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99]

Original Article

Assessment of Sleep and Quality of Life Among Chronic Obstructive

Airways Disease Patients
Mahima Malhotra, Ruchi Sachdeva1, Sandeep Sachdeva2

Department of Psychiatry, Objective: To assess sleep and quality of life among chronic obstructive airway

ABSTRACT
Govind Ballabh Pant disease patients. Materials and Methods: Patients with primary, mild-to-moderate,
Institute of Medical
Education and Research,
stable chronic obstructive airways disease [asthma and chronic obstructive pulmonary
New Delhi, 1Department disease (COPD)] on treatment visiting outpatient department of a government hospital
Respiratory Medicine, ESIC were interviewed using a predesigned, pretested, semi-structure schedule. The
Medical College, Faridabad, patients were then administered standardized Pittsburgh sleep quality index
Haryana, 2Department of (PSQI), St. George’s respiratory questionnaire (SGRQ), and Epworth sleepiness
Community Medicine, North scale (ESS) questionnaires. Patients with any other known chronic disease, chest
Delhi Municipal Corporation deformity, or long-term oxygen therapy were excluded. Using purposive sampling
Medical College and Hindu
frame, 120 chest patients (asthma and COPD) and in addition, 30 ambulatory patients
Rao Hospital, New Delhi,
India without having any underlying chronic respiratory diseases were also recruited for
comparison purpose. Results: Mean age was 50.2 years. Mean duration of sleep
during night was 5.40 h [±1.6; 95% confidence interval (CI) = 4.98–5.82] for patients
with COPD; 5.53 h (±1.6; 95% CI = 5.11–5.95) for patients with asthma, and 6.97 h
(±1.0; 95% CI = 6.57–7.36) for control patients (P < 0.001). It was noticed that 63.3%
of control patients had at least 6 h of night sleep in comparison to 23.3% of chest
patients (P < 0.01). Good PSQI score (up to 5 points) was found in 86.6% of control
patients while it was found only in 35.0% of chest patients (P < 0.01); mean PSQI
score among asthma was 8.08, 8.06 (COPD), and 3.46 among control patients,
respectively. All the control patients (100%) reported good score for quality of
life while chest patients reported good score for SGRQ (activity, impact, and
symptoms) as 64.1, 83.3, and 82.5%, respectively (P < 0.01). Based on ESS,
none of the patients complained of daytime sleepiness. To conclude, poor sleep
was noticed in our study sample.
KEYWORDS: Asthma, chest, chronic respiratory diseases, COPD, ESS, MMSE, PSQI,
Received: July 2017
Accepted: March 2018 quality of life, SGRQ, sleep quality, smoking, tobacco

INTRODUCTION have many systemic effects and complications related to

A sthma and chronic obstructive pulmonary disease
(COPD) are important public health respiratory
problems over the world. The global prevalence of
asthma and COPD in general population ranges from 1
to 18% and 3 to 11%, respectively.[1] India is currently
harboring a staggering 57,000,000 people suffering from
obstructive airway diseases with at least 35% of adult
population consuming tobacco in some form.[2,3] Although
chronic respiratory diseases affect primarily the
respiratory tract/lungs but lately have been found to
cardiovascular, musculoskeletal, neurological system,
with nutritional, and metabolic effects.[4,5]
Sleep-related disturbances and insomnia have been shown
to be higher in patients with COPDs than that in the general
population, ranging between 50 and 70% of patients
Address for correspondence: Dr. Ruchi Sachdeva, Department
Respiratory Medicine, ESIC Medical College, Faridabad,
Haryana, India.
E-mail: drsachdeva@hotmail.com

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DOI: How to cite this article: Malhotra M, Sachdeva R, Sachdeva S.

10.4103/jacp.jacp_20_17 Assessment of Sleep and Quality of Life Among Chronic Obstructive
Airways Disease Patients. J Assoc Chest Physicians 2018;6:45-52.

© 2018 The Journal of Association of Chest Physicians | Published by Wolters Kluwer - Medknow 45
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Malhotra, et al.: Sleep and quality of life in asthma and COPD patients
reporting difficulty in initiating or maintaining sleep, or
having poor sleep quality.[6] Disturbed sleep has been
found to be associated with more severe disease,
frequent exacerbations, and increased mortality. Poor
sleep quality also affects the quality of life in COPD
and patients with asthma.[7,8] There are limited studies
performed in Indian context exploring the sleep quality
pattern among chronic respiratory disease patients.
With this background a study was undertaken to
determine sleep and quality of life among primary
obstructive airway disease as well as control patients
visiting a government hospital.
MATERIALS AND METHODS
The interview schedule captured sociodemographic
details and consisted of mix of self rating response
items elicited in local language by researcher followed
by treatment, advice, and counseling. Sociodemographic
variables included age, gender, marital status, education,
tobacco consumption/smoking, duration of illness,
history of hospitalization of at least 24 h in past 1-year,
sleep pattern, and duration. Some of the details, especially
duration of sleep, daytime sleepiness, etc. was re-checked
with the patient’s accompanying spouse, if available.
The patients were then assessed using standardized
Pittsburgh sleep quality index (PSQI), St. George’s
respiratory questionnaire (SGRQ), Epworth sleepiness
scale (ESS), mini mental status examination (MMSE).
Patients with any known chronic liver, kidney, heart,
neurological disease, malignancy, chest deformity, or
long-term oxygen therapy were excluded.
A study was performed in Hindu Rao Hospital, New
Delhi a government teaching hospital among ambulatory,
stable, adult patients in a comfortable, confidential,
and nonjudgemental manner. Using purposive sampling
frame, 120 diagnosed chest patients (asthma and COPD)
on treatment visiting outpatient department were
clinically evaluated and interviewed using predesigned,
pretested, semi-structure interview schedule during the
period January to March 2014 after seeking informed
written consent of patients and ethical consideration.
In addition, 30 ambulatory patients without having
any underlying chronic respiratory disease reporting
for common cold/muscular pain/generalized weakness,
etc., were also mobilized for comparison purpose.
Brief on study instruments.
Pittsburgh sleep quality index
Sleep quality was measured using the PSQI, a self-rated
subjective questionnaire comprising 19 questions that
generate seven “component” scores (sleep quality, sleep
latency, sleep duration, habitual sleep efficiency, sleep
disturbances, use of sleeping medication, and daytime
dysfunction).[9] Each component score is marked from
46 The Journal of Association of Chest Physicians ¦ Volume 6 ¦ Issue 2 ¦ July-December 2018
0 to 3, with a maximum total score of 21 and a minimum
score of 0. The sum of the component scores yields
a global PSQI score. A global score up to 5 indicates
“good” overall sleep quality, whereas a score >5 indicates
“poor” sleep quality with a diagnostic sensitivity
and specificity of 89.6 and 86.5%, respectively. In
comparison with other tools to measure sleep, the PSQI
has undergone extensive psychometric evaluation. It
has been shown to have high test–retest reliability and
construct validity.
St. George’s respiratory questionnaire
It is designed to measure impact on overall health, daily
life, and perceived well-being in patients with obstructive
airways disease. It covers three domain-symptoms,
activity, and impact. It addresses the frequency of
respiratory symptoms and patient’s current health
state (i.e., how they are these days). The activity score
measures disturbances in daily physical activity. The
impacts score covers a range of disturbances of psycho-
social function.[10] Score ranges from 0 to 100 with
zero indicating best and higher score indicating worse
state.
Mini mental status examination
It has 22 items, which examines various cognitive
capacities (orientation to time and place, memory,
attention, concentration, recognition of objects, language
function, comprehension and expressive speech, motor
functioning, and praxis). The total score is 30
with higher score indicating worse condition. Hindi
adaptation of the MMSE instrument was used in this
study.[11]
Epworth sleepiness scale
The ESS is intended to measure daytime sleepiness.[12]
The patients were interviewed to rate their probability
of falling asleep on a scale of 0–3 with increasing
probability for eight situations that most people engage
during their daily lives, though not necessarily every
day. The scores for the eight questions are added
together to obtain a single number. A number in the
0–9 range is considered to be normal, while a number
in the 10–24 range indicates that expert medical advice
should be sought.
Statistical and data analyses
All categorical variables were expressed as frequencies
and percentages, and continuous variables were expressed
as mean and standard deviation. For the purpose of
analysis, PSQI score of 0 and 1 (better score) was
classified into good and score of 2 and 3 as worse.
Same concept was applied to other scales as applicable.
Among all the patients, it was found out that average
night sleep was 5.7 h; therefore, sleep duration in the night
was dichotomised into less than and more 6 h duration to
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Malhotra, et al.: Sleep and quality of life in asthma and COPD patients

explore association with other co-variables. There were no RESULTS

missing values. Descriptive statistics and association
between variables were determined using chi-square
test while the strength of association with co-variables
was measured by contingency coefficient and considered
significant at P < 0.05. Data management was undertaken
using the Statistical Package for the Social Sciences
version 16.0 software (IBM, Chicago, USA). Some of
the inherent limitations of this study include hospital
based convenience sampling; sleep duration was
assessed on subject recall that is prone for bias; in
addition, patients could not undergo polysomnography
evaluation due to resource constraints.
Background details
Out of a total of 150 patients, there were 60 (40%)
patients with asthma; 60 (40%) patients with COPD;
and 30 (20%), control patient. Overall mean age
was 50.2 years [chest patients had mean age of 51.0
(±13.4) years while control patients were 47.2 (±12.7)
years old (P > 0.05)]. Table 1 shows the background
information of patients.
Sleep duration
Mean duration of sleep during night was 5.40 h [±1.6;
95% confidence interval (CI): 4.98–5.82] for patients

Table 1: Background information of study patients (chest and control patients)

Variable Control Chest patients Total Chi square value CC P value
patients (asthma and COPD) subjects
N = 30 (%) n = 120 N = 150 (%)
Age (years) Up to 50 9 (30.0) 31 (25.8) 40 (26.6) 0.213 0.038 0.644
>50 21 (70.0) 89 (74.1) 110 (73.3)
Gender Female 7 (23.3) 45 (37.5) 52 (34.6) 2.127 0.118 0.145
Male 23 (76.6) 75 (62.5) 98 (65.3)
Marital status Un-married 0 6 (5.0) 6 (4.0) 1.562 0.102 0.211
Married 30 (100) 114 (95.0) 144 (96.0)
Education Up to primary 15 (50.0) 59 (49.1) 74 (49.3) 0.007 0.007 0.953
> Primary 15 (50.0) 61 (50.9) 76 (50.6)
Tobacco Yes 13 (43.3) 69 (57.5) 82 (54.6) 1.94 0.041 0.616
consumption No 17 (56.6) 51 (42.5) 68 (45.3)
Psych illness Yes 2 (6.6) 8 (6.7) 10 (6.6) 0 0 1.0
No 28 (93.3) 112 (93.3) 140 (93.3)
Sleep-night <6 h 11 (36.6) 92 (76.6) 103 (68.6) 17.84 0.32 <0.01
≥6 h 19 (63.3) 28 (23.3) 47 (31.3)
PSQI-global Good 26 (86.6) 42 (35.0) 68 (45.3) 25.85 0.383 <0.01
Worse 4 (13.3) 78 (65.0) 82 (54.6)
PSQI-duration Good 23 (76.6) 48 (40.0) 71 (47.3) 12.94 0.282 <0.01
Worse 7 (23.3) 72 (60.0) 79 (52.6)
PSQI-disturbance Good 30 (100) 76 (63.3) 106 (70.6) 15.56 0.307 <0.01
Worse 0 44 (36.6) 44 (29.3)
PSQI-latency Good 24 (80.0) 43 (35.8) 67 (44.6) 18.94 0.335 <0.01
Worse 6 (20.0) 77 (64.1) 83 (55.3)
PSQI-daytime Good 28 (93.3) 54 (45.1) 82 (54.6) 22.62 0.362 <0.01
dysfunction Worse 2 (6.9) 66 (55.0) 68 (45.3)
PSQI-habitual Good 28 (93.3) 73 (60.8) 101 (67.3) 11.52 0.267 <0.01
sleep efficiency Worse 2 (6.9) 47 (39.1) 49 (32.6)
PSQI-quality Good 30 (100) 117 (97.5) 147 (98.0) 1.02 0.082 0.598
Worse 0 3 (2.5) 3 (2.0)
PSQI-medication Good 30 (100) 115 (95.8) 145 (96.6) 1.26 0.092 0.261
Worse 0 5 (4.2) 5 (3.3)
SGRQ-activity Good 30 (100) 77 (64.1) 107 (71.3) 49.03 0.496 <0.01
Worse 0 43 (35.8) 43 (28.6)
SGRQ-impact Good 30 (100) 100 (83.3) 130 (86.6) 29.06 0.404 <0.01
Worse 0 20 (16.6) 20 (13.3)
SGRQ-symptom Good 30 (100) 99 (82.5) 129 (86.0) 20.42 0.346 <0.01
Worse 0 21 (17.5) 21 (14.0)
PSQI = Pittsburgh sleep quality index, SGRQ = St. George’s respiratory questionnaire, CC = contingency coefficient. Percentage given in
brackets.

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Malhotra, et al.: Sleep and quality of life in asthma and COPD patients

with COPD; 5.53 h (±1.6; 95% CI: 5.11–5.95)
for patients with asthma; and 6.97 h (±1.0; 95% CI:
6.57–7.36) for control patients (P < 0.001). Association
between demographic variables, sleep quality, and
sleep duration is shown in Table 1. Significantly
higher proportion of control patients had positive
feature in comparison to chest patients, that is,
63.3% of control patients had more than 6 h of
night sleep in comparison to 23.3% of chest patients
(P < 0.01).
Sleep quality
Good PSQI score (up to 5) was found in 86.6%
of control patients while it was found only in
35.0% of chest patients (P < 0.01). Mean PSQI
score was 8.08 (asthma), 8.06 (COPD), and 3.46
(control) patients, respectively, with higher score
indicating worse condition. On considering duration of
illness among chest patients into <2 and ≥2 years, mean
PSQI score was 6.5 and 8.19 for asthma while it was 8.2
and 8.0 for patients with COPD. With regard to
presence or absence of psychiatric co-morbidity
among chest patients, average PSQI score was 9.5
(present) and 7.98 (normal) among asthma while it
was 12.5 (present) and 7.75 (normal) patients with
COPD. On considering tobacco consumption, overall
mean PSQI score was 7.20 for tobacco consumer
and 7.08 for nonconsumer. Component wise PSQI
score (good/worse) is shown in Figures 1 and 2,
respectively.

Proportion of asthma patients with good and worse PSQI score

100% 2 4
90%
20 22
80%
28
70% 34
41 39
60%
50% 58 56
40%
40 38
30%
32
20% 26
19 21
10%
0%
PSQI dur PSQI dist PSQI late PSQI dady PSQI effic PSQI qual PSQI med PSQI
global

Good score Worse score

Figure 1: Proportion of asthma patients (n = 60) with good and worse PSQI score

Proportion of COPD patients with good and worse PSQI score

100% 1 2
90%
80% 24 25
70% 38 36 38 39
60%
50% 59 58
40%
30% 36 35
20% 22 24 22 21
10%
0%
PSQI dur PSQI dist PSQI late PSQI dady PSQI effic PSQI qual PSQI med PSQI
global

Good score Worse score

Figure 2: Proportion of COPD patients (n = 60) with good and worse PSQI score

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Malhotra, et al.: Sleep and quality of life in asthma and COPD patients

Quality of life good PSQI score (good quality) slept for >6 h. This
All the control patients (100%) reported good score for is adequately reflected by moderately incremental
quality of life (SGRQ-activity, impact and symptoms) values of contingency coefficient, a factor of strength
while only 64.1, 83.3, and 82.5% of chest patients of association.
reported good score for SGRQ, respectively (P < 0.01).
Based on MMSE, all the chest and control patients had
Mean values of quality of life (SGRQ score) is shown in
normal cognitive capacities. Similarly on ESS, none of the
Table 2.
patient complained of daytime sleepiness.
Duration of night-sleep, PSQI and SGRQ score was
significantly associated (P < 0.01) with type of patients
(chest vs. control). Further association was explored for
DISCUSSION
sleep duration (less than and >6 h) with sleep quality. A descriptive study was undertaken to assess subjective
Details are shown in Tables 3 and 4. Quality and sleep pattern among ambulatory, mild-to-moderate, stable,
quantity (duration) of sleep is an inter-linked primary cases of obstructive airway disease (asthma and
concept. Higher proportion of patients with poor COPD) on treatment presenting as follow up visits
PSQI score (poor quality) slept for <6 h while the at outpatient department of a mid level government
inverse, that is, higher proportion of patients with hospital of Delhi, India. Our study showed significant
differences reflecting poor quality of sleep and quality
of life among chronic obstructive airway disease (asthma
Table 2: Quality of life score among all study patients and COPD) patients in comparison to controls. Among
Quality of life (SGRQ) Asthma COPD Control chest patients, it was noticed that only 23.3% had at least
Mean value (range: 0–100)* 6 h of night sleep while 65% had poor PSQI global score
SGRQ-activity 63.69 67.26 10.49 (>5 points); 35.8, 16.6, and 17.5% had poor SGRQ score
SGRQ-impact 50.16 54.27 5.93 related to activity, impact and symptoms, respectively. All
SGRQ-symptoms 45.53 54.25 8.77 the patients were nonobese, had normal cognitive capacity
Total score 53.13 58.16 9.27 with none reporting daytime sleepiness. Globally it is
*Value near 0 indicates best while 100 indicates worst quality of life known that poor sleep quality is observed more
score. frequently among patients with COPD; however, in our

Table 3: Association of sleep quality with sleep duration (<6 h) among patients
Sleep quality parameter Sleep duration (<6 h)
Score Control Asthma COPD Total Chi-square CC P value
N = 11 N = 45 N = 47 N = 103
PSQI-global Good 7 (63.6) 12 (26.6) 10 (21.2) 29 (28.1) 7.99 0.268 0.018
Worse 4 (36.3) 33 (73.3) 37 (78.7) 74 (71.8)
PSQI-duration Good 4 (36.3) 11 (24.4) 9 (19.1) 24 (23.3) 1.53 0.121 0.464
Worse 7 (63.6) 34 (75.5) 38 (80.8) 79 (76.6)
PSQI-disturbance Good 11 (100) 29 (64.4) 26 (55.3) 66 (64.0) 7.73 0.264 0.021
Worse 0 16 (35.5) 21 (44.6) 37 (35.9)
PSQI-latency Good 7 (63.6) 12 (26.6) 16 (34.0) 35 (33.9) 5.38 0.223 0.068
Worse 4 (36.3) 33 (73.3) 31 (65.9) 68 (66.0)
PSQI-daytime dysfunction Good 11 (100) 22 (48.8) 15 (31.9) 48 (46.6) 16.77 0.374 0
Worse 0 23 (51.1) 32 (68.0) 55 (53.3)
PSQI-habitual sleep efficiency Good 9 (81.8) 25 (55.5) 23 (48.9) 57 (55.3) 3.901 0.191 0.142
Worse 2 (18.1) 20 (44.4) 24 (51.0) 46 (44.6)
PSQI-quality Good 11 (100) 43 (95.5) 46 (97.8) 100 (97.0) 0.80 0.08 0.668
Worse 0 2 (4.4) 1 (2.1) 3 (2.9)
PSQI-medication Good 11 (100) 41 (91.1) 46 (97.8) 98 (95.1) 5.27 0.222 0.072
Worse 0 4 (8.8) 1 (2.1) 5 (4.9)
SGRQ-activity Good 11 (100) 28 (62.2) 29 (61.7) 68 (66.0) 6.34 0.241 0.042
Worse 0 17 (37.7) 18 (38.2) 35 (33.9)
SGRQ-impact Good 11 (100) 35 (77.7) 39 (82.9) 85 (82.5) 3.27 0.176 0.195
Worse 0 10 (22.2) 8 (17.0) 18 (17.4)
SGRQ-symptoms Good 11 (100) 39 (86.6) 40 (85.1) 90 (87.3) 2.72 0.16 0.256
Worse 0 6 (13.3) 7 (14.8) 13 (12.6)
PSQI = Pittsburgh sleep quality index, SGRQ = St. George’s respiratory questionnaire, CC = contingency coefficient. Percentage given in brackets.

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Malhotra, et al.: Sleep and quality of life in asthma and COPD patients

Table 4: Association of sleep quality with sleep duration (>6 h) among patients
Sleep quality parameter Sleep duration (≥6 h)
Score Control Asthma COPD Total Chi-square CC P value
N = 19 N = 15 N = 13 N = 47
PSQI-global Good 19 (100) 9 (60.0) 11 (84.6) 39 (82.9) 9.53 0.411 0.009
Worse 0 6 (40.0) 2 (15.3) 8 (17.0)
PSQI-duration Good 19 (100) 15 (100) 13 (100) 47 (100) –
Worse 0 0 0 0
PSQI-disturbance Good 19 (100) 11 (73.3) 10 (76.9) 40 (85.1) 5.652 0.328 0.059
Worse 0 4 (26.6) 3 (23.0) 7 (14.8)
PSQI-latency Good 17 (89.4) 7 (46.6) 8 (61.5) 32 (68.0) 7.423 0.369 0.024
Worse 2 (10.5) 8 (53.3) 5 (38.4) 15 (31.9)
PSQI-daytime dysfunction Good 17 (89.4) 10 (66.6) 7 (53.8) 33 (70.2) 5.251 0.317 0.072
Worse 2 (10.5) 5 (33.3 6 (46.1) 13 (27.6)
PSQI-habitual sleep efficiency Good 19 (100) 13 (86.6) 12 (92.3) 44 (93.6) 2.545 0.227 0.28
Worse 0 2 (13.3) 1 (7.6) 3 (6.3)
PSQI-quality Good 19 (100) 15 (100) 13 (100) 47 (100) –
Worse 0 0 0 0
PSQI-medication Good 19 (100) 15 (100) 12 (92.3) 46 (97.8) 2.595 0.231 0.273
Worse 0 0 1 (7.6) 1 (2.1)
SGRQ-activity Good 19 (100) 10 (66.6) 10 (76.9) 39 (82.9) 7.061 0.361 0.029
Worse 0 5 (33.3) 3 (23.0) 8 (17.0)
SGRQ-impact Good 19 (100) 15 (100) 11 (84.6) 45 (95.7) 5.463 0.323 0.065
Worse 0 0 2 (15.3) 2 (4.2)
SGRQ-symptoms Good 19 (100) 12 (80.0) 11 (84.6) 42 (89.3) 3.953 0.279 0.139
Worse 0 3 (20.0) 2 (15.3) 5 (10.6)
PSQI = Pittsburgh sleep quality index, SGRQ = St. George’s respiratory questionnaire, CC = contingency coefficient. Percentage given in brackets.

study COPD and patients with asthma had similar poor
results. Quality of sleep can be improved by ensuring
compliance to treatment, management of co-morbidities
including gastro esophageal reflux, oxygen therapy,
providing training for inhaler technique, counseling, life
style changes, behavior change communication, avoidance
of trigger factors and rehabilitation.[13-18]
On review of literature, Nunes et al.[7] reported that
70% of patients with COPD had poor sleep quality; and
the quality of sleep was the major determinant of quality
of life in those patients. In another recent study more than
half of the patients with COPD experienced poor sleep
quality. The most common sleep complaints included
getting up for the bathroom, waking up at night or in
the early morning, and coughing or snoring loudly.[19] In a
study by Scharf et al.[20] sleep quality was also associated
with quality of life and sleep disturbance predicted poor
survival in patients with COPD.[21] The factors resulting
in sleep disturbance are not well understood. There
are multi-factorial causation and/or determinants of a
particular health state yet conservatively it can be
commented that quality of sleep was disproportionately
more affected than quality of life among our sampled
asthma and patients with COPD. With regard to quality
of life, similar but slightly better status has been reported
among COPD in a community based study conducted by
Ahmed et al. in Aligarh, Uttar Pradesh.[22] The mean
SGRQ score in this community based study was 49.54
(symptom score), 41.47 (activity score), 33.58 (impact
score) and 38.89 (total score). In our hospital based
study, the mean score (poor condition) was found to be
slightly higher [Table 2].
It is noted that according to Global Adult Tobacco
Survey, prevalence of tobacco consumption among
adults in India has decreased by 6.0% point from 35%
(2009–10) to 28.6% (2016–17).[23] Based on these,
there were 274.9 million tobacco users with 163.7
million users of only smokeless tobacco, 68.9 million
only smokers and 42.3 million users of both smoking
and smokeless tobacco in the country with mean age at
initiation being 18.9 years. The survey also reported that
38.7% [rural (44.4%) to urban (27.9%)] of adults were
exposed to second-hand-smoke at home. According to
Census 2011, two third of households in country are
using firewood/crop residue, cow dung cake/coal, etc.,
in their kitchen. The tobacco epidemic, environmental
pollution, other risk exposure, and poor health practices
worldwide and particularly in developing country along
with extensive use of bio fuel is now presenting itself
with its adverse and diverse consequences in community
and at health facilities. This observation is further
substantiated, as COPD accounted for second most

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Malhotra, et al.: Sleep and quality of life in asthma and COPD patients
common reason for respiratory morbidity and mortality in
India after tuberculosis.[24]
Sleep is a physiological process essential to life yet one-
third of adult’s reports difficulty in sleep and the
prevalence of insomnia in general population ranges
between 10 and 48%.[25-27] Among our hospital based
study (chest plus control) patients, overall 54.6% (PSQI
score: >5) reported the same. The pattern of sleep and
wakefulness in different patients is known to vary with
their age, demands of their occupation, their physiological
and psychosocial characteristics, psychiatric illness, and
some types of physical illness.[28] In the last couple of
decades, there has been a growing attention to sleep and
sleeplessness related problems across the globe. A new
determinant of adverse sleep quality is being observed
with emergence and constant encroachment in human
life by information technology (smart phones, internet)
tools and media. This interest is mainly due to the
recognition that sleepiness and fatigue are becoming
endemic in the population.[29]
Quality of sleep can be assessed subjectively by
administration of questionnaire, clinical interviews
and sleep diaries. The objective sleep quality is
determined by polysomnography (laboratory or
home based) and actigraphy; however, it is more
challenging considering the availability of resources.
Even in mild-to-moderate patients with COPD,
polysomnography evaluation has demonstrated poor
quality and low duration of sleep[30] as observed in
our study too.
In conclusion, this study can be considered to be unique,
because the influence of chronic respiratory ailments on
sleep quality and quality of life was assessed simultaneously
using diverse globally acknowledged measurement scale
upon clinical confirmation using standard definitions. The
findings are suggestive of significantly impaired sleep
quality among chronic obstructive airway disease
patient’s in-comparison to control patients.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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52 The Journal of Association of Chest Physicians ¦ Volume 6 ¦ Issue 2 ¦ July-December 2018