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Original article
Analysis of nocturnal actigraphic sleep measures in patients with COPD and their association with daytime physical activity
  1. Gabriele Spina1,2,
  2. Martijn A Spruit3,4,5,
  3. Jennifer Alison6,7,
  4. Roberto P Benzo8,
  5. Peter M A Calverley9,
  6. Christian F Clarenbach10,
  7. Richard W Costello11,
  8. David Donaire-Gonzalez12,13,14,
  9. Selina Dürr15,
  10. Judith Garcia-Aymerich12,13,14,
  11. Arnoldus J R van Gestel10,
  12. Marco Gramm16,
  13. Nidia A Hernandes17,
  14. Kylie Hill18,
  15. Nicholas S Hopkinson19,
  16. Diana Jarreta20,
  17. Malcolm Kohler10,
  18. Anne M Kirsten16,
  19. Jörg D Leuppi15,
  20. Helgo Magnussen16,
  21. François Maltais21,
  22. William D-C Man19,
  23. Zoe J McKeough6,
  24. Rafael Mesquita3,22,
  25. David Miedinger15,
  26. Fabio Pitta17,
  27. Sally J Singh23,
  28. Frank W J M Smeenk24,
  29. Ruth Tal-Singer25,
  30. Barbara Vagaggini26,
  31. Benjamin Waschki16,
  32. Henrik Watz16,
  33. Emiel F M Wouters3,22,
  34. Stefanie Zogg15,
  35. Albertus C den Brinker2
  1. 1 Department of Signal Processing Systems, Technische Universiteit Eindhoven, Eindhoven, The Netherlands
  2. 2 Data Science Group, Philips Research, Eindhoven, The Netherlands
  3. 3 Department of Research and Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
  4. 4 REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
  5. 5 Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
  6. 6 Clinical and Rehabilitation Sciences, The University of Sydney, Sydney, New South Wales, Australia
  7. 7 Physiotherapy Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
  8. 8 Mindful Breathing Laboratory, Mayo Clinic, Rochester, Minnesota, USA
  9. 9 School of Ageing and Chronic Disease, University Hospital Aintree, Liverpool, UK
  10. 10 Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland
  11. 11 Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
  12. 12 Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
  13. 13 CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
  14. 14 Universitat Pompeu Fabra (UPF), Barcelona, Spain
  15. 15 Medical University Clinic, Cantonal Hospital Baselland, Liestal and Medical Faculty, University of Basel, Basel, Switzerland
  16. 16 Pulmonary Research Institute at Lung Clinic Grosshansdorf, Airway Research Center North, Member of the German Centre for Lung Research, Grosshansdorf, Germany
  17. 17 Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
  18. 18 School of Physiotherapy and Exercise Science, Curtin University, Perth, Washington, Australia
  19. 19 NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK
  20. 20 AstraZeneca, Barcelona, Spain
  21. 21 Centre de recherche, Institut Universitaire de cardiologie et de pneumologie de Québec, 2725 Chemin Ste-Foy Québec, Université Laval, Québec, Canada
  22. 22 Department of Respiratory Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
  23. 23 Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS Trust, Leicester, UK
  24. 24 Department of Respiratory Medicine, Catharina Hospital, Eindhoven, The Netherlands
  25. 25 GSK R&D, King of Prussia, Pennsylvania, USA
  26. 26 Cardio-Thoracic and Vascular Department, University of Pisa, Pisa, Italy
  1. Correspondence to Gabriele Spina, Dr Data Science Group, Philips Research, High Tech Campus 34, Eindhoven 5656 AE, The Netherlands; gabriele.spina{at}


Background Sleep disturbances are common in patients with chronic obstructive pulmonary disease (COPD) with a considerable negative impact on their quality of life. However, factors associated with measures of sleep in daily life have not been investigated before nor has the association between sleep and the ability to engage in physical activity on a day-to-day basis been studied.

Aims To provide insight into the relationship between actigraphic sleep measures and disease severity, exertional dyspnoea, gender and parts of the week; and to investigate the association between sleep measures and next day physical activity.

Methods Data were analysed from 932 patients with COPD (66% male, 66.4±8.3 years, FEV1% predicted=50.8±20.5). Participants had sleep and physical activity continuously monitored using a multisensor activity monitor for a median of 6 days. Linear mixed effects models were applied to investigate the factors associated with sleep impairment and the association between nocturnal sleep and patients' subsequent daytime physical activity.

Results Actigraphic estimates of sleep impairment were greater in patients with worse airflow limitation and worse exertional dyspnoea. Patients with better sleep measures (ie, non-fragmented sleep, sleeping bouts ≥225 min, sleep efficiency ≥91% and time spent awake after sleep onset <57 min) spent significantly more time in light (p<0.01) and moderate-to-vigorous physical activity (p<0.01).

Conclusions There is a relationship between measures of sleep in patients with COPD and the amount of activity they undertake during the waking day. Identifying groups with specific sleep characteristics may be useful information when designing physical activity-enhancing interventions.

  • COPD Pathology
  • Exercise

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  • Contributors GS, MAS, ACdB, conceived and designed the analysis. GS analysed the data and drafted the first version of the manuscript. MAS and ACdB. provided advice at all stages of the analysis. ACdB provided statistical support. MAS, JA, RPB, PMAC, CFC, RWC, DD-G, SD, JG-A, AJRvG, MG, NAH, KH, NSH, DJ, MK, AK, JDL, HM, FM WD-CM, ZJMcK, RM, DM, FP, SJS, FWJMS, RT-S, BV, BW, HW, EFMW and SZ. contributed to the acquisition of data in each centre included and/or participated in the critical revision of the manuscript. All authors accepted the final version of the manuscript.

  • Funding The Eindhoven-based authors and the CIRO-based authors gratefully acknowledge the financial support received by the iCare4COPD Project of Agentschap NL under Contract PNE101005. The Basel-based authors gratefully acknowledge the financial support received by the foundations ‘Gottfried und Julia Bangerter-Rhyner-Stiftung’, ‘Freiwillige Akademische Gesellschaft Basel’ and ‘Forschungsfonds der Universität Basel’.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The data collection was conducted in accordance with the declaration of Helsinki and approved by ethics committees at each of the participating centres, according to local regulations.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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