Subjective sleep quality and daytime sleepiness in a large sample of patients with chronic fatigue syndrome (CFS)

Chronic fatigue syndrome (CFS) is characterised by incapacitating fatigue in combination with a number of minor criteria, including unrefreshing sleep without further specifications, in the absence of psychiatric and internal disease. As little data exist on subjective sleep quality and daytime sleepiness, these parameters were assessed in a large sample of CFS patients. Consecutive patients with a diagnosis of CFS in a tertiary referral centre filled out the Fatigue Questionnaire (FQ), Medical Outcomes Study 36-Item Short Form Health Survey (MOS SF-36), Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI). Inclusion comprised 415 individuals (mean age 40.5 yr, SD 7.9, range 18-64; 86% female). Mean FQ (26.90; SD 4.04), mean Global Physical Health from the MOS SF-36 (29.30; SD 12.25) and Global Mental Health from the MOS SF-36 (49.62; SD 18.31) scores corresponded with literature data for similar CFS samples. High mean ESS (10.51; SD 5.52) and global PSQI (10.17; SD 4.02) were observed. No significant relationship was found between ESS and global PSQI. In contrast, regression analysis demonstrated a significant cubic relation between ESS and 'PSQI without daytime dysfunction'. A subgroup (n=69) with an insomnia-like phenotype low ESS (<5), high PSQI (mean 11.51; SD 3.86) was observed. The assessment of subjective sleep quality and daytime sleepiness in a large sample of CFS patients indicated high mean PSQI and ESS values. ESS and 'PSQI without daytime dysfunction' were inversely related at the spectral ends of ESS. A distinct subgroup with clinical features of insomnia was identified.     

Night‐time sleep disturbance does not correlate with neuropsychiatric impairment in patients with cirrhosis

Background: Sleep–wake disturbances are common in patients with cirrhosis and are generally attributed to the presence of hepatic encephalopathy. Aim: To determine the relationship between sleep and neuropsychiatric disturbances in patients with cirrhosis. Methods: The study population comprised 87 patients, classified as neuropsychiatrically unimpaired or as having minimal/overt hepatic encephalopathy. Nineteen healthy volunteers served as controls. Validated questionnaires were used to assess sleep quality [Pittsburgh sleep quality index (PSQI)], day‐time sleepiness [Epworth sleepiness scale (ESS)] and diurnal preference. Health‐related quality of life (H‐RQoL) was assessed using the 36‐item short form health profile (SF‐36v1) and the chronic liver disease questionnaire. Results: Patients slept significantly less well than the healthy volunteers (PSQI score: 8.4 ± 4.9 vs. 4.6 ± 2.5, P<0.01) and had more pronounced day‐time sleepiness (abnormal ESS: 21 vs. 0%; χ²=3.8, P=0.05). No significant relationships were observed between sleep indices and the presence/degree of hepatic encephalopathy. H‐RQoL was significantly impaired in the patients (SF‐36v1 physical score: 36 ± 15 vs. 50 ± 10, P<0.001; SF‐36v1 mental score: 46 ± 11 vs. 50 ± 10, P<0.01); night‐time sleep disturbance was an independent predictor of poor H‐RQoL (P<0.01). Conclusions: Sleep–wake abnormalities are common in patients with cirrhosis; they significantly affect H‐RQoL but are not related to the presence of hepatic encephalopathy.     

Are psychiatric disorders associated with worse asthma control and quality of life in asthma patients?

BACKGROUND: Achieving good asthma control has become the major goal of asthma treatment. Studies have reported a high rate of psychiatric disorders among asthma patients, though the impact of these disorders on asthma control and quality of life remains unexplored. This study evaluated the prevalence of psychiatric disorders in 406 adult asthma patients, and associations between psychiatric status, levels of asthma control, and asthma-related quality of life. METHODS: Consecutive asthma patients presenting to the asthma clinic underwent a brief, structured psychiatric interview, completed the Asthma Control Questionnaire (ACQ) and Asthma Quality of Life Questionnaire (AQLQ), and reported the frequency of bronchodilator use in the past week. All patients underwent standard pulmonary function testing. RESULTS: A total of 34% (n=136) of patients had one or more psychiatric diagnosis, including major depression (15%), minor depression (5%), dysthymia (4%), panic disorder (12%), generalized anxiety disorder (5%), and social phobia (4%). Though there were no differences in pulmonary function, patients with versus without psychiatric disorders had worse ACQ and AQLQ scores and reported greater bronchodilator use, independent age, sex and asthma severity. CONCLUSIONS: Results suggest that psychiatric disorders are prevalent among asthmatics and are associated with worse asthma control and quality of life. Physicians should be aware of the potential risk of poorer asthma control and functional impairment in this population.     

Sleep quality and asthma control and quality of life in non-severe and severe asthma

Purpose

The effect of sleep quality on asthma control independent from common comorbidities like gastroesophageal reflux disease (GERD) and obstructive sleep apnea (OSA) is unknown. This study examined the association between sleep quality and asthma control and quality of life after accounting for OSA and GERD in non-severe (NSA) and severe (SA) asthma.

Methods

Cross-sectional data from 60 normal controls, 143 with NSA, and 79 with SA participating in the Severe Asthma Research Program was examined. Those who reported using positive airway pressure therapy or were at high risk for OSA were excluded.

Results

Both SA and NSA had poorer sleep quality than controls, with SA reporting the worst sleep quality. All asthmatics with GERD and 92% of those without GERD had poor sleep quality (p?=?0.02). The majority (88?C100%) of NSA and SA participants who did not report nighttime asthma disturbances still reported having poor sleep quality. In both NSA and SA, poor sleep quality was associated with worse asthma control and quality of life after controlling for GERD and other covariates.

Conclusions

These results suggest that poor sleep quality is associated with poor asthma control and quality of life among asthmatics and cannot be explained by comorbid GERD and nighttime asthma disturbances.     

Validation of the asthma quality of life questionnaire (AQLQ-UK English version) in Indian asthmatic subjects

BACKGROUND: The Asthma Quality of Life Questionnaire (AQLQ) has been shown to have strong measurement properties. Quality of life instruments need to be validated under local conditions before these can be accepted for application in that community. The AQLQ has not been formally validated in India. OBJECTIVES: To measure the evaluative and discriminative properties of the AQLQ (UK English version) in Indian asthmatics. METHODOLOGY: Thirty-eight adult patients with asthma underwent spirometry and completed the AQLQ and the Asthma Control Questionnaire (ACQ), administered by an interviewer. Standard treatment was given for four weeks during which daytime and nocturnal symptoms of asthma, and use of rescue medication were recorded in diaries. The questionnaires were administered again at the end of four weeks and spirometry was repeated. RESULTS: The total and domain-wise scores of AQLQ improved in patients whose control of asthma improved during treatment. It had good reproducibility with no changes in scores in patients whose condition remained stable, and also high intraclass correlation coefficients for the total and domain-wise scores in these patients. Significant correlations were found between the changes in AQLQ scores and in ACQ scores confirming the longitudinal construct validity. The symptoms domain score of the AQLQ was related significantly to the patient diary-recorded scores of cough, sputum and nocturnal asthma. Cross-sectional construct validity of AQLQ was established by demonstrating significant correlation of total, and symptoms and emotions domain scores with the ACQ scores. CONCLUSIONS: It was concluded that the AQLQ (UK English version) has sufficiently acceptable evaluative and discriminatory properties in Indian subjects and is therefore a valid instrument for quality of life measurements in clinical and research studies in asthmatics in Indian patients.     

Correlation between degree and quality of sleep disturbance and the level of neuropsychiatric impairment in patients with liver cirrhosis

Sleep disturbances are common in patients of cirrhosis and has a significant effect on their health related quality of life (HRQOL). Thus far, no study has demonstrated a systematically studied significant correlation between the sleep disturbance observed and the neuropsychiatric impairment status of patients of cirrhosis. On the basis of PHES, we divided 100 cirrhotics into those having minimal hepatic encephalopathy (MHE) (PHES≤?5) and those not (NMHE). Now, in these MHE (n=46) and NMHE (n=54) patients, sleep disturbance was measured with Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) and HRQOL with SF-36(v2) questionnaire. Sixty (60 %) patients were found to be ‘poor sleepers’ (PSQI>5) while 38 (38 %) patients had excessive daytime sleepiness (ESS≥11). Univariate and multivariate analyses showed MHE has significant effect among ‘poor sleepers’ (P<0.0001) as well as on those with EDS (P<0.0001). Significant correlation existed between PHES and both the sleep parameters of PSQI (r = ?0.518, P <0.0001) as well as ESS (r = ?0.383, P <0.0001), implying independently strong correlation between poor cognition and the presence of night time sleep disturbance and excessive daytime sleepiness among cirrhotics. Significant correlation existed between PSQI and ESS and the various scales and component scores of SF-36(v2) signifying the negative impact of sleep disturbance on the HRQOL. In conclusion, both night time sleep disturbance and excessive daytime sleepiness have significant relation with the neuropsychiatric impairment in patients of cirrhosis and are significantly associated with the observed impairment in HRQOL.     

The influence of asthma control on psychosocial outcomes for pregnant women with asthma

Objective: To investigate the relationship between asthma control and psychosocial outcomes in pregnant women with asthma. Methods: Secondary analysis (N?=?221) of a randomized controlled trial of treatment adjustments, based on fractional exhaled nitric oxide versus clinical guideline-based algorithms. Psychosocial variables included generic and asthma-specific quality of life (SF12, AQLQ-M), illness perceptions (BIPQ), perceived control (PCAQ), perceived risk of side effects (PRSE) and anxiety (STAI-6). Asthma control was defined as controlled (Asthma Control Questionnaire (ACQ7)?≤1.5 at randomization and end of study), improved (ACQ7?>?1.5 at randomization and ≤1.5 at end of study) and unimproved (ACQ7?>1.5 at end of study). Regression models were fitted for each psychosocial measure at the end of the study, with adjustment for baseline values and smoking status, with predictor variable asthma control. Results: Women with unimproved asthma had poorer physical (SF12, p?=?0.012) and asthma-specific quality of life across all domains (AQLQ-M, p?≤?0.012) compared to women with controlled asthma. They believed that they had less control over their asthma (PCAQ total p?=?0.014), had more symptoms and that their illness had a greater effect on their emotions and their lives in general (BIPQ identity, consequences, concern, emotional response p?≤?0.015). Women with improved asthma control had significantly lower AQLQ-M breathlessness (p?=?0.048) and lower total scores (p?=?0.04) than women with controlled asthma. Conclusions: Pregnant women who are not able to get control of their asthma symptoms may experience worse quality of life and are likely to have more negative perceptions about their condition.     

The Association of Anxiety with Asthma Among a Sample of Asthmatics in ILE-IFE Osun State Nigeria

Background. The association between asthma and anxiety has been a subject of various studies in developed countries, but there has been little work done in this area in developing countries. The goal of this study is to determine whether asthmatics are more anxious than orthopaedic patients and healthy individuals. Method. Fifty consecutive asthmatics were assessed. All completed a sociodemographic questionnaire, the General Health Questionnaire (GHQ—30) and the State Trait Anxiety Inventory (STAI—1 and 2). Healthy individuals (30) and orthopaedic patients (30) were also recruited as controls; they also completed the GHQ and the STAI—1 and 2. Results. No significant difference was found in the sociodemographic variables such as age, sex, occupation, and marital status. The asthmatics had a mean GHQ score of 4.2 (SD ± 4.6) while orthopaedic and healthy control groups scored 1.6 (SD ± 1.8) and 2 (SD ± 1.8), respectively. There was a significant difference in the mean score of the index population (Asthmatics) and the comparison groups (F = 7.09, DF = 2/107, P = 0.004). With GHQ, cutoff point of ≥ 5.34% of asthmatics scored above 5 while 10% and 13.3% of the orthopaedic patients and healthy controls each scored ≥ 5. A significant difference was obtained in the mean scores on the STAI—1 questionnaire (F = 4.6, DF = 2/107, P =.012) indicating state anxiety whereas there was no significant difference on the STAI—2 questionnaire (F = 1.2, DF = 2/107, P = 0.31). Conclusion. Although asthmatics have higher anxiety compared to controls, this is not an inherent problem or trait among them.     

偏头痛患者睡眠及生活质量调查研究

目的探讨偏头痛患者的睡眠状况及生活质量。方法采用匹兹堡睡眠指数（PSQI）及生活质量综合评定问卷对50例偏头痛患者进行测试,并与正常对照组比较。结果偏头痛组患者的睡眠质量、入睡时间、睡眠时间、睡眠效率、日间功能和PSQI总分均高于对照组（P〈0.05或〈0.01）。两组生活质量比较,健康对照组得分明显高于偏头痛组,两组在活动、日常生活、健康、前景及生活质量总分均存在显著差异（P〈0.05）。结论偏头痛患者睡眠状况及生活质量均较差,今后治疗中应予以重视。     

A prospective cohort study of pulmonary function during pregnancy in women with and without asthma

Background and objective: Pregnancy alters the severity of asthma unpredictably. Uncertainty still exists about longitudinal changes in pulmonary function during pregnancy in both healthy and asthmatic women. This study aimed to compare pulmonary function changes during pregnancy in healthy and asthmatic women and to determine the relationship between pulmonary function and asthma-related quality of life during pregnancy. A secondary aim was to investigate the application of forced expiratory volume in 6?s (FEV₆) for monitoring asthma during pregnancy. Methods: Pregnant women with (n?=?20) and without asthma (n?=?20) had pulmonary function tests at 8–20, 21–28 and 29–40 weeks gestation. Those with asthma also completed the Asthma Control Questionnaire (ACQ) and mini Asthma Quality of Life Questionnaire (mAQLQ) at each visit. Results: Pulmonary function declined in both groups at follow-up #1 (more markedly in those with asthma) but then improved at follow-up #2 (more markedly in those with asthma). In those with asthma, ACQ scores increased, while mAQLQ scores declined at follow-up #1; whilst at follow-up #2 these changes were in the opposite direction. FEV₆ and forced vital capacity (FVC) were highly correlated (r?=?0.88, p?<?0.01) in asthmatics. Conclusions: Pulmonary function changes during second and third trimesters were more pronounced in asthmatics than in healthy women. FEV₆ monitoring may assist pregnant women and their health professionals in optimizing asthma management. The changes in pulmonary function in women with asthma were not significantly associated with changes in asthma control or asthma-related quality of life.     

The effect of circadian-adjusted LED-based lighting on sleep,daytime sleepiness and biomarkers of inflammation in a randomized controlled cross-over trial by pragmatic design in elderly care home dwellers

AimElderly multimorbid care home dwellers are a heterogenic group of frail individuals that exhibit sleep disturbances and a range of co-morbidities. The project aimed to study the possible effect of indoor circadian-adjusted LED-lighting (CaLED) in the elderly residents’ care home on their sleeping patterns and systemic biomarkers associated with inflammation.MethodsA 16-week trial study was performed to follow the intervention and control groups using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) to monitor sleep and daytime sleepiness, and biomarkers IL-6, TNF-α and suPAR, to estimate the levels of inflammation.ResultsThere was no significant impact on sleep improvement after the short intervention time when analyzing the PSQI and ESS results. However, we found several challenges using these tools for this specific group of individuals. Thus, important knowledge was gained for future studies in elderly care home dwellers. The inflammation state throughout the entire study period was stable for most of the elderly and no significant change was detected from before to after the intervention. This study represents a first-to-date attempt to ameliorate the adverse effects of sleep disturbances that characterize a randomly chosen group of elderly multimorbid subjects, by using circadian-adjusted LED-lighting in a natural care home environment.ConclusionIn this pragmatic randomized study of home dwelling individuals we were not able to demonstrate an improved sleep pattern as judged by PSQI, ESS or a change in inflammatory state.     

Hospital Attendance Prediction Tool Also Identifies Impaired Quality of Life in Adults with Asthma in General Practice

Study objective. To assess the ability of an adult risk screening questionnaire (RSQ), previously shown to predict attendance at hospital emergency departments, to identify impaired quality of life in adult patients with asthma in general practice. Design. Baseline data from an RCT of asthma clinics in general practice, using the St. George Respiratory Questionnaire (SGRQ) to measure quality of life. Setting. Twelve general practices in Adelaide, Australia. Results. A total of 184 adult asthmatics were recruited, with a mean (standard deviation) age of 50.3 years (16.6 years). Age, gender, weight, number of comorbidities, smoking status, FEV₁ and percent predicted FEV₁ (pre-and post-bronchodilator), peak flow (pre and post), and RSQ were independently related to SGRQ scores. After adjusting for potential confounders, an RSQ score predictive of hospital attendance was also associated with an average increase (worsening) in SGRQ total score of 11.9 (95% CI: 7.6, 16.3), an average increase in activity score of 9.0 (2.5, 15.5), symptom score of 14.8 (8.6, 21.0), and impact score of 13.1 (8.6, 17.6). These represent clinically significant differences. Conclusion. An RSQ score predictive of hospital attendance should alert the general practitioner to explore and address symptom, activity, and impact domains associated with impaired quality of life in adult asthma.     

Effect of esomeprazole on nighttime heartburn and sleep quality in patients with GERD: a randomized, placebo-controlled trial

OBJECTIVES: Sleep disturbances are common in patients with gastroesophageal reflux disease (GERD). This study examined the effects of esomeprazole on nighttime heartburn, GERD-related sleep disturbances, sleep quality, work productivity, and regular activities. METHODS: This multicenter, randomized, double-blind, placebo-controlled trial included adults with GERD-associated sleep disturbances and moderate-to-severe nighttime heartburn (recorded by patient diary during screening). Patients received oral esomeprazole 40 mg (n = 220) or 20 mg (n = 226) or placebo (n = 229) once daily for 4 wk. The primary outcome was relief of nighttime heartburn. Secondary outcomes included resolution of sleep disturbances, sleep quality measured by the Pittsburgh Sleep Quality Index (PSQI) questionnaire, and work productivity measured by the Work Productivity and Activity Impairment Questionnaire. RESULTS: Nighttime heartburn was relieved in 53.1% (111/209), 50.5% (111/220), and 12.7% (28/221) of patients who received esomeprazole 40 mg, esomeprazole 20 mg, and placebo, respectively. Differences (95% CI) versus placebo were 40.5% (32.4%, 48.5%) and 37.8% (29.9%, 45.7%) and were highly significant (p < 0.0001). GERD-related sleep disturbances resolved in significantly more (p < 0.0001) patients who received esomeprazole 40 (73.7%) or 20 mg (73.2%) than in those who received placebo (41.2%). Both esomeprazole groups had greater PSQI global score changes from baseline (p < 0.0001 vs placebo) and more (p < 0.0001 vs placebo) work hours saved per week per patient compared with baseline (esomeprazole 40 mg, 11.6 h; esomeprazole 20 mg, 12.3 h; placebo, 6.2 h). CONCLUSIONS: Esomeprazole reduced nighttime heartburn and GERD-related sleep disturbances and improved sleep quality and work productivity.     

What is worse for asthma control and quality of life: depressive disorders, anxiety disorders, or both?

BACKGROUND: The high burden of asthma appears to be related to poor asthma control. Although previous studies have reported associations between depressive disorders (DDs) and anxiety disorders (ADs) and worse asthma control and quality of life, the relative impact of these disorders on asthma control and quality of life has not been explored. This study evaluated the relative impact of having a DD and/or AD on asthma control and quality of life. METHOD: Five hundred four consecutive adults with confirmed, physician-diagnosed asthma underwent a brief, structured psychiatric interview using the Primary Care Evaluation of Mental Disorders. Asthma control and asthma-related quality of life were assessed using the Asthma Control Questionnaire (ACQ) and the Asthma Quality of Life Questionnaire (AQLQ). All patients underwent standard spirometry. RESULTS: Thirty-one percent of patients (n = 157) met the diagnostic criteria for one or more psychiatric disorders (8% had DD only, 12% had AD only, and 11% had both). Analyses revealed independent effects for DDs on total ACQ scores (p < 0.01), and for DDs and ADs on total AQLQ scores and all four AQLQ subscales (p < 0.05). There were no interaction effects. CONCLUSIONS: Results suggest that DDs and ADs are associated with worse asthma-related quality of life, but only DDs are associated with worse asthma control. Interestingly, having both a DD and an AD did not confer additional risk for worse asthma control or quality of life. Physicians may want to consider the differential impact of negative mood states when assessing levels of asthma control and quality of life.     

Furosemide Given by Inhalation Ameliorates Acute Exacerbation of Asthma

Previous studies have suggested that inhaled furosemide may have a protective effect against a wide variety of bronchoconstrictor agents, but a therapeutic effect has not been established in acute exacerbation of asthma. The purpose of this study was to investigate whether inhaled furosemide would exhibit any therapeutic benefit in acute asthma. We conducted a double-blind, placebo-controlled, randomized study in 40 patients with acute mild or moderate exacerbation of asthma. All patients received intravenous (IV) aminophylline 250 mg for 90 min and IV hydrocortisone 100 mg at entry. After randomization, 3 patients were excluded from the final analysis. At 30 min after starting IV aminophylline, 20 patients were given inhaled furosemide 20 mg and 17 patients received normal saline as placebo-control. Both inhalations were given by a jet nebulizer. The baseline forced expiratory volume at 1 sec (FEV₁), peak expiratory flow rate (PEFR), and serum concentration of theophylline did not differ between the two groups. An increase in FEV₁ in the furosemide group by 28.2 ± 5.9% (mean ± SE) was noted at 60 min, and this was significantly higher than in the control group. PEFR at 60 min was also significantly higher in the furosemide group than in control group. We conclude that inhaled furosemide has a bronchodilator effect on mild to moderate exacerbation of asthma when it is used with IV theophylline. Inhaled furosemide may benefit certain acute asthma patients, especially those suffering complications from the adverse effects of β₂-agonists.     

Reliability and validity of the Spanish version of the Pittsburgh Sleep Quality Index (PSQI) in patients with fibromyalgia

Fibromyalgia (FM) is recognized as a common condition, characterized by widespread pain and associated with sleep disturbances and poor-quality sleep. The Pittsburgh Sleep Questionnaire Index (PSQI) is one of the most recommended instruments to measure sleep quality and sleep disorders. The purpose of our study was to translate the questionnaire into Spanish and to assess the psychometric properties of the Spanish version of the PSQI. A total of 138 women with FM belonging to a FM association (AFIXA, Andalusia, Spain) completed the study. Internal consistency and test–retest reliability were analyzed. Factorial analysis was performed for the PSQI components. Convergent validity of the PSQI was evaluated using Spearman’s rank correlation coefficient with the Spanish versions of the Fibromyalgia Impact Questionnaire (FIQ) and the health survey short form-36 (SF-36). In our analysis, the Spanish version of the PSQI has shown a good internal consistency of the total score, with a Cronbach’s alpha of 0.805, and an acceptable test–retest reliability, with a Spearman’s correlation coefficient of 0.773 (p < 0.001), for the total score. A two-factor structure was generated by exploratory factor analysis, with a Cronbach’s alpha of 0.866 for factor 1 and of 0.712 for factor 2. In convergent validity analysis, the PSQI total score showed a significant correlation (p < 0.01) with the FIQ total score and with the mental and physical health summaries scores of the SF-36. Our results show that the Spanish version of the PSQI provides a reliable instrument, with a good convergent validity for measuring sleep quality among Spanish FM patients.     

Fatigue in primary biliary cirrhosis is associated with excessive daytime somnolence

A significant proportion of patients with primary biliary cirrhosis (PBC) suffer from severe fatigue. The aim of this study was to characterize patterns of daytime sleep in patients with PBC (using both objective and subjective assessment approaches) and to study the association between sleep abnormality and fatigue severity. Fatigue severity was assessed in 48 female subjects with PBC (using a disease-specific quality of life instrument (the PBC-40) and a generic fatigue measure (Fatigue Impact Scale [FIS]) as well as 48 case-matched normal controls. All participants also completed the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS, which assesses daytime hypersomnolence). Objective sleep assessment was performed using accelerometry over 7 days. Global sleep quality assessed by the PSQI was significantly lower in the PBC group compared to controls (P < .0001). ESS scores were significantly higher in patients with PBC than controls (P = .0001), suggesting significantly greater daytime somnolence in the patients with PBC. Objective sleep assessment confirmed that subjects with PBC were sleeping on average almost twice as long as controls during the daytime. Both degree of daytime somnolence (ESS) and actual daytime sleep activity (accelerometry) correlated strongly with fatigue severity in the patient group (r2 = 0.5, P < .0001 and r2 = 0.2, P < .01, respectively). In conclusion, Sleep abnormality, in the form of excessive daytime somnolence, is present in a significant proportion of patients with PBC, with the degree of daytime somnolence correlating strongly with the degree of fatigue. Existing agents effective at reducing daytime somnolence (such as modafinil) hold potential for the treatment of fatigue in PBC.     

An Assessment of Change in Asthma Control among Adolescents and Adults with Persistent Asthma In Mometasone Furoate/Formoterol Fumarate Clinical Trials

Objective. This article provides evidence on the psychometric properties of the Asthma Control Questionnaire (ACQ) in adolescent and adult patients with persistent asthma treated with a combination of inhaled glucocorticoid and long-acting beta2-agonist (LABAs), and explores the factors associated with important improvements in asthma control. Methods. Data from patients in two large (n = 737 and 772) Phase III, randomized, double-blind, parallel-group, multi-center, placebo-controlled studies of mometasone furoate/formoterol fumarate (MF/F) combination formulation compared with monotherapies in subjects with persistent asthma previously treated with either low- or medium-dose inhaled glucocorticoids were used to evaluate the ACQ psychometric properties and predictors of important ACQ improvement, defined as an ACQ score decline from baseline of 0.5 or more at the end of treatment. Results. With 15% and 8% participation from adolescents in the low- and medium-dose studies, the ACQ yielded acceptable reliability (intraclass correlation coefficient ≥ 0.75), and baseline and change scores demonstrated moderate to strong correlations with other baseline measures and change scores in other measures of asthma-related health, including the Asthma Quality of Life Questionnaire (AQLQ12+) domains and total scores. More MF/F treatment group patients (48%) achieved an important ACQ change at 26 weeks compared with MF (32%), F (26%), and placebo (18%) treatment groups (p < .001). Use of rescue medications before randomization was a significant predictor of important ACQ improvement in both studies. Conclusions. These findings support the psychometric properties of the ACQ to measure asthma control among persistent asthma patients and provide confidence in the significant improvements in asthma control demonstrated by the MF/F treatment group.     

Pulmonary Rehabilitation Improves Sleep Quality in Chronic Lung Disease

Abstract

Sleep-related disorders are common in patients with chronic obstructive pulmonary disease (COPD) and, possibily, other lung disorders. Exercise has been shown to improve sleep disturbances. In patients with COPD, pulmonary rehabilitation (PR) produces important health benefits with improvement in symptoms, exercise tolerance, and quality of life. However, the effect of PR on sleep quality remains unknown. The aim of this observational study was to evaluate sleep quality in patients with chronic lung disease and the role of PR as a non-pharmacologic treatment to improve sleep. Sixty-four patients with chronic lung disease enrolled in an 8-week comprehensive PR program, and completed the study (48% male; obstructive [72%], restrictive [20%], mixed [8%]; 44% on supplemental oxygen). Baseline spirometry [mean (SD)]: FEV₁% pred = 48.9 (17.4), FVC% pred = 72.5 (18.1), and FEV₁/FVC% = 53.1 (18.9). Exercise tolerance and questionnaires related to symptoms, health-related quality of life (HRQL), and sleep quality using the Pittsburgh Sleep Quality Index (PSQI) were obtained before and after PR. 58% reported poor sleep quality (PSQI > 5) at baseline. Sleep quality improved by 19% (p = 0.017) after PR, along with significant improvements in dyspnea, exercise tolerance, self-efficacy, and HRQL. Sleep quality in patients with chronic lung disease was poor. In addition to expected improvements in symptoms, exercise tolerance, and HRQL after PR, the subgroup of patients with COPD had a significant improvement in sleep quality. These findings suggest that PR may be an effective, non-pharmacologic treatment option for sleep problems in patients with COPD.