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The prevalence of poor sleep quality and its associated factors in patients with interstitial lung disease: a cross-sectional analysis

Jin-Gun Cho, Alan Teoh, Mary Roberts, John Wheatley
ERJ Open Research 2019 5: 00062-2019; DOI: 10.1183/23120541.00062-2019
Jin-Gun Cho
1Westmead Hospital, Dept of Respiratory and Sleep Medicine, Westmead, Australia
2University of Sydney, Ludwig Engel Centre for Respiratory Research, Westmead Institute for Medical Research, Sydney, Australia
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  • ORCID record for Jin-Gun Cho
  • For correspondence: Jin-Gun.Cho@health.nsw.gov.au
Alan Teoh
1Westmead Hospital, Dept of Respiratory and Sleep Medicine, Westmead, Australia
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Mary Roberts
2University of Sydney, Ludwig Engel Centre for Respiratory Research, Westmead Institute for Medical Research, Sydney, Australia
3Westmead Hospital, Respiratory Ambulatory Care Service, Dept of Respiratory and Sleep Medicine, Westmead, Australia
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John Wheatley
1Westmead Hospital, Dept of Respiratory and Sleep Medicine, Westmead, Australia
2University of Sydney, Ludwig Engel Centre for Respiratory Research, Westmead Institute for Medical Research, Sydney, Australia
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  • FIGURE 1
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    FIGURE 1

    Frequency histogram of the distribution of Pittsburgh Sleep Quality Index (PSQI) for 101 patients. Green shaded columns represent normal PSQI (i.e. ≤5 units), black columns represent increased PSQI (>5 units).

Tables

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  • TABLE 1

    Baseline characteristics of patients with interstitial lung disease

    VariablePoor sleep quality (PSQI>5)Good sleep quality (PSQI≤5)p-value
    Subjects n6734
    Age years68.3±10.471.6±10.30.13
    Males n (%)35 (54%)21 (62%)0.52
    BMI kg·m−228.1 (25.2–32.9)27.9 (23.8–32.5)0.57
    FEV1 % pred65.1±19.268.7±20.40.40
    FVC % pred63.3±18.865.9±20.50.54
    STOP-Bang au4.0±1.63.6±1.40.19
    ESS au7 (4–8)4 (2–7)0.003
    Neck circumference cm39.7±4.839.3±3.70.75
    mMRC au2.3±1.11.9±1.00.08
    SGRQ-Symptoms57.2±20.739.4±19.2<0.0001
    SGRQ-Activities75.8±19.466.7±19.00.03
    SGRQ-Impacts48.0±20.235.7±19.70.005
    SGRQ-Total au58.0±16.046.1±16.80.001
    HADS-Anxiety au7.1±4.64.4±3.40.004
     0–7 n/N (%)37/65 (57%)28/34 (82%)
     8–21 n/N (%)28/65 (43%)6/34 (18%)
    HADS-Depression au6.8±3.84.4±3.90.004
     0–7 n/N (%)37/65 (57%)29/34 (85%)
     8–21 n/N (%)28/65 (43%)5/34 (15%)

    Data are presented as mean±sd or median (interquartile range), unless stated otherwise. PSQI: Pittsburgh Sleep Quality Index; BMI: body mass index; FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; ESS: Epworth Sleepiness Scale; mMRC: modified Medical Research Council Dyspnoea Scale; SGRQ: St George's Respiratory Questionnaire; HADS: Hospital Anxiety and Depression Scale (0–7=normal, 8–10=borderline abnormal, 11–21=abnormal); au: arbitrary units.

    • TABLE 2

      Sleep latency, sleep duration and Pittsburgh Sleep Quality Index (PSQI) component score data obtained from PSQI questionnaire

      VariablePoor sleep quality (PSQI>5)Good sleep quality (PSQI≤5)p-value
      Sleep latency min30 (15–45)10 (5–15)<0.0001
      Sleep duration h6 (5–7)8 (7–9)<0.0001
      PSQI global score au9.8±2.93.5±1.2
      PSQI component scores#
       Sleep quality1.43±0.660.68±0.64<0.0001
       Sleep latency1.77±0.900.44±0.61<0.0001
       Sleep duration1.25±1.050.12±0.41<0.0001
       Habitual sleep efficiency1.68±1.090.15±0.36<0.0001
       Sleep disturbance1.97±0.691.38±0.55<0.0001
       Use of sleep medications0.62±1.140.03±0.170.004
       Daytime dysfunction1.25±0.790.71±0.720.001

      Data are presented as mean±sd or median (interquartile range), unless stated otherwise. au: arbitrary units. #: Each component score ranges from 0 (no difficulty) to 3 (severe difficulty) on a Likert scale.

      • TABLE 3

        Individual questions for component 5 (sleep disturbance) in the Pittsburgh Sleep Quality Index (PSQI) questionnaire

        VariablePoor sleep quality (PSQI>5)Good sleep quality (PSQI≤5)p-value
        Cannot get to sleep within 30 min2 (1–3)0 (0–1)<0.0001
        Wake up in the middle of the night or early morning3 (2–3)2 (0–3)0.002
        Have to get up to use the bathroom3 (2–3)3 (2–3)0.45
        Cannot breathe comfortably2 (0–3)0 (0–2)0.02
        Cough or snore loudly3 (1–3)1 (0–3)0.07
        Feel too cold1 (0–3)1 (0–1.25)0.02
        Feel too hot1 (0–2.5)0 (0–0.25)0.0004
        Have bad dreams1 (0–3)0 (0–0)0.14
        Have pain1 (0–3)0 (0–2)0.006
        Other reasons1 (0–3)0 (0–1)0.001

        Data presented as median (interquartile range), unless stated otherwise. Scores are as follows. 0: not during the past month; 1: less than once a week; 2: one or twice a week; 3: three or more times a week.

        • TABLE 4

          Final model from multivariable logistic regression

          Adjusted odds ratio#
          (95% CI)
          Wald χ2DFp-value
          HADS-Depression score
           0 to 21.0¶13.7830.003
           3 to 42.59 (0.69–9.75)
           5 to 810.05 (2.5–40.0)
           ≥98.91 (2.1–37.8)
          ESS score
           0 to 21.0¶8.9030.03
           3 to 51.19 (0.33–4.25)
           6 to 85.64 (1.2–26.5)
           ≥84.47 (1.2–16.5)

          HADS: Hospital Anxiety and Depression Scale; ESS: Epworth Sleepiness Scale; DF: degrees of freedom. #: adjusted for HADS-D and ESS; ¶: reference category.

          Supplementary Materials

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            Supplementary tables 1 and 2 00062-2019_Supplementary_material

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          The prevalence of poor sleep quality and its associated factors in patients with interstitial lung disease: a cross-sectional analysis
          Jin-Gun Cho, Alan Teoh, Mary Roberts, John Wheatley
          ERJ Open Research Jul 2019, 5 (3) 00062-2019; DOI: 10.1183/23120541.00062-2019

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          The prevalence of poor sleep quality and its associated factors in patients with interstitial lung disease: a cross-sectional analysis
          Jin-Gun Cho, Alan Teoh, Mary Roberts, John Wheatley
          ERJ Open Research Jul 2019, 5 (3) 00062-2019; DOI: 10.1183/23120541.00062-2019
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