Analysis of the Change in Sleep Quality in Lung Transplant Recipients

PURPOSE: We previously reported that sleep quality is impaired in waitlisted patients for lung transplantation in Japan, and that respiratory symptoms and psychological status were main contributive factors to sleep quality. However, it is unknown whether sleep quality would improve after lung transplantation or not. Then we aim to assess changes in sleep quality and other patient reported measures including health related quality of life (HRQL) after lung transplantation. METHODS: In this multicentric study, we prospectively collected patient-reported data of 56 lung transplant recipients. We assessed sleep quality using the Pittsburgh Sleep Quality Index (PSQI), HRQL using the St. George's Respiratory Questionnaire (SGRQ), psychological status using Hospital Anxiety and Depression Scale (HADS) and dyspnea using modified Medical Research Council Dyspnea Scale (mMRC). We then examined the changes in sleep quality, HRQL, psychological status and dyspnea within about one year after lung transplantation. We also assessed PSQI subscale scores to examine the details of changes in sleep quality. RESULTS: Interstitial pneumonia (n=24), pulmonary complication after post hematopoietic stem cell transplantation (n=8), chronic obstructive pulmonary disease (n=7) and lymphangioleiomyomatosis (n=7) were the four most frequent indications. HRQL, psychological status and dyspnea significantly improved after lung transplantation (p< 0.0001). The PSQI score neither significantly change from 6.7 ± 3.6 to 7.1 ± 3.8 (p = 0.38), nor the percentage of the patients with poor sleep quality (PSQI > 5) changed significantly from 51.7% (at baseline) to 62.5% (after lung transplantation) (p = 0.25). In PSQI subscales, sleep medication worsened significantly (p= 0.04) after lung transplantation. CONCLUSION: While lung transplantation had positive impacts on HRQL, psychological status and dyspnea, sleep quality remained unchanged. Sleep quality should be followed separately from those patient-reported measures not to miss its worsening.