What is the most effective non-pharmacological treatment for poor sleep quality in Chronic obstructive pulmonary disease patients? a systematic review.

Clinical Snapshot

Key Findings

• P Value: Not reported for pooled analysis

• Effect Size: Not quantified - qualitative synthesis only

• Primary Outcome: Sleep quality improvement

• Nnt Or Sensitivity: Not calculated - insufficient data for meaningful clinical interpretation

• Confidence Interval: Not reported

Clinical Application

Variable - some interventions like PMRT and relaxation exercises are readily implementable, while others like therapeutic touch require specialized training Limited applicability - no discussion of integration with existing COPD management pathways, Medicare Benefits Schedule coverage, or alignment with COPD-X guidelines Adults with COPD experiencing sleep disturbances in primary and secondary care settings

Abstract

BACKGROUND: Chronic obstructive pulmonary disease (COPD) features poor sleep quality due to nocturnal dyspnea and psychological distress, leading to increased hospital admissions and reduced quality of life. Considering patient preference and existing evidence, non-pharmacological intervention, i.e. cognitive behavioral therapy for insomnia (CBT-I), on sleep for COPD patients had its potential efficacy. However, current guidelines do not include sleep management as standard care, and there is a lack of comprehensive reviews on this topic. This systematic review hence evaluated the effectiveness of non-pharmacological treatments for poor sleep in COPD patients. METHODS: Literature identification was conducted through MEDLINE, CINHAL PLUS, AMED and ScienceDirect under PRISMA guidance. Randomized controlled trials, cohort studies and cross-sectional studies regarding poor sleep quality among COPD population were retrieved. Abstract, title and full text screening were performed by the author and assessed by a second reviewer. Risk of bias and quality appraisal was done with JBI scale. RESULTS: 12 articles (783 patients) were identified, including 9 randomized controlled trials, 1 cohort study and 2 cross-sectional studies. The risk of bias (quality) was ranked: low (high) for 3, moderate (moderate) for 7 and high (low) for 2. Several interventions were identified (number of study): CBT-I (2) and cognitive behavioral therapy (1), pulmonary rehabilitation (PR) (2), progressive muscle relaxation technique (PMRT) (2), non-invasive ventilation (NIV) (3), relaxation exercise (RE) (1) and therapeutic touch (TT) (1). Significant improvement in sleep quality was reported in PMRT, TT and RE. CONCLUSION: PMRT, TT and RE showed improvement in sleep quality in COPD patients yet unable to rank their effectiveness as heterogeneous outcome measures across studies. No substantial evidence was capable to demonstrate effectiveness of CBT-I, CBT, PR and NIV to explicit COPD patients. Moreover, future research including combination of non-pharmacological treatments is needed.

References

1. 1.Yeung, G., & Atef, H. (2026). What is the most effective non-pharmacological treatment for poor sleep quality in Chronic obstructive pulmonary disease patients? a systematic review. Sleep & Breathing, Article 42069826. https://doi.org/10.1016/j.aucc.2021.04.001