![]() 7 After we adjusted for differences in age, sex, and insurance coverage, these patients were 1.65-fold more likely to have insomnia than controls without respiratory disease. In another survey, insomnia was the third most common comorbidity reported by patients with chronic airway obstruction, after locomotive diseases (rheumatoid arthritis, arthrosis, slipped disc, a back disorder lasting for more than three months), and hypertension. Only 36% of non-COPD patients reported difficulty initiating or maintaining sleep, and fewer than 11% reported excessive daytime sleepiness. These rates were significantly higher compared with those in patients without respiratory disease. 6 COPD was defined as either chronic bronchitis alone, chronic bronchitis with asthma, or emphysema. In a survey of 2,187 participants in the Tucson Epidemiologic Study of Obstructive Airways Disease, more than 50% of patients with COPD complained of difficulty initiating or maintaining sleep and more than 25% reported excessive daytime sleepiness. Patients with COPD often have a high prevalence of sleep-related problems. We then supplemented the clinical literature according to an analysis of the references collected from the original literature search.ĪSSOCIATION BETWEEN SLEEP-RELATED DISORDERS AND PULMONARY DISEASE Our search included all studies conducted between January 1996 and September 2008. In researching this topic, we conducted a PubMed literature search using the terms hypnotics and sedatives insomnia sleep disorders pulmonary disease, chronic obstructive and ramelteon. We emphasize the benzodiazepines, the non-benzodiazepines, and a melatonin receptor agonist, ramelteon (Rozerem, Takeda). Our article reviews the relationship between COPD and insomnia, as well as nonpharmacological and pharmacological management strategies. Therefore, special considerations are needed to ensure optimal outcomes while minimizing the potential for adverse events, especially among patients with impaired lung function. It is already well established that the prevalence of insomnia is higher among older adults and that its management and treatment is especially challenging in this population because of multiple comorbidities, polypharmacy, and safety concerns. Thus, with the expected increase in the elderly population over the next 20 years, the prevalence of COPD is expected to rise. 4 According to one survey, 34% of patients reported that they were prevented from working because of COPD, and among patients of working age with COPD, an average of 18.7 days of work were missed during the preceding year. 1 COPD has also had a detrimental effect on patients’ quality of life, often resulting in poor physical functioning, an inability to work, and depression. 1 The remaining $15.9 billion was attributed to lost productivity resulting from excess morbidity ($8 billion) and mortality ($7.9 billion). 1 The $26.7 billion in direct costs included $11.3 billion for hospital care, $6.2 billion for prescription drugs, $4.9 billion for physician services, $3.3 billion for nursing-home care, and $1.0 billion for home health care. In 2007, COPD was associated with $42.6 billion in direct and indirect costs. health care system also is expected to increase. 1 With the proportion of Americans 65 years of age and older expected to increase from 12.4% in 2005 to 20.7% in 2050, 3 the burden of COPD on the U.S. 2 COPD is more prevalent among people 65 years of age and older and affects 10% of individuals in this age group. 1 Each year, approximately 726,000 hospitalizations, 1.5 million emergency department (ED) visits, and 8 million physician visits are associated with COPD. 1 COPD and allied conditions are the fourth leading cause of death in the U.S., with more than 120,000 deaths having been reported in 2004. Approximately half of these cases remain undiagnosed. Chronic obstructive pulmonary disease (COPD) is a prevalent medical condition in the U.S, affecting almost 24 million adults.
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