• Sugunesvaran Parasuraman Clinical Research Committee, Hospital Tanjong Karang, Jalan Besar, 45500, Tanjong Karang, Selangor, Malaysia
  • Tan Chung Keat School of Healthy Aging, Medical Aesthetic and Regenerative Medicine, Faculty of Medicine and Health Sciences, UCSI University, 56000 Cheras, KL, Malaysia
  • Nurhayati Binti Mohd Marzuki Institut Perubatan Respiratori, Jalan Pahang, Pekeliling, 53000 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia



Chronic Obstructive Pulmonary Disease, Health-related Quality of Life, Sleep Quality


In Malaysia, chronic respiratory disease including COPD is responsible for 7% of the total Disability-Adjusted Life Years (DALYs). Sleep disturbance in COPD patients is often underestimated and overlooked clinically. Respiratory symptoms caused by COPD often leads to poor sleep quality and insomnia. Poor sleep quality contributes to frequent episodes of exacerbation which directly increases mortality risk. This study aims to determine health-related quality of life and sleep quality among COPD patients and their associations with severity. In this cross-sectional study, 102 COPD patients classified according to Global Initiative for Chronic Obstructive Lung Disease were evaluated. EQ5D and Pittsburgh Sleep Quality Index (PSQI) questionnaires were used to assess health-related quality of life and sleep quality respectively. Results showed the severity of COPD is significantly associated (p<0.05) with all 5 dimensions of EQ5D among COPD patients in Kuala Lumpur. In this study, 71 patients (69.9%) were reported to be poor sleepers (PSQI>5) with a mean g l o b a l score of 6.93 ± 4.072. Sleep quality was also found to be significantly associated (p <0.05) with COPD severity, in which patients with lower severity showed better sleep quality. In this study, COPD severity was found to be significantly associated with health-related quality of life. As the disease severity progresses, both quality of life and sleep quality worsens gradually. Findings from this study highlight the importance to consider the quality of life and sleep quality as part of the management plan for COPD patients.


Onishi K. Total management of chronic obstructive pulmonary disease (COPD) as an independent risk factor for cardiovascular disease. J Cardiol 2017; 70(2):128-34.

Guidelines in The Management of Chronic Obstructive Pulmonary Disease-A Consensus Statement of The Ministry of Health of Malaysia, Academy of Medicine of Malaysia And Malaysian Thoracic Society. Med J Malaysia 1999; 54:387-400.

Oliveira AS, Munhá J, Bugalho A, et al. Identification and assessment of COPD exacerbations. Pulmonology 2018; 24(1):42-7.

Ferrer M, Alonso J, Morera, J, et al. Chronic obstructive pulmonary disease stage and health-related quality of life. Ann Intern Med 127, 1072-1079.

Jansson SA, Andersson F, Borg S, et al. Costs of COPD in Sweden according to disease severity. Chest 2002; 122(6):1994-2002.

Omachi TA, Blanc PD, Claman DM, et al. Disturbed sleep among COPD patients is longitudinally associated with mortality and adverse COPD outcomes. Sleep Med 2012; 13(5):476-83.

McNicholas WT, Verbraecken J, Marin JM. Sleep disorders in COPD: the forgotten dimension. Eur Respir Rev 2013; 22(129):365-75.

Dignani, L., Toccaceli, A., Lucertini, C.,et al Sleep and quality of life in people with COPD: a descriptive-correlational study. Clinical nursing research, 25(4), pp.432-447

Global Initiative for Chronic Obstructive Lung Disease. [May;2019];

Vogelmeier CF, Criner GJ, Martinez FJ, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report. GOLD executive summary. Am J Respir Crit Care Med 2017; 195(5):557-82.

Buysse DJ, Reynolds III CF, Monk TH, et al. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989; 28(2):193-213

Rabin R, Charro FD. EQ-SD: a measure of health status from the EuroQol Group. Ann Med 2001; 33(5):337-43

Chang CH, Chuang LP, Lin SW, et al. Factors responsible for poor sleep quality in patients with chronic obstructive pulmonary disease. BMC Pulm Med 2016; 16(1):118.

Balcells E, Gea J, Ferrer J, et al. Factors affecting the relationship between psychological status and quality of life in COPD patients. Health Qual Life Outcomes 2010; 8(1):108.

Castelino F, Prabhu M, Pai MS, et al. Socio-demographic and clinical characteristics of Chronic Obstructive Pulmonary Disease (COPD) patients. Manipal Journal of Nursing and Health Sciences (MJNHS). 2017; 3(2):55-8.

Lim HK, Ghazali SM, Kee CC, et al. Epidemiology of smoking among Malaysian adult males: prevalence and associated factors. BMC Public Health 2013; 13(1):8.

Nicola S, Raffaele AI, Francesco B, et al. Circadian rhythm of COPD symptoms in clinically based phenotypes. BMC Pulm Med 2019 ;19(1):171.

Lee AL, Goldstein RS, Brooks D. Chronic pain in people with chronic obstructive pulmonary disease: prevalence, clinical and psychological implications. Chronic Obstr Pulm Dis 2017;4(3):194.

Ståhl E, Lindberg A, Jansson SA, et al. Health-related quality of life is related to COPD disease severity. Health Qual Life Outcomes 2005; 3(1):56.

Hong JY, Kim SY, Chung KS, et al. Factors associated with the quality of life of Korean COPD patients as measured by the EQ-5D. Qual Life Res 2015; 24(10):2549-58.

Wacker ME, Jörres RA, Karch A, et al. Assessing health-related quality of life in COPD: comparing generic and disease-specific instruments with focus on comorbidities. BMC Pulm Med 2016; 16(1):70.

McNicholas WT, Calverley PM, Lee A, et al. Long-acting inhaled anticholinergic therapy improves sleeping oxygen saturation in COPD. Eur Respir J 2004; 23(6):825-31.

Zohal MA, Yazdi Z, Kazemifar AM. Daytime sleepiness and quality of sleep in patients with COPD compared to control group. Glob J Health Sci 2013; 5(3):150.

Scharf SM, Maimon N, Simon-Tuval T, et al. Sleep quality predicts quality of life in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2011; 6:1.

Lan CC, Huang HC, Yang MC, et al. Pulmonary rehabilitation improves subjective sleep quality in COPD. Respiratory care 2014; 59(10):1569-76.

Lewis CA, Ferguson W, Eaton T, et al. Isolated nocturnal desaturation in COPD: prevalence and impact on quality of life and sleep. Thorax 64:133–138

Hynninen MJ, Pallesen S, Nordhus IH. Factors affecting health status in COPD patients with co-morbid anxiety or depression. Int J Chron Obstruct Pulmon Dis 2007 ;2(3):323.

Shackell BS, Jones RCM, Harding G, et al. Am I going to see the next morning? A qualitative study of patients’ perpectives of sleep in COPD. Prim Care Respir J 2007;16(6) 378-383.

Redeker NS. Sleep disturbance in people with heart failure: implications for self-care. J Cardiovasc Nurs 2008; 23(3):231-8.

de Miguel-Díez J, López-de-Andrés A, Hernandez-Barrera V, et al. Prevalence of Pain in COPD Patients and Associated Factors. Clin J Pain 2018; 34(9):787-94.

Onen SH, Onen F, Courpron P, et al. How pain and analgesics disturb sleep. Clin J Pain 2005; 21(5):422-31.

Gudmundsson G, Gislason T, Janson C, et al. Depression, anxiety and health status after hospitalization for COPD: a multicentre study in the Nordic countries. Respir Med 2006; 100(1):87-93.




How to Cite

Parasuraman, S., Keat, T. C., & Binti Mohd Marzuki, N. (2021). HEALTH-RELATED QUALITY OF LIFE AND SLEEP QUALITY AMONG COPD PATENTS IN MALAYSIA. Malaysian Journal of Public Health Medicine, 21(1), 112–120.