Impact of cough on insomnia and sleep quality in bronchiectasis

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Chronic cough is one of the main symptoms of bronchiectasis patients and it is responsible for poor quality of life. No studies explored the impact of cough on sleep quality (SQ). In order to investigate if cough may affect SQ and evaluate its correlation with sleep impairment, adults (≥18 years) with non-CF bronchiectasis were consecutively enrolled in a prospective study at the Bronchiectasis Program of the Policlinico Hospital, Milan, from Dec. ‘19 to Feb. ‘20. Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and Insomnia Severity Index (ISI) were collected to evaluate SQ and presence of sleepiness and insomnia. Leicester Cough Questionnaire (LCQ) was collected to assess cough. A global sum of 5 or more according to PSQI indicated a poor SQ. A cut-off value of 1,3 in LCQ was used to identify symptomatic cough. Association between PSQI, ESS, ISI, Sleep Efficacy (SE) and LCQ was evaluated. A total of 119 patients (95 F, median [IQR] 65 [49-73] years; 57% idiopathic) were enrolled. Median [IQR] levels of LCQ was 18 [13-20], ISI was 6 [2-12], PSQI was 6 [4-10], and ESS was 4 [2-7]. Patients affected by symptomatic cough had a higher prevalence of sleep disturbances (PSQI>5; 68% vs. 30%, P=0.001) and insomnia (ISI>7; 52% vs 13%, P<0,001), but no daytime sleepiness (ESS≥10) nor SE impairment (SE<85%) in comparison to those without symptomatic cough. A correlation was found between LCQ and insomnia (ISI; R:-0.498, P<0.001), PSQI (R:-0.399, P<0.001), ESS (R:-0.263, P0.004) and SE (R:0.293, P=0.001). The relative risk (RR) to have insomnia was higher in patients with cough (RR=4.62). Chronic cough may affect SQ in adults with bronchiectasis and could generate insomnia rather than other sleep disorders.

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