Sleep Quality and Self-Reported Symptoms of Anxiety and Depression Are Associated with Physical Activity in Patients with Severe COPD

Sleep quantity, quality and symptoms of depression or anxiety potentially affect the level of daily physical activity (PAL) and plausibly counteracts benefits from pulmonary rehabilitation programs. Their collective impact on PAL is sparsely investigated, particularly in patients with severely progressed chronic obstructive pulmonary disease (COPD). Aim: To investigate if sleep quantity, quality and symptoms from self-reported hospital anxiety and depression scores (HADS) are associated with PAL. Methods: In this exploratory cross-sectional study data were analysed from 148 participants with COPD; GOLD grade II-IV; GOLD group B to D (52% female, mean 69.7 ± SD of 8.4 years, FEV1% predicted 33.6 ± 10.9, 6MWD 327 ± 122 m, CAT 20 ± 7 points), eligible for conventional outpatient hospital-based pulmonary rehabilitation. Participants had sleep and PAL measured 24 h per day for five consecutive days with an activPAL monitor. Adjusted negative binomial regression was applied to investigate the associations with PAL. Results: Participants walked median (25th, 75th percentile) of 2358 (1325.75; 3822.25) steps per day and 14% walked >5000 steps per day on average. Time in bed (TIB) were a median (25th, 75th percentile) of 8.3 (7.1; 9.7) hours and numbers of nocturnal sleeping bouts (NSB) were 1.5 (0.8; 3), Anxiety (HADS-A) and depression (HADS-D) scores were median (25th, 75th percentile) of 5 (3; 8) points and 3 (2; 6) points, respectively, whereof 29% (HADS-A) and 15% (HADS-D) reported scores ≥8 points indicating significant symptoms. The fully adjusted rate ratio (RR) for steps per day for TIB (hours) [RR 0.97 (95% CI: 0.92; 1.02)], NSB (numbers) [RR 1.02 (95% CI: 0.97; 1.07)] were not significantly associated with number of steps per day, while there was a significantly association with number of steps per day for HADS-A [RR 1.04 (95% CI: 1.01; 1.07)] and HADS-D [RR 0.95 (95% CI: 0.91; 0.99)]. Conclusion: This exploratory cross-sectional study found a statistically significant association between HADS-A and HADS-D with numbers of steps per day in patients with severe COPD.

[1]  R. Owens,et al.  Sleep Deficiency, Sleep Apnea, and Chronic Lung Disease. , 2022, Clinics in chest medicine.

[2]  E. Regan,et al.  Depressive and anxiety symptoms in patients with COPD: A network analysis. , 2022, Respiratory medicine.

[3]  N. Beyer,et al.  Inter-Day Test–Retest Reproducibility of the CAT, CCQ, HADS and EQ-5D-3L in Patients with Severe and Very Severe COPD , 2020, Patient related outcome measures.

[4]  O. Ekholm,et al.  Pain Prevalence, Localization, and Intensity in Adults with and without COPD: Results from the Danish Health and Morbidity Survey (a Self-reported Survey) , 2020, International journal of chronic obstructive pulmonary disease.

[5]  F. Pitta,et al.  Tossing and turning: association of sleep quantity–quality with physical activity in COPD , 2020, ERJ Open Research.

[6]  S. Vikjord,et al.  The association of anxiety and depression with mortality in a COPD cohort. The HUNT study, Norway. , 2020, Respiratory medicine.

[7]  M. Kapella,et al.  Sleep disturbance and next-day physical activity in COPD patients. , 2020, Geriatric nursing.

[8]  N. Beyer,et al.  Supervised pulmonary tele-rehabilitation versus pulmonary rehabilitation in severe COPD: a randomised multicentre trial , 2020, Thorax.

[9]  J. Anholm,et al.  Impact of Pulmonary Rehabilitation on Sleep in COPD Patients as Measured by Actigraphy , 2019, C106. PULMONARY REHABILITATION.

[10]  E. Wouters,et al.  Disease-Specific Comorbidity Clusters in COPD and Accelerated Aging , 2019, Journal of clinical medicine.

[11]  W. Janssens,et al.  The likelihood of improving physical activity after pulmonary rehabilitation is increased in patients with COPD who have better exercise tolerance , 2018, International journal of chronic obstructive pulmonary disease.

[12]  N. Beyer,et al.  Intra- and inter-rater reproducibility of the 6-minute walk test and the 30-second sit-to-stand test in patients with severe and very severe COPD , 2018, International journal of chronic obstructive pulmonary disease.

[13]  L. Que,et al.  Test Performance Characteristics of the AIR, GAD‐7, and HADS‐Anxiety Screening Questionnaires for Anxiety in Chronic Obstructive Pulmonary Disease , 2018, Annals of the American Thoracic Society.

[14]  A. Lindberg,et al.  The COPD Assessment Test (CAT) can screen for fatigue among patients with COPD , 2018, Therapeutic advances in respiratory disease.

[15]  Haejung Lee,et al.  Factors associated with low-level physical activity in elderly patients with chronic obstructive pulmonary disease , 2015, The Korean journal of internal medicine.

[16]  T. Olds,et al.  Physical activity, sedentary behaviour and sleep in COPD guidelines: A systematic review , 2017, Chronic respiratory disease.

[17]  U. Holmgren,et al.  A cross-sectional survey of night-time symptoms and impact of sleep disturbance on symptoms and health status in patients with COPD , 2017, International journal of chronic obstructive pulmonary disease.

[18]  S. Mukherjee,et al.  Occurrence of Anxiety and Depression among Stable COPD Patients and its Impact on Functional Capability. , 2017, Journal of clinical and diagnostic research : JCDR.

[19]  Andrew Krystal,et al.  National Sleep Foundation's sleep quality recommendations: first report☆ , 2017, Sleep health.

[20]  M. Polkey,et al.  Physical activity is increased by a 12-week semiautomated telecoaching programme in patients with COPD: a multicentre randomised controlled trial , 2017, Thorax.

[21]  Malcolm Kohler,et al.  Analysis of nocturnal actigraphic sleep measures in patients with COPD and their association with daytime physical activity , 2017, Thorax.

[22]  Melanie J. Davies,et al.  Considerations when using the activPAL monitor in field-based research with adult populations , 2016, Journal of sport and health science.

[23]  E. Wouters,et al.  Management of chronic obstructive pulmonary disease beyond the lungs. , 2016, The Lancet. Respiratory medicine.

[24]  A. Holland,et al.  Home-based rehabilitation for COPD using minimal resources: a randomised, controlled equivalence trial , 2016, Thorax.

[25]  Y. Kuo,et al.  Association of Psychological Disorders With 30-Day Readmission Rates in Patients With COPD. , 2016, Chest.

[26]  N. Hopkinson,et al.  Can health status questionnaires be used as a measure of physical activity in COPD patients? , 2016, European Respiratory Journal.

[27]  M. Decramer,et al.  Physical Activity Counselling during Pulmonary Rehabilitation in Patients with COPD: A Randomised Controlled Trial , 2015, PloS one.

[28]  Daniel J Buysse,et al.  Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society on the Recommended Amount of Sleep for a Healthy Adult: Methodology and Discussion. , 2015, Sleep.

[29]  H. Magnussen,et al.  Disease Progression and Changes in Physical Activity in Patients with Chronic Obstructive Pulmonary Disease. , 2015, American journal of respiratory and critical care medicine.

[30]  S. Quan,et al.  Sleep disorders in chronic obstructive pulmonary disease: etiology, impact, and management. , 2015, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[31]  K. Tödt,et al.  Factors associated with low physical activity in patients with chronic obstructive pulmonary disease: a cross-sectional study. , 2015, Scandinavian journal of caring sciences.

[32]  Magnus Lindwall,et al.  The relationships of change in physical activity with change in depression, anxiety, and burnout: a longitudinal study of Swedish healthcare workers. , 2014, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[33]  Thierry Troosters,et al.  An official European Respiratory Society statement on physical activity in COPD , 2014, European Respiratory Journal.

[34]  Thierry Troosters,et al.  An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease , 2014, European Respiratory Journal.

[35]  I. Yang,et al.  Anxiety and depression-Important psychological comorbidities of COPD. , 2014, Journal of thoracic disease.

[36]  G. Alexopoulos,et al.  Depression and anxiety in patients with COPD , 2014, European Respiratory Review.

[37]  M. Polkey,et al.  Determinants and outcomes of physical activity in patients with COPD: a systematic review , 2014, Thorax.

[38]  I-Min Lee,et al.  Using accelerometers to measure physical activity in large-scale epidemiological studies: issues and challenges , 2013, British Journal of Sports Medicine.

[39]  Thierry Troosters,et al.  An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. , 2013, American journal of respiratory and critical care medicine.

[40]  E. Atlantis,et al.  Bidirectional associations between clinically relevant depression or anxiety and COPD: a systematic review and meta-analysis. , 2013, Chest.

[41]  Huong Q. Nguyen,et al.  Patients with COPD with higher levels of anxiety are more physically active. , 2013, Chest.

[42]  A. Yohannes,et al.  Anxiety Disorders in Patients With COPD: A Systematic Review , 2013, Respiratory Care.

[43]  Lucas J Carr,et al.  Letter to the editor: standardized use of the terms "sedentary" and "sedentary behaviours". , 2012, Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme.

[44]  Kylie Hill,et al.  Accuracy and responsiveness of the stepwatch activity monitor and ActivPAL in patients with COPD when walking with and without a rollator , 2012, Disability and rehabilitation.

[45]  M. Polkey,et al.  Stanford Seven-Day Physical Activity Recall questionnaire in COPD , 2011, European Respiratory Journal.

[46]  M. Cazzola,et al.  Night-time symptoms: a forgotten dimension of COPD , 2011, European Respiratory Review.

[47]  Paul E. Croarkin,et al.  Psychomotor retardation in depression: Biological underpinnings, measurement, and treatment , 2011, Progress in Neuro-Psychopharmacology and Biological Psychiatry.

[48]  D. Mannino,et al.  Walking abnormalities are associated with COPD: An investigation of the NHANES III dataset. , 2011, Respiratory medicine.

[49]  Catrine Tudor-Locke,et al.  Expected values for steps/day in special populations. , 2009, Preventive medicine.

[50]  Yoshiharu Yamamoto,et al.  Panic disorder and locomotor activity , 2008, BioPsychoSocial medicine.

[51]  Malcolm H Granat,et al.  Activity-monitor accuracy in measuring step number and cadence in community-dwelling older adults. , 2008, Journal of aging and physical activity.

[52]  M. Granat,et al.  The validation of a novel activity monitor in the measurement of posture and motion during everyday activities , 2006, British Journal of Sports Medicine.

[53]  G. Town,et al.  Psychopathology and illness beliefs influence COPD self-management. , 2004, Journal of psychosomatic research.

[54]  M. Jetté,et al.  Metabolic equivalents (METS) in exercise testing, exercise prescription, and evaluation of functional capacity , 1990, Clinical cardiology.

[55]  C. Caspersen,et al.  Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. , 1985, Public health reports.