Relationship Between Severity Of Symptoms And Sleep Quality Of Patients With Chronic Obstructive Pulmonary Disease (COPD) in Abdul Moeloek Regional Hospital Lampung Province


  • Ayu Dinda Fatimah Fakultas Kedokteran Universitas Lampung
  • Iswandi Darwis Bagian Ilmu Penyakit Dalam, Fakultas Kedokteran, Universitas Lampung
  • Agustyas Tjiptaningrum Bagian Patologi Klinik, Fakultas Kedokteran, Universitas Lampung
  • Khairun Nisa Berawi Bagian Fisiologi, Fakultas Kedokteran, Universitas Lampung


COPD, Sleep Quality, Symptom


Chronic Obstructive Pulmonary Disease is a disease that has a high prevalence. The prevalence of COPD is always increasing in every country in the world. Deaths of people with COPD are associated with an increase in the severity of symptoms of the disease. The symptoms of COPD continue to worsen and have an impact on the decline in sleep quality of COPD patients. The Lampung Provincial Government makes COPD as one of the threats in carrying out health development in Lampung Province in 2015 to 2019. The purpose of this study was to determine the relationship relationship between severity of symptoms and sleep quality of patients with Chronic Obstructive Pulmonary Disease (COPD) in Abdul Moeloek regional hospital Lampung Province. It is used observational analytical method with cross sectional design was registered in this research. The sample was 40 COPD patients in Abdul Moeloek Regional Hospital Lampung Province, taken by consecutive sampling method. The study was conducted using the COPD Assessment Test questionnaire and Pittsburgh Sleep Quality Index questionnaire in the hospital, patient’s house, or patient’s office. Then the results of this study were processed using computer software. Result of analysis with Chi Square test with 95% confidence level (α = 0,05) showed p value 0,01 < 0,05. There is a significant association of Severity of Symptoms and Sleep Quality of Patients with Chronic Obstructive Pulmonary Disease (COPD) in Abdul Moeloek Regional Hospital Lampung Province.


Sasirekha B, Sara B. Burden of COPD [Chronic Obstructive Pulmonary Disease]: Evidenced Based Report. Biomed J Sci Tech Res. 2018;2(1):2164–5.

Soriano JB, Abajobir AA, Abate KH, Abera SF, Agrawal A, Ahmed MB, et al. Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Respir Med. 2017;5(9):691–706.

WHO. Global status report on noncommunicable diseases 2010 [Internet]. WHO. Geneva: WHO; 2010. Tersedia pada:

Kementerian Kesehatan RI. Riset Kesehatan Dasar [Internet]. Jakarta: Kementerian Kesehatan RI; 2013. Tersedia pada: jesus/capitulos_espanyol_jesus/2005_motivacion para el aprendizaje Perspectiva alumnos.pdf%0A

Adeloye D, Chua S, Lee C, Basquill C, Papana A, Theodoratou E, et al. Global and regional estimates of COPD prevalence: Systematic review and meta–analysis. J Glob Health [Internet]. 2015;5(2):1–17. Tersedia pada:

European Federtion of Allergy and Airway Disease. Book on Chronic Obstructive Pulmonary Disease in Europe. Sharing and Caring [Internet]. European Federtion of Allergy and Airway Disease. Brussels; 2009. Tersedia pada:

Benowitz NL, Brunetta PG. Smoking Hazards and Cessation. In: Murray and Nadel’s Textbook of Respiratory Medicine [Internet]. Philadelphia: Elsevier Inc.; 2016. hal. 807–21. Tersedia pada:

GOLD. Pocket Guide To COPD Diagnosis, Management, and Prevention [Internet]. USA: GOLD; 2019. Tersedia pada:

Joint National Clinical for Respiratory Disease. A Guide to Performing Quality Assured Diagnostic Spirometry. London: PCC; 2013.

Johns DP, Walters JAE, Walters EH. Diagnosis and early detection of COPD using spirometry. J Thorac Dis. 2014;6(11):1557–69.

Jo YS, Yoon H Il, Kim DK, Yoo CG, Lee CH. Comparison of COPD assessment test and clinical COPD questionnaire to predict the risk of exacerbation. Int J COPD. 2018;13:101–7.

CAT Development Streering Group. COPD Assessment Test TM ( CAT ): Expert guidance on frequently asked questions. London: CAT Development Streering Group; 2012.

Gupta N, Pinto LM, Morogan A, Bourbeau J. The COPD assessment test: A systematic review. Eur Respir J. 2014;44(4):873–84.

Sarioglu N, Hismiogullari A, Billen C, Erel F. Is the COPD assessment test (CAT) effective in demonstrating the systemic inflammation and other components in COPD? Rev Port Pneumol. 2016;22(1):11–7.

Flynn RW V., MacDonald TM, Chalmers JD, Schembri S. The effect of changes to GOLD severity stage on long term morbidity and mortality in COPD. Respir Res. 2018;19(1):1–10.

Donaire-Gonzalez D, Gimeno-Santos E, Balcells E, Rodríguez DA, Farrero E, De Batlle J, et al. Physical activity in COPD patients: Patterns and bouts. Eur Respir J. 2013;42(4):993–1002.

Van Remoortel H, Hornikx M, Demeyer H, Langer D, Burtin C, Decramer M, et al. Daily physical activity in subjects with newly diagnosed COPD. Thorax. 2013;68(10):962–3.

Miravitlles M, Ribera A. Understanding the impact of symptoms on the burden of COPD. Respir Res. 2017;18(1):1–11.

Anzueto A, Miravitlles M. Pathophysiology of Dyspnea In COPD. Postgrad Med [Internet]. 2017;129(3):366–74. Tersedia pada:

Lewthwaite H, Effing TW, Olds T, Williams MT. Physical activity, sedentary behaviour and sleep in COPD guidelines: A systematic review. Chron Respir Dis. 2017;14(3):231–44.

Zohal MA, Yazdi Z, Kazemifar AM, Mahjoob P, Ziaeeha M. Sleep Quality and Quality of Life in COPD Patients with and without Suspected Obstructive Sleep Apnea. Sleep Disord [Internet]. 2014;2014:1–4. Tersedia pada:

Mcsharry DD, Ryan S, Calverey P, Edwards JC, Mcniholas WT. Disability in chronic obstructive pulmonary disease. Respirology. 2012;187–99.

Zaremba S, Chamberlin NL, Eikermann M. Sleep Medicine. In: Miller’s Anesthesia. Philadelphia: Elsevier; 2015. hal. 303–28.

Dahlan MS. Statistik untuk Kedokteran dan Kesehatan. Edisi 1. Jakarta: Epidemiologi Indonesia; 2014.

Chang CH, Chuang LP, Lin SW, Lee CS, Tsai YH, Wei YF, et al. Factors responsible for poor sleep quality in patients with chronic obstructive pulmonary disease. BMC Pulm Med [Internet]. 2016;16(1):1–8. Tersedia pada:

Mehta JR, Ratnani IJ, Dave JD, Panchal BN, Patel AK, Vala AU. Association of psychiatric co-morbidities and quality of life with severity of chronic obstructive pulmonary disease. East Asian Arch Psychiatry. 2014;24(4):148–55.

Ban WH, Joo H, Lim JU, Kang HH, Moon HS, Lee SH. The relationship between sleep disturbance and health status in patients with COPD. Int J COPD. 2018;13:2049–55.

Ellingsen I, Fondenes O, Øverland B, Holmedahl NH. The severity of sleep hypoventilation in stable chronic obstructive pulmonary disease. Sleep Breath. 2020;2.

Shorofsky M, Bourbeau J, Kimoff J, Jen R, Malhotra A, Ayas N, et al. Impaired Sleep Quality in COPD Is Associated With Exacerbations: The CanCOLD Cohort Study. Chest. 2019;156(5):852–63.

Kirkham PA, Barnes PJ. Oxidative stress in COPD. Chest [Internet]. 2013;144(1):266–73. Tersedia pada:

Caramori G, Adcock IM, Di Stefano A, Chung KF. Cytokine Inhibition in The Treatment of COPD. Int J COPD. 2014;9:397–412.

Niewoehner DE. Chronic Obstructive Pulmonary Disease. In: Goldman-Cecil Medicine [Internet]. Elsevier Inc.; 2016. hal. 555–62. Tersedia pada:

Curtis JL, Freeman CM. Why Do We Need A Nonhuman Primate Model of Smoking-Induced COPD? Am J Pathol [Internet]. 2015;185(3):610–3. Tersedia pada:

Macnee W, Vestbo J, Agusti A. COPD: PATHOGENESIS AND NATURAL HISTORY. In: Murray and Nadel’s Textbook of Respiratory Medicine. 2016. hal. 751–66.

Khurana S, Ravi A, Sutula J, Milone R, Williamson R, Plumb J, et al. Clinical Characteristics and Airway Inflammation Profile of COPD Persistent Sputum Producers. Respir Med [Internet]. 2014;108(12):1761–70. Tersedia pada:

Corriveau ML, Fagan JB. Chronic Obstructive Pulmonary Disease [Internet]. Conn’s Current Therapy 2018. Philadelphia: Elsevier Ltd.; 2018. 801–806 hal. Tersedia pada:

Samanta S, Hurst JR. Chronic Obstructive Pulmonary Disease: Aetiology, Pathology, Physiology and Outcome. Medicine (Baltimore) [Internet]. 2016;44(5):305–9. Tersedia pada:

Lee PN. The effect of reducing the number of cigarettes smoked on risk of lung cancer, COPD, cardiovascular disease and FEV1 - A review. Regul Toxicol Pharmacol [Internet]. 2013;67(3):372–81. Tersedia pada:

Gagnon P, Guenette JA, Langer D, Laviolette L, Mainguy V, Maltais F, et al. Pathogenesis of hyperinflation in chronic obstructive pulmonary disease. Int J COPD. 2014;9:187–201.

O’Donnell DE, Webb KA, Neder JA. Lung hyperinflation in COPD: Applying physiology to clinical practice [Internet]. Vol. 1, COPD Research and Practice. COPD Research and Practice; 2015. hal. 1–12. Tersedia pada:

Rossi A, Butorac-Petanjek B, Chilosi M, Cosío BG, Flezar M, Koulouris N, et al. Chronic obstructive pulmonary disease with mild airflow limitation: Current knowledge and proposal for future research – A consensus document from six scientific societies. Int J COPD. 2017;12:2593–610.

GOLD. Globat Strategy For The Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease Update 2018 Report [Internet]. Barcelona: Global Initiative for Chronic Obstructive Lung Disease, Inc; 2018. Tersedia pada:

Mejza F, Gnatiuc L, Buist AS, Vollmer WM, Lamprecht B, Obaseki DO, et al. Prevalence and burden of chronic bronchitis symptoms: results from the BOLD study. Eur Respir J [Internet]. 2017;50(5):1–10. Tersedia pada:

Martin MJ, Harrison TW. Causes of chronic productive cough: An approach to management. Respir Med [Internet]. 2015;109(9):1105–13. Tersedia pada:

Gupta N, Pinto L, Benedetti A, Li PZ, Tan WC, Aaron SD, et al. The COPD Assessment Test: Can It Discriminate Across COPD Subpopulations? Chest. 2016;150(5):1069–79.

Jones PW, Harding G, Berry P, Wiklund I, Chen WH, Kline Leidy N. Development and first validation of the COPD Assessment Test. Eur Respir J. 2009;34(3):648–54.

Mokoagow MI, Uyainah A, Subardi S, Rumende CM, Amin Z. Peran Skor COPD Aseessment Test ( CAT ) sebagai Prediktor Kejadian Eksaserbasi Akut Penyakit Paru Obstruktif Kronik pada Jemaah Haji Provinsi DKI Jakarta Tahun 2012. Indones J Chest Crit Emerg Med. 2014;1(2).

Chokroverty S, Avidan AY. Sleep and its disorders. In: Bradley’s Neurology in Clinical Practice: Neurological Disorders [Internet]. Seventh Ed. Philadelphia: Elsevier Inc.; 2016. hal. 1615–85. Tersedia pada:

Sherwood L. Fisiologi Manusia: Dari Sel ke Sistem. Edisi 8. Jakarta: EGC; 2014.

Verschuren O, Gorter JW, Pritchard-Wiart L. Sleep: An Underemphasized Aspect of Health and Development in Neurorehabilitation. Early Hum Dev. 2017;113(2017):120–8.

Ezzie ME, Parsons JP, Mastronarde JG. Sleep and Obstructive Lung Diseases. Sleep Med Clin. 2008;3(4):505–15.

Marin JM, Carrizo SJ. Overlap Syndromes of Sleep and Breathing Disorders. In: Principles and Practice of Sleep Medicine [Internet]. Sixth Edit. Philadelphia: Elsevier Inc.; 2017. hal. 1179-1188.e5. Tersedia pada:

Budhiraja R, Siddiqi TA, Quan SF. Sleep Disorders in Chronic Obstructive Pulmonary Disease: Etiology, Impact, and Management. J Clin Sleep Med. 2015;11(3):259–70.

Ding B, Small M, Bergström G, Holmgren U. A cross-sectional survey of night-time symptoms and impact of sleep disturbance on symptoms and health status in patients with COPD. Int J COPD. 2017;12:589–99.

Zdanys KF, Steffens DC. Sleep Disturbances in the Elderly. In: Psychiatric Clinics of North America [Internet]. Elsevier Inc; 2015. hal. 723–41. Tersedia pada:

Guillien A, Laurent L, Soumagne T, Puyraveau M, Laplante JJ, Andujar P, et al. Anxiety and depression among dairy farmers: The impact of COPD. Int J COPD. 2018;13:1–9.

Eisner MD, Blanc PD, Yelin EH, Katz PP, Sanchez G, Iribarren C, et al. Influence of anxiety on health outcomes in COPD. Thorax. 2010;65(3):229–34.

Hegerl U, Mergl R. Depression and suicidality in COPD: Understandable reaction or independent disorders? Eur Respir J. 2014;44(3):734–43.

Simonelli G, Leanza Y, Boilard A, Hyland M, Augustinavicius JL, Cardinali DP. Sleep and quality of life in urban poverty: the effect of a slum housing upgrading program. Sleep [Internet]. 2013;36(11):1670–6. Tersedia pada:

McNicholas WT, Hansson D, Schiza S, Grote L. Sleep in chronic respiratory disease: COPD and hypoventilation disorders. Eur Respir Rev [Internet]. 2019;28(153). Tersedia pada:

Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: A New Instrument for Psychiatric Practice and Research. Psychiatry Res [Internet]. 1988;28:192–213. Tersedia pada:

Rohmaningsih N. Hubungan antara Kualitas Tidur dengan Tingkat Kecemasan. Karya Tulis Ilmiah Fakultas Kedokteran Universitas Diponegoro. 2013.

Mollayeva T, Thurairajah P, Burton K, Mollayeva S, Shapiro CM, Colantonio A. The Pittsburgh Sleep Quality Index as A Screening Tool For Sleep Dysfunction in Clinical and Non-Clinical Samples: A Systematic Review and Meta-Analysis. Sleep Med Rev [Internet]. 2016;25(2016):52–73. Tersedia pada:

Additional Files