Chronic obstructive pulmonary disease and sleep: an update on relevance, prevalence and management

Despite the importance of sleep in patients with COPD, this is frequently left unassessed in clinical practice. This review is intended to highlight the inter-relationship between COPD and sleep with an overview of the underlying pathophysiology and symptom burden followed by a review of the current management.

Recent data has indicated that specific respiratory support provided to patients with COPD and sleep disordered breathing improves clinical outcomes. The provision of respiratory support has expanded from established noninvasive ventilation and continuous positive airway pressure therapy to include novel interventions such as nasal high flow therapy. Sleep is impacted in many ways in patients with COPD and this poor sleep quality can be shown to be associated with worse clinical outcomes. Although data to support a causal effect is lacking, there is increasing interest in interventions such as cognitive behavioural therapy to improve patient symptom burden.

Clinicians managing patients with COPD should be alert to and actively elicit symptoms of comorbid sleep disorders. Once diagnosed, these sleep disorders should be actively managed in line with best practice. Research should focus on whether the active management of sleep disturbance improves long-term outcomes in COPD.