ArticlePloS one2021
Impact of pulmonary rehabilitation in sleep in COPD patients measured by actigraphy.
Article in PloS one, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
10 citing papers in PubMed, 2 syntheses or guidelines pooled it, 16 citations in OpenAlex.
- What is the most effective non-pharmacological treatment for poor sleep quality in Chronic obstructive pulmonary disease patients? a systematic review.Sleep & breathing = Schlaf & Atmung · 2026Pooled it
- Pooled it
- Impact of positive expiratory pressure buddy during exercise on chronic obstructive pulmonary disease patients' functional performance, lung function, and sleep quality: a randomized controlled trial.European journal of physical and rehabilitation medicine · 2025Trial
- Wearable Sleep Measures May Improve Machine Learning Prediction of Home-Based Pulmonary Rehabilitation Engagement Among Patients With Chronic Obstructive Pulmonary Disease: A Proof-of-Concept Study.Mayo Clinic proceedings. Digital health · 2026Article
- Article
- Article
- Pulmonary rehabilitation improves sleep efficiency measured by actigraphy in poorly sleeping COPD patients.Scientific reports · 2023Article
- Sleep Quality and Self-Reported Symptoms of Anxiety and Depression Are Associated with Physical Activity in Patients with Severe COPD.International journal of environmental research and public health · 2022Article
- Improving Physiological, Physical, and Psychological Health Outcomes: A Narrative Review in US Veterans with COPD.International journal of chronic obstructive pulmonary disease · 2022Review
- Comparison of the Effects of Diaphragmatic Breathing and Pursed-lip Breathing Exercises on the Sleep Quality of Elderly Patients with Chronic Obstructive Pulmonary Disease (COPD): A Clinical Trial Study.Therapeutic advances in pulmonary and critical care medicineArticle
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionChronic obstructive pulmonary disease (COPD) patients have poor sleep quality, longer time to sleep onset and frequent nocturnal awakenings. Poor sleep quality in COPD is associated with poor quality of life (QoL), increased exacerbations and increased mortality. Pulmonary rehabilitation (PR) improves functional status and QoL in COPD but effects on sleep are unclear. PR improves subjective sleep quality but there is paucity of objective actigraphy data. We hypothesized that actigraphy would demonstrate subjective and objective improvement in sleep following PR. Paired comparisons (t-test or Wilcoxon-signed-rank test) were performed before and after PR data on all variables.
methodsThis retrospective study of COPD patients undergoing PR utilized actigraphy watch recordings before and after 8-weeks of PR to assess changes in sleep variables including total time in bed (TBT), total sleep time (TST), sleep onset latency (SOL), sleep efficiency (SE), wakefulness after sleep onset (WASO) and total nocturnal awakenings. A change in Pittsburg Sleep Quality Index (PSQI) was a secondary outcome. PSQI was performed before and after PR.
resultsSixty-nine patients were included in the final analysis. Most participants were male (97%), non-obese (median BMI 27.5, IQR 24.3 to 32.4 kg/m2) with an average age of 69 ± 8 years and 71% had severe COPD (GOLD stage 3 or 4). Prevalence of poor sleep quality (PSQI ≥5) was 86%. Paired comparisons did not show improvement in actigraphic sleep parameters following 8-weeks PR despite improvements in 6-min-walk distance (6MWD, mean improvement 54 m, 95% CI 34 m to 74 m, p<0.0001) and St. George's Respiratory Questionnaire scores (SGRQ, mean improvement 7.7 points, 95% CI 5.2 to 10.2, p<0.0001). Stratified analysis of all sleep variables by severity of COPD, BMI, mood, mental status, 6-MWD and SGRQ did not show significant improvement after PR. In Veterans with poor sleep quality (PSQI ≥ 5), PR improved subjective sleep quality (PSQI, mean difference 0.79, 95% CI 0.07 to 1.40, p = 0.03).
conclusionsPulmonary rehabilitation improved subjective sleep quality in Veterans who had poor sleep quality at the beginning of the PR but did not improve objective sleep parameters by actigraphy. Our findings highlight the complex interactions among COPD, sleep and exercise.
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