Dr Surya Kant
A new study published in the journal Respiratory Medicine suggests that female gender, lower education level, greater disease severity, poorer sleep quality, more frequent exacerbations within a year, and use of systemic corticosteroids are associated with a higher risk of insomnia in chronic obstructive pulmonary disease (COPD) patients.
The study sought to assess the risk factors for insomnia and its severity in patients experiencing acute exacerbation of chronic obstructive pulmonary disease (AECOPD). It included 155 patients managed at Chaohu Hospital, Anhui Medical University, between September 2022 and October 2023. Eighty seven had comorbid insomnia and were categorized into mild (n=46), moderate (n=36) and severe (n=5) insomnia groups based on Insomnia Severity Index (ISI) score of >7. A comparison group of 68 participants was also selected. Sleep quality and severity were measured using the Pittsburgh Sleep Quality Index (PSQI), COPD Assessment Test (CAT) score, and mMRC (Modified Medical Research Council) classification.
The prevalence of insomnia in AECOPD patients was 56.1%; most of AECOPD patients (80%) experienced poor sleep quality as evident by a PSQI score >5. In addition, 71% of AECOPD patients were found to be at high risk for obstructive sleep apnea (OSA), the most common form of sleep-disordered breathing. Insomnia was more common in female patients, those with lower education levels, shorter smoking histories, higher CAT and PSQI scores, and more frequent hospitalizations. Patients using oral or intravenous glucocorticoids had a higher prevalence of insomnia. Moderate insomnia cases had more severe clinical symptoms with higher CAT and PSQI scores and prolonged hospitalization compared to mild insomnia cases. No significant differences were observed in ventilator use, glucocorticoid administration, quinolone use, or resuscitation across the three insomnia groups.
This study underscores the high prevalence of insomnia among patients with AECOPD and the importance of also addressing sleep disorders in AECOPD management to improve patient outcomes and quality of life. Those with severe insomnia had more severe COPD symptoms and a greater risk of disease exacerbations and consequently more frequent hospital admissions. Routine screening for insomnia can help identify at-risk individuals enabling targeted interventions for sleep disturbances.
Reference
1. Qianqian Gao, et al. Investigating the risk factors for the coexistence of insomnia and its exacerbation in AECOPD. Respir Med. 2025 Mar:238:107987. doi: 10.1016/j.rmed.2025.107987.
Dr Surya Kant is Professor and Head, Dept. of Respiratory Medicine, KGMU, UP, Lucknow. National Vice Chairman IMA-AMS