Chronic Obstructive Pulmonary Disease (COPD), a condition that damages the lung airways causing a range of symptoms like chest tightness, breathlessness, wheezing and persistent cough, is one of the leading causes of morbidity and mortality in the country.
In India, COPD accounts for five lakhs deaths, more than four times the number of people dying in the USA and Europe due to this disease. With an estimated prevalence of more than 57?million in the year 2016, COPD is not just one of the most prevalent diseases in the country but also one of the lesser understood as well.
A very significant aspect of COPD that affects almost 75% of the patients, the night-time discomfort, often goes unnoticed by the clinician. Night-time syndrome is so overlooked aspect of COPD that even patients do not report it themselves, resulting in detrimental effects on their overall health.
Explaining nigh-time symptom in COPD, Dr. PP Bose, Pulmonologist, Founder, Saans Foundation, New Delhi says, "Normally our breathing changes during sleep due to general muscle relaxation that slightly increases airway resistance. In a healthy individual, because of an overall relaxed state and lesser oxygen demand in the body, this slightly reduced pace is normal. But with people suffering from COPD, this change brings added challenge because the airflow in their lungs is already restricted. Therefore, this nocturnal change in breathing can lead to a whole set of immediate and long-term symptoms."
Immediate effects of night-time symptom include fatigue and low productivity, the long-term consequences involve lung function changes, increased exacerbation frequency, emergence or worsening of cardiovascular disease, cognitive effects, depression, impaired quality of life and increased mortality.
Despite a numerous under-reporting and poor understanding of clinical effects of sleep disturbances, the data suggests that the prevalence of nocturnal symptoms and symptomatic sleep disturbance is extremely high in COPD patients.
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"Giving its serious health implications and significant role in overall COPD management, night-time symptoms should be taken as in important indicator of treatment efficiency. In COPD there is a marked difference in morning and night symptoms. While in the morning symptom includes an increase in phlegm and cough, at night it is wheezing, chest tightness, frequent nocturnal awakenings, difficulty falling back to sleep after an awakening and shortened sleep duration. Therefore, an effective treatment regimen should consider both set of symptoms," says Dr. R. Vijaikumar, Pulmonologist, Apollo Hospital, Hyderabad.
There are studies which indicate that night time symptoms may be the marker for the emergence of severe condition with more risk for an exacerbation.
So when it comes to achieving the treatment goals for the COPD patients, ensuring proper sleep by managing night-time symptom is very important. For this, addressing the underlying causes that disturb the sleep with medicines or assisted ventilation can be helpful.
While most COPD patients respond reasonably well to the pharmacological therapies (the drugs that improve the passages of air into the lungs), in cases where such therapies are not effective enough to ensure a disturbance-free sleep, some form of assisted ventilation is recommended such as noninvasive ventilation (NIV) therapy.
Unlike surgical airway assistance, where either unhealthy part of the lungs or a pocket of air from one of the lungs is surgically removed to aid healthier part of the lung to work better, NIV helps patients to breathe better by delivering mechanically assisted breaths.
NIV provides predetermined pressure support through a mask attached to an air tube that helps the patients with night-time symptoms by reversing nocturnal respiratory insufficiency and facilitating an easier breathing.
The benefits of NIV is not confined to giving immediate help with night-time symptom in COPD, but due to the long-term effects of quality sleep on health, it goes on to improving survival in COPD patients.
Since a better disease control also effectively means an all-round health benefit, NIV has shown to reduce hospital stay, complications, exacerbations and bring an overall improvement in the quality of life in the COPD patients with recognized night-time symptoms.
So, while we have options to effectively manage the night-time symptoms in COPD, the real problem lies with identifying it as a serious clinical issue. Therefore, it is important that not just patients, but clinicians should acknowledge that addressing the problem of disturbed sleep in COPD is crucial in reducing exacerbations and improving treatment outcomes.