The Effect of Symptom Clusters and Sleep Disorder on Quality of Life among Patients with Chronic Obstructive Pulmonary Disease

BACKGROUND: Symptoms (cough, dyspnea, fatigue, depression, and sleep disorder) in chronic obstructive pulmonary disease (COPD) are related to poor quality of life (QOL). Better understanding of the symptom clusters (SCs) and sleep disorder in COPD patients could help to accelerate the development of symptom-management interventions. OBJECTIVE: We aim to explore the effect of sleep disorder and symptom clusters on the QOL in patients with COPD. METHODS: 223 patients with stable COPD from November 2019 to November 2020 at the Affiliated People's Hospital of Ningbo University in China were included in this cross-sectional survey. A demographic and clinical characteristics questionnaire, the Revised Memorial Symptom Assessment Scale (RMSAS), the Pittsburgh Sleep Quality Index (PSQI), and the St George Respiratory Questionnaire for COPD (SGRQ-C) were completed by the patients. Exploratory factor analysis was conducted to extract SCs, and logistic regression analysis was performed to analyze the risk factors affecting QOL. RESULTS: Three clusters were extracted: respiratory functional cluster, emotional cluster, and fatigue-sleep cluster. 70.4% of the participants were poor sleepers. Subgroup analysis showed that COPD patients with poor sleep quality were significantly different in QOL, emotional cluster, and fatigue-sleep cluster compared with patients with normal sleep. In multiple regression, sleep quality and respiratory functional cluster were associated with QOL. CONCLUSION: In patients with stable COPD, three symptom clusters were explored. Symptom clusters correlate with clinical features and negatively affect QOL. Appropriate interventions are expected to inform future approaches to symptom management. Future studies are needed to test interventions that may be effective at improving the QOL of COPD patients.