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Copd and asthma fatigue scale, stress - Within Minutes

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Sleep problems are a common and important, but poorly understood and under-researched, aspect of chronic obstructive pulmonary disease (COPD).
Table 1 Summary of the occurrence of common sleep disorders in COPD populationsAbbreviation: COPD, chronic obstructive pulmonary disease.
Given the importance of sleep disorders in COPD, being able to accurately classify their nature and severity is important in the management of COPD. Examine associations with sleep disturbance recorded by sleep instruments used in clinical studies of COPD patients.
In this study, we conducted a systematic computerized literature review designed to identify all PROMs concerned with sleep problems experienced by people with COPD.
The first stage of the search was to identify sleep outcome measures that had been used in COPD. Outcome-related terms: development, validation, or psychometric properties of sleep PROMs designed specifically for people with COPD.
We also screened the reference lists and citations of included articles to identify additional relevant publications. Identified articles were examined for descriptions of concepts contained within the instrument, including the rationale and process for deriving scale scores from raw scores, identifying and dealing with floor and ceiling effects, and scale variability. Table 2 Number of papers found and excluded or included in the reviewAbbreviation: COPD, chronic obstructive pulmonary disease. None of the non-disease-specific sleep scales reported any tests of reliability or validity to justify their use in the COPD population. Although the results provide some evidence of the validity of measures of sleep disturbance in people with COPD, none of the above sleep measures were specifically evaluated for people with COPD.
The point estimates of sleep disturbance from clinical studies of COPD patients using the ESS and the PSQI are shown on Tables 4 and 5. Sleep disturbances are an important problem that can seriously impact on physical and mental well-being as well as quality of life for people with COPD.
The majority of sleep studies in COPD have relied on two general measures of sleep dysfunction, the ESS and the PSQI, and although both of these instruments have been extensively used in a variety of clinical populations, neither has been validated for use in COPD patients.
The review identified only one PROM, ie, the CASIS, which has been specifically designed and validated for use in COPD patients. This review has highlighted the current reliance of sleep research on generic sleep measures and the paucity of disease-specific instruments currently available to assess the patient’s experience of sleep in relation to COPD. This review highlights the complexity of sleep assessment, the inadequacy of non-disease-specific measures to capture problems experienced by people with COPD, and the absence of robust and validated methods of assessing and classifying symptoms associated with disrupted sleep in COPD.
This work is published by Dove Medical Press Limited, and licensed under a Creative Commons Attribution License. The license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. The opinions expressed in all articles published here are those of the specific author(s), and do not necessarily reflect the views of Dove Medical Press Ltd or any of its employees.
The library is an integral part of a project being developed by FAPESP - Fundacao de Amparo a Pesquisa do Estado de Sao Paulo, in partnership with BIREME - the Latin American and Caribbean Center on Health Sciences Information. The Project envisages the development of a common methodology for the preparation, storage, dissemination and evaluation of scientific literature in electronic format. The interface also provides access to the full text of articles via author index or subject index, or by a search form on article elements such as author names, words from title, subject, words from the full text and publication year. We have reviewed the literature to identify disease-specific and non-disease-specific sleep PROMs that have been validated for use in COPD patients. The search included all instruments that had been developed and validated in people with COPD as well as generic instruments that had been developed for use in other disease areas and then administered to adult COPD patients.
Similarly, we excluded all articles with mixed study samples where the results from COPD patients were not reported separately. COSMIN checklists are used to evaluate the measurement properties of instruments in terms of their internal consistency, reliability, measurement error, content validity, structural validity, hypothesis testing, cross-cultural validity, criterion validity, and responsiveness to change.


When considering construct validity, we also recorded methods to differentiate between people with different levels of lung function or disease severity, such as the Global Initiative for Chronic Obstructive Lung Disease staging system that classifies people with COPD according to the results of pulmonary tests. Similarly, we did not find any articles that provided data on test-retest, intrarater, or inter-rater reliability or responsiveness to change among COPD patient groups. This review identified seven outcome measures that have been used in COPD populations but none has been sufficiently validated to satisfy US Food and Drug Administration requirements to support labeling claims in medical product development.
By definition, generic measures tend to cover broad aspects such as functional status and perceptions and are more likely to identify aspects that are not disease-related. APG carried out the literature searches, produced draft manuscripts for review, and edited the manuscript prior to submission. Disturbed sleep among COPD patients is longitudinally associated with mortality and adverse COPD outcomes. Prevalence of reported sleep disturbances in a general adult population and their relationship to obstructive airways diseases. Diagnostic and therapeutic approach to coexistent chronic obstructive pulmonary disease and obstructive sleep apnea.
Chronic obstructive pulmonary disease and obstructive sleep apnea: overlaps in pathophysiology, systemic inflammation, and cardiovascular disease. Patient reported outcome measures: their role in measuring and improving patient experience.
International consensus on taxonomy, terminology, and definitions of measurement properties: results of the COSMIN study.
The significance of respiratory symptoms and the diagnosis of chronic bronchitis in a working population. Validation of the International Restless Legs Syndrome Study Group rating scale for restless legs syndrome. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Prevalence of sleep-related symptoms in a primary care population – their relation to asthma and COPD.
Temazepam 10 mg does not affect breathing and gas exchange in patients with severe normocapnic COPD. Restless legs syndrome, sleep impairment, and fatigue in chronic obstructive pulmonary disease. Cognitive behavioral therapy for insomnia comorbid with COPD is feasible with preliminary evidence of positive sleep and fatigue effects.
A randomized controlled trial of cognitive behavioral therapy for anxiety and depression in COPD.
Sleep quality, daytime sleepiness and fasting insulin levels in women with chronic obstructive pulmonary disease. Sleep profile and symptoms of sleep disorders in patients with stable mild to moderate chronic obstructive pulmonary disease. There is no relationship between chronic obstructive pulmonary disease and obstructive sleep apnea syndrome: a population study.
Home overnight pulse oximetry in patients with COPD: more than one recording may be needed.
Isolated nocturnal desaturation in COPD: prevalence and impact on quality of life and sleep. Set-up and pilot of a population cohort for the study of the natural history of COPD and OSA: the PULSAIB study.
Pattern of variables describing desaturator COPD patients, as revealed by cluster analysis.
Fixed-pressure nCPAP in patients with obstructive sleep apnea (OSA) syndrome and chronic obstructive pulmonary disease (COPD):a 24-month follow-up study. Depression, but not sleep disorder, is an independent factor affecting exacerbations and hospitalization in patients with chronic obstructive pulmonary disease.


The effect of anxiety on heart rate variability, depression, and sleep in chronic obstructive pulmonary disease. Noninvasive positive pressure ventilation in subjects with stable COPD: a randomized trial.
The review also examined the psychometric properties of identified sleep outcome measures and extracted point and variability estimates of sleep instruments used in COPD studies.
All titles, abstracts, and full texts from the identified papers were examined by the lead author (APG) for reference to specific sleep instruments or data indicating that at least one sleep outcome measure had been used. As it was anticipated that the number of PROMs that had been developed and validated for use in COPD populations was likely to be very small, rather than using the full COSMIN checklist we used four PROM characteristics recommended by the US Food and Drug Administration22 to evaluate the measurement properties of identified sleep PROM instruments in relation to their use in COPD patients, ie, conceptual and measurement model, reliability, validity, and responsiveness to change. Where available, we also collected data regarding the relationships between sleep outcome instruments and other established COPD outcome measures (such as the St George’s Respiratory Questionnaire,23 the Medical Research Council Dyspnea scale,24 and routine clinical tests). We believe that we have identified all of the main PROMs of sleep disorders that have been used in COPD populations. Only one item relates specifically to breathing problems, ie, shortness of breath, coughing, and chest tightness.
KTP aims to help businesses to improve their competitiveness and productivity through the better use of knowledge, technology, and skills that reside within the UK knowledge base. JY read and verified the suitability of the articles for review and also participated in consensus meetings.
Methods: The online EMBASE, MEDLINE, PsycINFO, and SCOPUS databases for all years to May 2014 were used to source articles for the review. Two investigators (APG and JY) read independently all titles, abstracts, and full texts of all the retrieved articles to determine which were eligible for review. Most studies involved patients with moderate-severe COPD recruited from hospital outpatient or specialist respiratory clinics.
The items are scored on a five-point scale ranging from 0 if the item never applies, to 4 if the item applies very often. Further, as these symptoms are all contained within the same item, it is not possible to differentiate patients who may have different severity of symptoms; for example, between patients who wake up at night only with shortness of breath or wake up with both shortness of breath and coughing. The need for validated COPD-specific sleep outcome measures was emphasized in an expert panel meeting held in 2011.45 While appreciating the multifactorial nature of sleep disturbance in COPD, the panel highlighted the need for an instrument to classify patients according to their night or daytime symptoms, which is not possible using existing PROMs for sleep. The review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The reference lists and citations of selected articles were also searched to identify any additional sleep PROMs not found by the electronic database search. A total raw score is produced from the sum of the seven individual scores which is then linearly transformed to a 0–100 total scale score. However, by cross-checking the reference lists of all included papers and that of a recent systematic review of instruments designed to measure sleep dysfunction in adults,15 we believe we have minimized the loss of any important papers. Since the publication of the original paper, the CASIS has not been used in any intervention studies, so further evidence is needed to confirm the utility of this instrument in guiding the clinical management of COPD patients and in research. Development work on new COPD sleep PROMs to address these limitations is currently being carried out by the authors of this review. ST and JY are guarantors of the paper, taking responsibility for the integrity of the work as a whole from inception to the published article. Results: One COPD-specific and six non-COPD-specific sleep outcome measures were identified and 44 papers met the review selection criteria. We only identified one instrument, the COPD and Asthma Sleep Impact Scale, which was developed specifically for use in COPD populations.
Conclusion: The results highlight a need for existing non-disease-specific instruments to be validated in COPD populations and also a need for new disease-specific measures to assess the impact of sleep problems in COPD.



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