COPD with Greater Mortality Risk Linked to Worse Sleep Quality

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A study presented as a late breaker at SLEEP 2024 found patients with COPD who have a greater mortality risk have a worse sleep quality.

Sleep quality is worse in patients with chronic obstructive pulmonary disease (COPD) who have a greater mortality risk, according to a late breaker presented in June at SLEEP 2024, the 38th annual meeting of the Associated Professional Sleep Societies.1

COPD, the third leading cause of death worldwide, led to 3.23 million deaths in 2019.2 The most common symptoms include difficulty breathing, chronic cough, and feeling tired.

The tiredness may stem from patients with COPD often having poor sleep quality. Patients with COPD often have insomnia, obstructive sleep apnea, and nocturnal hypoxemia.3 The latter can be severe in rapid eye movement sleep. Additionally, some factors unique to COPD can contribute to sleep-related hypoventilation—being aware of hypoventilation is crucial as supplemental oxygen therapy can worse hypoventilation and lead to harmful consequences.

Investigators, led by Truong-An Andrew Ho, MD, from the department of thoracic medicine and surgery, Lewis Katz School of Medicine at Temple University, sought to confirm their hypothesis that sleep quality is worse in COPD patients with a greater mortality risk.1 They leveraged participants from the COPDGene project and the NETT trial who completed overnight polysomnogram. Before the polysomnogram participants had spirometry perform to confirm the presence of COPD.

Additionally, to determine mortality risk with the BODE index, participants in the COPDGene project underwent a 6-minute walk and completed the mMRC score questionnaire. Participants in the NET trial had their BODE index calculated using the UCSD SOBQ based on a quartile distribution. Moreover, sleep quality was measured by total sleep time and sleep efficiency.

For all participants, their BODE score determined what quartile they would belong in: quartile 1 (score of 0 – 2), quartile 2 (score of 3 – 4), quartile 3 (score of 5 – 6), and quartile 4 (score of 7 – 10).

The sample included 59 patients with 48% males and the mean age 62±8 years. Participants had a mean BMI of 28 ±7 kg/m2 and a mean apnea-hypopnea index of 5.7 ±9.6 events/hr].

In total, quartile 1 had 14 patients, quartile 2 had 21 patients, quarter 3 had 10 patients, and quartile 4 had 14 patients.

Investigators observed sleep quality was significantly worse for patients in quartile 4 with poor total sleep time (199±101 min) and sleep efficiency (49±23%), compared to quartile 3 259±88 min and 65±22%, respectively), quartile 2 (298±80 min and 74±20%, respectively) and quartile 1 (290±69 min and 67±19%, respectively (P =.008 and P =.01, respectively). The quartiles had no significant differences in nocturnal oxygenation as measured by mean SaO2 (P = .28), lowest SaO2 (P = .11), and the percentage of total sleep time SaO2 < 90% (P = .42).

“Sleep quality, as measured by total sleep time and sleep efficiency, is worse in COPD patients with a higher mortality risk based on the BODE index,” investigators concluded. “Whether poor sleep quality contributes to a higher mortality is yet to be determined.”


  1. Ho, T. Ayyoub, J, Vega-Sanchez, M. Association Between Sleep Quality and Predicted Mortality in Patients with COPD. Abstract presented at SLEEP 2024. Houston, TX. June 1-5, 2024.
  2. Chronic Obstructive Pulmonary Disease (COPD). World Health Organization. March 16, 2023. Accessed March 16, 2024.
  3. Budhiraja R, Siddiqi TA, Quan SF. Sleep disorders in chronic obstructive pulmonary disease: etiology, impact, and management. J Clin Sleep Med. 2015;11(3):259-270. Published 2015 Mar 15. doi:10.5664/jcsm.4540