Abstract
Abstract
Introduction
Chronic obstructive pulmonary disease (COPD) is the 3rd leading cause of morbidity and mortality in the US, and results in significant cost to the health care system. Obstructive Sleep Apnea (OSA) is a common sleep disorder in 25% of US adults. “Overlap Syndrome” is COPD and OSA in the same patient. These patients have more frequent nocturnal oxygen desaturations, hypoxemia, and hypercapnea. Patients with overlap who do not wear continuous positive airway pressure (CPAP) have increased risk of death and rehospitalization. Many inpatients are at high risk for OSA. Patients at high risk of OSA have worse in-hospital sleep as measured by actigraphy. Poor sleep quality is independently associated with increased risk for acute COPD exacerbations. No studies characterize risk of undiagnosed sleep disorders among hospitalized patients with obstructive lung disease (COPD or asthma).
Methods
In this retrospective secondary analysis of prospective cohort study, medical inpatients 50 years of age were interviewed on admit, and their charts were reviewed to obtain demographic data and diagnosis. Initial sleep evaluation was based on survey questionnaires (Berlin, Pittsburg Sleep Quality Index, Epworth Sleepiness Scale, and Insomnia Severity Index) completed on day of admission, and examined by Cochran Mantel Haenszel (CMH) or Wilcoxon rank sum.
Results
A total of 585 patients (322 female and 415 African American) were enrolled. Roughly one-quarter (128, 22%) had a prior diagnosis of Obstructive Lung Disease (OLD). No association was found between OLD and risk of obstructive sleep apnea (RR 1.14 [95% CI 0.98, 1.33] p=0.109), risk of poor sleep quality (RR 1.06 [95% CI 0.90, 0.1.24] p=0.482), or risk of being excessively sleepy (RR 0.97 [95% CI 0.72, 1.32] p=0.867). A diagnosis of OLD carried a 88% higher odds (OR 1.88 [95% CI 1.43, 3.21] p=0.005) of having insomnia.
Conclusion
Among medical inpatients, having obstructive lung disease was independently associated with higher proportional odds of having insomnia, yet no association was found with risk of obstructive sleep apnea, risk of poor sleep quality, or risk of being excessively sleepy.
Support (If Any)
none