Obstructive Lung Diseases |

Longitudinally-Assessed Sleep and Activity Variables Before, During, and After a COPD Exacerbation: An N of 1 Study FREE TO VIEW

Prerna Mota*, MBBS; Rana Khan, MBBS; Mohsin Ehsan, MBBS; Kriti Lonial, MBBS; Richard ZuWallack, MD; Nancy Leidy, PhD
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University of Connecticut, Farmington, CT

Chest. 2012;142(4_MeetingAbstracts):666A. doi:10.1378/chest.1387908
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PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: The COPD exacerbation often has profound negative effects that are not limited to the respiratory system. We initiated a longitudinal study of frequent COPD exacerbators, with daily assessment of activity and sleep variables.

METHODS: The 14-item Exacerbations of Chronic Pulmonary Disease Tool (EXACT) defined exacerbations. We report data on the first patient (female, age 70, FEV1 49%) in the study with an exacerbation requiring a hospitalization. Data from 89 consecutive days were analyzed; 4 consecutive days beginning on day 77 met EXACT criteria as exacerbation days. Regression analysis controlling for autocorrelation was used to relate daily EXACT scores to sleep and activity variables. Sleep was assessed using the Stanford Sleepiness Scale and wrist actigraphy (ActiGraph) to determine sleep time and sleep efficiency. The activity variable was the number of minutes per day at moderate or greater intensity, from ActiGraph output.

RESULTS: Mean daily values across the entire study period were: EXACT, 52 ± 7; Stanford, 2.4 ± 0.9; sleep time 429 ± 135 minutes; sleep efficiency, 75 ± 11%; and physical activity, 142 ± 57 min. Higher EXACT scores (greater COPD symptoms) were related to increased daytime sleepiness (p < 0.0001), lower sleep time (p = 0.008), decreased sleep efficiency (p < 0.0001), and less moderate or greater physical activity (p = 0.11). Comparing EXACT-defined exacerbation days with non-exacerbation days using nonparametric analysis, daytime sleepiness was greater (5.3 ± 1.5 vs 2.2 ± 0.5, p < 0.0001), and activity was decreased (68 ± 20 vs 145 ± 56 minutes, p = 0.02) in the former.

CONCLUSIONS: These preliminary data highlight the pervasive effects of the COPD exacerbation on the individual patient.

CLINICAL IMPLICATIONS: Longitudinal, multi-variable assessment in the COPD patient such as this will provide important information and complement standard assessment.

DISCLOSURE: Richard ZuWallack: Grant monies (from industry related sources): Unrestricted grant for this study from Boehringer Ingelheim, Consultant fee, speaker bureau, advisory committee, etc.: Speaker for Boehringer

Nancy Leidy: Grant monies (from industry related sources): Employed by the United BioSource Corporation (UBC), which provides consulting and other research services to pharmaceutical, device, government and non-government organizations. In this salaried position, Dr. Leidy works with a variety of companies and organizations. She receives no payment or honoraria directly from these organizations for services rendered.

The following authors have nothing to disclose: Prerna Mota, Rana Khan, Mohsin Ehsan, Kriti Lonial

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University of Connecticut, Farmington, CT




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