Chronic Obstructive Pulmonary Disease and its association with sleep and mental disorders in the general population

To assess the prevalence of insomnia symptoms in Chronic Obstructive Pulmonary Disease (COPD) participants, their association with psychiatric disorders and their impact on health care utilization and quality of life.

It is a cross-sectional telephone study using a representative sample consisting of 10,854 non-institutionalized individuals aged 15 or over living in Germany, Spain and the United Kingdom. Interviews were managed by the Sleep-EVAL expert system. The questionnaire included questions on sleeping habits, life habits, health, DSM-IV mental disorders, DSM-IV and ICSD sleep disorders. COPD was defined as chronic bronchitis or emphysema (treated or not) diagnosed by a physician.

A total of 2.5% [2.1%-2.8%] of the sample reported having been diagnosed with COPD. As many as 48.1% of COPD had insomnia symptoms, which was twice higher than the rate observed in non-COPD (OR: 2.4). Only 11.8% of COPD addressed their sleep difficulties to their physician. Mental disorders were higher in COPD compared to non-COPD participants: Major Depressive disorder (AOR: 2.8); Generalized Anxiety Disorder (AOR: 11.0); Panic Disorder (AOR: 7.1) and Specific Phobia (AOR: 3.7). As many as 84.4% of COPD with depression and 59.7% of those with an Anxiety Disorder had associated insomnia symptoms. The co-occurrence of both conditions increased by five times the likelihood of hospitalizations in the previous year among COPD. Both conditions were associated with a diminished Quality of Life in COPD.

COPD is a debilitating disease accompanied with psychiatric disorders and sleep disturbances in the overwhelming majority of cases. This high comorbidity is associated with greater health care utilization and great deterioration of the quality of life.