The Complex Relationship Between Poor Sleep Quality and Chronic Obstructive Pulmonary Disease

Abstract

Sleep-related symptoms are prevalent among patients with chronic obstructive pulmonary disease (COPD). The disease process often manifests with nocturnal respiratory symptoms. Long-acting antimuscarinic medications improve nocturnal COPD symptoms, though their effect on sleep quality requires further investigation. Those with COPD often suffer from comorbidities that negatively impact sleep, including obstructive sleep apnea (OSA) and mood disorders such as anxiety and depression. Sleep quality is also predictive of COPD exacerbations. Patients with concurrent COPD and OSA suffer from overlap syndrome (OVS), characterized by a synergistic effect on poor health outcomes. The intersection of COPD and OSA offers the clinical pulmonary audience a useful lens for ongoing basic, clinical, and translational research. Patients with OVS experience higher mortality compared with either COPD or OSA alone. This observation is attributable to the compound effect each condition has on adverse cardiovascular events. A complex interplay exists between COPD, sleep symptoms, and OSA. COPD appears to influence important nonanatomical contributors to OSA. The presence of underlying COPD makes the definitive diagnosis of OSA a challenge. Chronic noninvasive ventilation (NIV) is the backbone of therapy for OVS, OSA, and hypercarbic COPD. NIV is additionally a well-established treatment for acute COPD exacerbations and emerging research demonstrates that NIV decreases mortality and hospitalizations in patients with hypercarbic COPD. Clinicians often need to individualize therapeutic interventions for patients with COPD, OSA, and OVS, balancing the benefits and adverse effects of such interventions. NIV can have unwanted impact on the quality of life for some patients with COPD. Certain medications used for COPD, such as corticosteroids, have adverse effects on sleep quality. Future therapeutic approaches are needed to improve the sleep symptoms and health outcomes of patients suffering from COPD and OVS.