Gabriele Spina1,2, Martijn A Spruit3,4,5, Jennifer Alison6,7, Roberto P Benzo8, Peter M A Calverley9, Christian F Clarenbach10, Richard W Costello11, David Donaire-Gonzalez12,13,14, Selina Dürr15, Judith Garcia-Aymerich12,13,14, Arnoldus J R van Gestel10, Marco Gramm16, Nidia A Hernandes17, Kylie Hill18, Nicholas S Hopkinson19, Diana Jarreta20, Malcolm Kohler10, Anne M Kirsten16, Jörg D Leuppi15, Helgo Magnussen16, François Maltais21, William D-C Man19, Zoe J McKeough6, Rafael Mesquita3,22, David Miedinger15, Fabio Pitta17, Sally J Singh23, Frank W J M Smeenk24, Ruth Tal-Singer25, Barbara Vagaggini26, Benjamin Waschki16, Henrik Watz16, Emiel F M Wouters3,22, Stefanie Zogg15, Albertus C den Brinker2. 1. Department of Signal Processing Systems, Technische Universiteit Eindhoven, Eindhoven, The Netherlands. 2. Data Science Group, Philips Research, Eindhoven, The Netherlands. 3. Department of Research and Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands. 4. REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium. 5. Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands. 6. Clinical and Rehabilitation Sciences, The University of Sydney, Sydney, New South Wales, Australia. 7. Physiotherapy Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia. 8. Mindful Breathing Laboratory, Mayo Clinic, Rochester, Minnesota, USA. 9. School of Ageing and Chronic Disease, University Hospital Aintree, Liverpool, UK. 10. Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland. 11. Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland. 12. Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain. 13. CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. 14. Universitat Pompeu Fabra (UPF), Barcelona, Spain. 15. Medical University Clinic, Cantonal Hospital Baselland, Liestal and Medical Faculty, University of Basel, Basel, Switzerland. 16. Pulmonary Research Institute at Lung Clinic Grosshansdorf, Airway Research Center North, Member of the German Centre for Lung Research, Grosshansdorf, Germany. 17. Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil. 18. School of Physiotherapy and Exercise Science, Curtin University, Perth, Washington, Australia. 19. NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK. 20. AstraZeneca, Barcelona, Spain. 21. Centre de recherche, Institut Universitaire de cardiologie et de pneumologie de Québec, 2725 Chemin Ste-Foy Québec, Université Laval, Québec, Canada. 22. Department of Respiratory Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands. 23. Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS Trust, Leicester, UK. 24. Department of Respiratory Medicine, Catharina Hospital, Eindhoven, The Netherlands. 25. GSK R&D, King of Prussia, Pennsylvania, USA. 26. Cardio-Thoracic and Vascular Department, University of Pisa, Pisa, Italy.
Abstract
BACKGROUND: Sleep disturbances are common in patients with chronic obstructive pulmonary disease (COPD) with a considerable negative impact on their quality of life. However, factors associated with measures of sleep in daily life have not been investigated before nor has the association between sleep and the ability to engage in physical activity on a day-to-day basis been studied. AIMS: To provide insight into the relationship between actigraphic sleep measures and disease severity, exertional dyspnoea, gender and parts of the week; and to investigate the association between sleep measures and next day physical activity. METHODS: Data were analysed from 932 patients with COPD (66% male, 66.4±8.3 years, FEV1% predicted=50.8±20.5). Participants had sleep and physical activity continuously monitored using a multisensor activity monitor for a median of 6 days. Linear mixed effects models were applied to investigate the factors associated with sleep impairment and the association between nocturnal sleep and patients' subsequent daytime physical activity. RESULTS: Actigraphic estimates of sleep impairment were greater in patients with worse airflow limitation and worse exertional dyspnoea. Patients with better sleep measures (ie, non-fragmented sleep, sleeping bouts ≥225 min, sleep efficiency ≥91% and time spent awake after sleep onset <57 min) spent significantly more time in light (p<0.01) and moderate-to-vigorous physical activity (p<0.01). CONCLUSIONS: There is a relationship between measures of sleep in patients with COPD and the amount of activity they undertake during the waking day. Identifying groups with specific sleep characteristics may be useful information when designing physical activity-enhancing interventions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
BACKGROUND: Sleep disturbances are common in patients with chronic obstructive pulmonary disease (COPD) with a considerable negative impact on their quality of life. However, factors associated with measures of sleep in daily life have not been investigated before nor has the association between sleep and the ability to engage in physical activity on a day-to-day basis been studied. AIMS: To provide insight into the relationship between actigraphic sleep measures and disease severity, exertional dyspnoea, gender and parts of the week; and to investigate the association between sleep measures and next day physical activity. METHODS: Data were analysed from 932 patients with COPD (66% male, 66.4±8.3 years, FEV1% predicted=50.8±20.5). Participants had sleep and physical activity continuously monitored using a multisensor activity monitor for a median of 6 days. Linear mixed effects models were applied to investigate the factors associated with sleep impairment and the association between nocturnal sleep and patients' subsequent daytime physical activity. RESULTS: Actigraphic estimates of sleep impairment were greater in patients with worse airflow limitation and worse exertional dyspnoea. Patients with better sleep measures (ie, non-fragmented sleep, sleeping bouts ≥225 min, sleep efficiency ≥91% and time spent awake after sleep onset <57 min) spent significantly more time in light (p<0.01) and moderate-to-vigorous physical activity (p<0.01). CONCLUSIONS: There is a relationship between measures of sleep in patients with COPD and the amount of activity they undertake during the waking day. Identifying groups with specific sleep characteristics may be useful information when designing physical activity-enhancing interventions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
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