Sleep in COPD: an understudied and clinically important issue

This review provides an overview of objective and subjective sleep characteristics in the general chronic obstructive pulmonary disease (COPD) population and discusses associations with airway symptoms, psychological factors, quality of life, and common sleep disorders. Available studies indicate that patients with COPD often exhibit altered sleep architecture, including increased light sleep, reduced slow-wave and rapid eye movement (REM) sleep, frequent arousals, reduced sleep efficiency, and shorter total sleep duration. Subjectively, 40-70% of patients report poor sleep quality, characterized by difficulty initiating or maintaining sleep and increased daytime sleepiness. Nocturnal respiratory symptoms such as dyspnea, cough, wheeze, sputum production, and hypoxemia may contribute to sleep disruption. Common sleep disorders such as insomnia, obstructive sleep apnea (OSA), and restless legs syndrome (RLS) are seen more frequently in COPD, and poor sleep may also negatively affect COPD outcomes through mechanisms such as systemic inflammation, reduced physical activity, and impaired treatment adherence. Sleep disturbances are further associated with anxiety, depression, fatigue, and reduced quality of life. Assessing sleep and sleep quality and treating both COPD and sleep disorders effectively in this patient population are of importance and would likely improve not only sleep and airway symptoms but also quality of life and overall clinical outcomes.