived from respiratory Disease-Specific Programs conducted in Europe, the USA, and China. Night-time COPD symptom burden was assessed from patient and physician perspectives. Patients completed the Jenkins Sleep Evaluation Questionnaire (JSEQ), COPD assessment test (CAT), and EuroQol five-dimension questionnaire (EQ-5D). A regression approach was used to analyze the relationship between sleep disturbance (JSEQ score) and health status (EQ-5D score), adjusting for confounding variables.
  
  
  RESULTS
  Frequency of night-time symptoms was high and was higher when reported by patients than physicians (69.7% and 65.7%, respectively). According to the JSEQ, 73.3% of patients had trouble falling asleep, 75.3% experienced night-time awakenings, 70.6% had trouble staying asleep, and 67.7% woke after a usual amount of sleep feeling worn out. Over half (52.7%) of patients received maintenance treatment where night-time symptom relief was stated by the physician as a treatment aim. A one unit increase in JSEQ score was associated with increased CAT score (0.7 units in Europe and the USA; 0.2 units in China). Sleep disturbance was significantly associated with worse health status (odds ratio [OR]: 1.27, 95% confidence interval [CI]: 1.18, 1.36,P<0.001 for Europe; OR: 1.23, 95% CI: 1.12, 1.38,P<0.001 for the USA; and OR: 1.19, 95% CI: 1.10, 1.28,P<0.001 for China).
  
  
  CONCLUSIONS
  Night-time symptoms and sleep disturbance are common among patients with COPD, and sleep disturbance has a detrimental impact on COPD symptoms and health status.
authors.affiliation: Global Medical Affairs, AstraZeneca, Gothenburg, Sweden.
authors.forename: Bo
authors.initials: B
authors.lastname: Ding
authors.affiliation: Adelphi Real World, Bollington, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Small
authors.affiliation: Global Medical Affairs, AstraZeneca, Gothenburg, Sweden.
authors.forename: Gina
authors.initials: G
authors.lastname: Bergström
authors.affiliation: Global Medical Affairs, AstraZeneca, Gothenburg, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Holmgren
mesh_terms: D000368:Aged; D002681:China / Q000453:epidemiology; D002940:Circadian Rhythm; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008168:Lung / Q000187:drug effects / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D000071066:Patient Reported Outcome Measures; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D011788:Quality of Life; D012307:Risk Factors; D012720:Severity of Illness Index; D012890:Sleep; D012893:Sleep Wake Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: COPD; health status; night-time symptom; sleep disturbance