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Σύγκριση της ποιότητας ύπνου ασθενών με σοβαρό βρογχικό άσθμα και χρόνια αποφρακτική πνευμονοπάθεια (Master thesis)

Πορπόδης, Κωνσταντίνος

Sleep is a vital function of the human body. Studies show that it is related both to one's physical and mental health but also to one's quality of life and survival. Currently there are no official guidelines with the aim to assess each person's needs and for implementing appropriate habits and programs to achieve quality and adequate sleep. Sleep disorders include any sleep-related disorder - from its onset to its maintenance - and affect all stages of sleep. Sleep disorders remain often underdiagnosed and without receiving any kind of treatment. Nowadays sleep disorders are considered as a major problem that affects not only each one of us but also the society because of their impact on quality of life. Asthma is a common disease that is characterized by chronic inflammation of the airways and variable obstruction of air flow. Recurrent episodes of symptomatic blockage of the airways are observed. These episodes are characterized by wheezing, shortness of breath, chest tightness and cough. After a diagnosis of bronchial asthma has been reached and all co-morbidities have been under control, severe asthma is defined as high-dose asthma requiring ICS + 2nd regimen (and / or OCS) treatment to be controlled or remaining "uncontrolled" rather than the above treatment or controlled asthma deregulated by reducing high doses of ICS or OCS (or other biological agents). Some of the dysfunctions that are found in asthma include difficulty in getting and maintaining sleep, very early morning wake up and excessive daytime sleepiness. According to the most recent definition of GOLD, COPD is a common disease that can be prevented and treated. It is characterized by persistent respiratory symptoms and restriction of air flow due to the pathology of the airways and / or cells, usually due to significant exposure to toxic particles or gases. 4 stages of disease severity are recognized: mild - moderate - severe - very severe degree of obstruction. Sleep disorders in COPD patients include difficulty in getting and maintaining sleep, reduced sleep duration, apnea-hypnosis, excessive daytime sleepiness, insomnia, hypoxemia and hypoventilation during sleep, obstructive sleep apnea syndrome, central apnea and restless legs syndrome. There is high need for achieving an early diagnosis and providing treatment at the early stages of the disease. The purpose of this study was to compare the sleep quality between patients with severe asthma and patients with severe and very severe chronic obstructive pulmonary disease. A cross - sectional observational study was conducted. From March 4, 2019 until June 28, 2019, patients who are periodically monitored at the Outpatient Clinic for Obstructive Pulmonary Disease participated in the study. At first each patient participated in a semi - structured interview in order to provide doctors with a detailed medical history. Afterwards patients were assessed with pulmonary function tests. At the end the participants completed a number of questionnaires (ACT, CAT, Mmrc, PSQI, Epworth Scale, Athens Insomnia Scale). Descriptive statistics were used to analyze both the qualitative and quantitative variables. Specific tests were later used in order to compare data. Fifty patients participated in the study (mean age of 61.28 ± 12.15 years). The participants were divided into two groups: a group of 25 patients with a confirmed diagnosis of severe asthma and a group of 25 patients, who were diagnosed with severe and very severe COPD. Results showed that patients with severe and very severe COPD had worse sleep quality compared to patients with severe asthma, as they scored higher on the Pittsburgh Sleep Quality Index (PSQI) questionnaire (9.2 ± 2.93 vs. 8, 52 ± 4.04), on the Epworth Sleepiness Scale (ESS) (8 ± 2.27 versus 6.48 ± 3.38) and on the Athens Sleep Scale (9.68 ± 2.94 compared to 9.12 ± 4.67). However, no statistically significant differences were found between them. There was a statistically significant difference in sleep duration between the two groups of patients (6.14 hours ± 1.02 in asthma compared to 5.48 hours ± 0.78, p = 0.029). There is a need to design and carry out new studies to investigate the pathophysiological mechanisms between sleep disorders and COPD and asthma and to organize a diagnosis and detection program for disorders, which will be implemented in daily clinical practice with the ultimate goal of improving quality of life of patients.