Cardio-pulmonary Rehabilitation and Sleep Quality
Cardio-pulmonary Rehabilitation and Sleep Quality
In this prospective cohort study the investigators aim to evaluate the effect of pulmonary
 rehabilitation on sleep quality. Disturbed sleep is associated with, frequent exacerbations,
 increase in the severity of disease and increased mortality in chronic obstructive pulmonary
 disease (COPD). Sleep quality is a good predictor of quality of life in patients with stable
 COPD. However, there has been little investigation into non-pharmacological methods to
 improve sleep quality in patients with COPD and heart failure. It is also uncertain, how long
 the beneficial effects of cardio-pulmonary rehabilitation on sleep quality, if any, usually
 last. Due to lack of robust data, the investigators sought to find the effect of
 cardio-pulmonary rehabilitation on sleep quality.
Sleep disorders including poor quality of sleep are common in patients with heart failure,
 chronic obstructive pulmonary disease (COPD) and, possibly, other chronic lung disorders.
 These patients complain of difficulty sleeping and sleep fragmentation, often related to
 symptoms such as cough, sputum production or shortness of breath. Patients with COPD and
 heart failure commonly have other abnormalities such as nocturnal oxygen desaturation that
 may further worsen sleep disturbances. Moreover, sleep disordered breathing (SDB), like
 obstructive sleep apnea syndrome (OSA), has been linked to higher morbidity and mortality if
 COPD is present (known as Overlap syndrome). In patients with COPD and heart failure,
 cardio-pulmonary rehabilitation has important health benefits such as improvement in disease
 related symptoms, exercise tolerance, and health-related quality of life. However, the effect
 of cardio-pulmonary rehabilitation on sleep quality is controversial. Disturbed sleep is
 associated with frequent exacerbations, increase in the severity of disease and increased
 mortality in COPD and heart failure patients.

 The investigators hypothesize that cardio-pulmonary rehabilitation results in improved sleep
 quality in patients with chronic lung disease and heart failure, this may be an important
 contributor to improved health outcomes after completion of cardio-pulmonary rehabilitation
 program.

 The study will use data from questionnaires filled by the patients before and after
 completion of cardio-pulmonary rehabilitation. A 3-month follow up survey using the same
 questionnaires will be conducted to determine the longevity of improved sleep quality (if
 present). The questionnaires that will be used include Pittsburgh sleep quality index (PSQI),
 Epworth sleepiness scale (ESS), Berlin questionnaire, COPD assessment test (CAT) for COPD
 patients, Kansas city cardiomyopathy questionnaire (KCCQ) for heart failure patients,
 hospital induced anxiety and depression scale (HADS) and insomnia severity index (ISI).
Inclusion Criteria:

 -  Age > 18 years

 -  Patient who are willing to participate in follow-up survey 3 months after completion
 of pulmonary rehabilitation.

 -  Patients who complete rehabilitation for at least 8 weeks.

 Exclusion Criteria:

 • Not meeting inclusion criteria