Nightly COPD Breathing Symptoms Affect Quality of Life, Activities

Nighttime breathing symptoms related to chronic obstructive pulmonary disease (COPD) significantly impaired daily activities and health-related quality of life, a survey of patients and physicians revealed.

Most of the surveyed patients (74%) reported having nocturnal symptoms, while physicians reported that they prescribed treatments based on 24-hour symptom relief for most of their patients (78%).

Researchers recommended that health care professionals explore individualizing treatments to maximize 24-hour symptom relief.

Survey findings were detailed in the study, “The Burden of Nocturnal Symptoms in Patients with Chronic Obstructive Pulmonary Disease: Results of a Real-World Survey in the USA,”published in the journal Pulmonary Therapy.

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People with COPD often report poor sleep quality and worse breathing symptoms at night. Nocturnal symptoms may also occur alongside sleep disorders, such as obstructive sleep apnea and low nighttime blood oxygen levels. Despite these reports, current COPD treatment guidelines seldom mention nocturnal symptoms and sleep disturbances.

The study, conducted and sponsored by GSK, sought to understand the significance of nighttime symptoms in COPD patients and evaluate the importance of controlling them compared to daytime symptoms.

The team collected data from the Adelphi Respiratory Disease Specific Programme, a survey of US physicians and their patients. The survey was completed by 800 adults with COPD and 171 physicians including 92 primary care physicians and 79 pulmonologists who cared for three or more COPD patients a month.

Timing and frequency of COPD symptoms

Data on nocturnal symptoms were available for 690 patients, of whom 33 (4.8%) reported having nocturnal symptoms every day. These patients were older on average compared with patients with no nocturnal symptoms and were less frequently engaged in full-time employment.

The frequency of nocturnal symptoms was comparable among those with different mean body mass indexes (BMI), a measure of body fat content, and among males and females.

Compared to nighttime symptoms, daytime symptoms were reported more frequently. Overall, 12% reported only daytime symptoms, 34% mainly reported daytime symptoms, 43% said their symptoms occurred equally during the day and night, 10% had mostly nighttime symptoms, and 2% experienced symptoms only during the night.

Among the 74% of those who reported nocturnal symptoms, 7% had nocturnal symptoms each night. Most (88%) had daytime symptoms, with 14% reporting them happening every day.

A higher proportion of those with nocturnal symptoms every day had comorbidities, or coexisting health conditions, including high blood pressure (76%), anxiety (36%), depression (24%), anemia, or low levels of red blood cells (21 %), and gastrointestinal reflux disease (33%).

Impact of nocturnal symptoms on quality of life

Sleep disruption was assessed by the Jenkins Sleep Evaluation Questionnaire (JSEQ), which measured the frequency of sleep disturbances, with lower scores indicating less disturbance. Mean JSEQ scores increased with a higher frequency of nocturnal symptoms, ranging from 3.2 in those with no symptoms at night to 9.5 in those who had symptoms each night.

Among patients who completed the Work Productivity and Activity Impairment (WPAI) questionnaire, those with symptoms each night showed the greatest impairment in activity. None were working. Their activity was impaired by 66.9% versus 41.1% in patients with less frequent nighttime symptoms and 26.4% in those without symptoms at night.

Symptoms every night were also associated with the lowest quality of life, as assessed by the EuroQoL 5-dimension 3-level (EQ-5D-3L) questionnaire. Participants with nocturnal symptoms every night had a mean EQ-5D-3L score of 0.602 compared with 0.882 in those without them.

Physician reports indicated COPD impacted many aspects of a patient’s life, including getting up and ready for the day, relationships, leisure activities, sleep, and work. COPD affected sleep occasionally, frequently, or constantly in 37% of patients.

Physicians’ reasons for treatment choice

Most patients (76%) took their maintenance medication daily, which was the same among patients reporting nocturnal symptoms every night. Physicians said controlling nighttime symptoms was the reason for their choice of therapy for 38% of their patients, and daytime symptom relief for 61%.

Physicians cited improvement of nocturnal symptoms as a reason for their treatment choice in patients taking once-daily maintenance treatment versus twice-daily treatment (40 vs. 42%).

“Daytime and nocturnal symptoms are common among patients with COPD,” the researchers wrote. “Frequency of nocturnal symptoms was related to significant impairment in activity and health-related [quality of life].”

“As a first step to reduce sleep complaints and increase sleep quality among patients with COPD, health care professionals should optimize COPD treatment as recommended in current guidelines,” the researchers wrote. “Maximizing 24-[hour] symptom control will likely minimize both daytime and nocturnal symptoms in patients with COPD.”

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