SLEEP BREATHING PHYSIOLOGY AND DISORDERS • ORIGINAL ARTICLE Subjective sleep quality is associated with disease status in COPD patients. The cross-sectional Greek UNLOCK study Despo Ierodiakonou 1,2 & Izolde Bouloukaki 1,3 & Maria Kampouraki 4 & Polyvios Papadokostakis 5 & Ioannis Poulorinakis 6 & Irene Lampraki 2 & Polyxeni Athanasiou 2 & Sophia Schiza 3 & Ioanna Tsiligianni 1 & On behalf of the Greek UNLOCK Group Received: 10 October 2019 /Revised: 12 February 2020 /Accepted: 13 February 2020 # Springer Nature Switzerland AG 2020 Abstract Purpose The association of chronic obstructive pulmonary disease (COPD) severity and related health status with sleep quality remains unclear. We aimed to investigate the association between COPD and sleep quality in the Greek national branch of the UNLOCK cohort. Methods A sample of 257 COPD patients enrolled cross-sectionally from primary care in Greece. Sleep quality was assessed by the COPD and Asthma Sleep Impact Scale (CASIS-7 items) questionnaire (higher score indicates worse sleep quality). We tested for associations of sleep impairment with health status (CAT and mMRC scores), exacerbations, hospitalizations, GOLD 2018 ABCD status, inhaler adherence, frailty, and sense of coherence, adjusting for age, gender, smoking status, and comorbidities. Results The majority of patients reported uncontrolled symptoms (91% with ≥ 10 CAT or 61% with ≥ 2 mMRC). Mean (SD) age was 65 (12.3) with 79% males. CASIS-7 mean (SD) score was 37.7 (12.9). After adjustments, CASIS was significantly associated with worse health status (e.g., CASIS increased with CAT ≥ 10 [β = 12.53, (95% CI, 6.82, 18.25); p < 0.001], mMRC ≥ 2[β = 4.96, (95% CI, 1.56, 8.34); p = 0.004]), COPD severity (CAT-based GOLD BD [β = 8.88 (95% CI, 2.50, 15.26); p = 0.007]), frailty [β = 8.85 (95% CI 4.45,13.25); p < 0.001], and sense of coherence [β = -0.14 (95% CI -0.21, -0.06), p < 001]. When using a CASIS cut-off score of 30 as indicator of sleep impairment, additional to the aforementioned associations, we found increased risk for sleep impairment with ≥ 2 exacerbations/year and poor inhaler adherence (p value < 0.05). Conclusions Our study suggests that worse health status and COPD severity are associated with poor sleep quality in COPD patients. Keywords Sleep quality . Chronic obstructive pulmonary disease . COPD and asthma sleep impact scale (CASIS) . Health status . Exacerbations Introduction Chronic obstructive pulmonary disease (COPD) is a common respiratory disease associated with high morbidity and mortality [1]. COPD patients more frequently experience poor sleep quality compared to healthy subjects and nocturnal symptoms that potentially impact long-term outcomes of the disease; however, these symptoms are often not reported or Despo Ierodiakonou and Izolde Bouloukaki contributed equally to this work. * Izolde Bouloukaki izolthi@gmail.com * Ioanna Tsiligianni i.tsiligianni@uoc.gr 1 Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Voutes Campus, GR-71003 Heraklion, Crete, Greece 2 Department of Public Health, Heraklion University Hospital, Heraklion, Crete, Greece 3 Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, Voutes Campus, GR-71003 Heraklion, Crete, Greece 4 Primary care practice, Health Center of Moires, Heraklion, Crete, Greece 5 Garipa primary care practice, Health Center of Arcalohori, Heraklion, Crete, Greece 6 Primary care practice, Health Center of Agia Varvara, Heraklion, Crete, Greece Sleep and Breathing https://doi.org/10.1007/s11325-020-02039-8