Impact of insomnia on exercise capacity and quality of life in patients with pulmonary arterial hypertension

Background: There is a high prevalence of poor sleep quality in patients with pulmonary arterial hypertension (PAH). However, the impact of insomnia on exercise capacity and quality of life (QOL) in these patients is unclear. Moreover, there is a lack of data on the use of sleep medication and the effects of cognitive behavioural therapy for insomnia (CBTI) in PAH. Methods: Patients who visited the outpatient clinic of a tertiary centre from September 2015 to March 2016 were asked to complete the Pittsburgh Sleep Quality Index, the Insomnia Severity Index, the Epworth Sleepiness Scale, the Depression Anxiety Stress Scales and the 36-Item Short Form Survey. Exercise capacity was assessed by six-minute walk distance (6MWD). Results: Seventy-two PAH patients (median age 60y, 75% female) were enrolled. More than half (52%) of the patients had a poor sleep quality, 13% had clinical insomnia. Patients with poor sleep quality had a significant lower 6MWD (479 vs 368 m, p=0.003). A significantly higher Borg score was found in patients with insomnia (5 vs 7, p=0.019). Insomnia patients were significantly more depressed, had a worse NYHA class and a lower QOL. Benzodiazepines, z-drugs and antidepressants use was twice as high for insomnia patients. A total of 40% of all PAH patients used psychotropics. Only 5% of the patients with poor sleep quality agreed to follow CBTI. In these patients an improvement in NYHA class and the 6MWD was seen after three months. Conclusion: The high prevalence of poor sleep quality and insomnia in patients with PAH warrants regular screening and appropriate treatment. Treating sleep problems may contribute to improve the QOL and exercise capacity in PAH.