Sleep quality, daytime sleepiness and fasting insulin levels in women with chronic obstructive pulmonary disease

Respir Med. 2005 Jul;99(7):856-63. doi: 10.1016/j.rmed.2004.11.017. Epub 2005 Jan 23.


Study objectives: To test the clinical observations that patients with chronic obstructive pulmonary disease (COPD) have impaired sleep quality without excessive daytime sleepiness (EDS), and to analyse the aetiological factors.

Participants: Fifteen non-diabetic postmenopausal women with moderate to severe COPD and 20 community dwelling age-matched control women.

Measurements and results: Patients completed questionnaires, had a polysomnography and blood tests. Controls filled in the questionnaires. In the Basic Nordic Sleep Questionnaire, the average (+/-sd) scores for sleepiness (9.9+/-3.0 in patients vs. 7.6+/-3.2 in controls, P = 0.025, test range 4-20) and insomnia (18.3+/-3.4 vs. 16.6+/-4.4, P = 123, test range 7-35) were low. Although 53% had a good night's sleep seldom or never and 70% slept restlessly, only 33% felt tired in the mornings. Controls reported better sleep quality, less tiredness and sleepiness. With polysomnography, the total sleep time was 4h 41 min +/-1h 20 min in patients. Sleep was fragmented, the proportion of stage 1 sleep high and rapid eye movement (REM) latency delayed. Sleepiness correlated with fasting serum insulin levels (r = 0.59, P = 0.027) and body movements (r = 0.52, P = 0.047). In stepwise linear regression analyses, sleepiness was positively associated with insulin levels (P = 0.025) but not with body movements. Insulin explained 38.0% of the variance in the sleepiness score, when adjusted for body mass index (BMI).

Conclusions: Despite short and fragmented sleep, non-diabetic patients with COPD did not have marked EDS. An association between fasting insulin and sleepiness suggests that insulin resistance is involved in EDS.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Case-Control Studies
  • Disorders of Excessive Somnolence / etiology*
  • Disorders of Excessive Somnolence / metabolism
  • Disorders of Excessive Somnolence / physiopathology
  • Fasting / blood
  • Female
  • Forced Expiratory Volume / physiology
  • Humans
  • Hypercapnia / etiology
  • Hypoxia / etiology
  • Insulin / metabolism*
  • Polysomnography
  • Postmenopause
  • Pulmonary Disease, Chronic Obstructive / complications*
  • Pulmonary Disease, Chronic Obstructive / metabolism
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Regression Analysis
  • Vital Capacity / physiology


  • Insulin