Impaired sleep quality in COPD patients was independently associated with diaphragm thickness, wall area percentage, and pulmonary artery to aorta ratio, with dPA/A showing the highest discriminative ability (AUC 0.688) among CT imaging parameters.
56% of enrolled COPD patients had impaired sleep quality as defined by a PSQI score ≥5.
COPD patients with impaired sleep quality had higher CAT scores and lower FEV1/FVC ratios compared to those with normal sleep quality.
The impaired sleep quality group demonstrated multiple CT-measured airway abnormalities compared to the non-impaired group.
Diaphragm thickness (DT) was smaller in COPD patients with impaired sleep quality and was identified as an independent risk factor for impaired sleep.
Pulmonary artery to aorta ratio (dPA/A) was higher in the impaired sleep group and showed the highest discriminative ability among CT parameters for impaired sleep quality.
Diaphragm thickness, wall area percentage, and pulmonary artery to aorta ratio were independent risk factors for impaired sleep quality in COPD patients.
This research suggests that COPD (chronic obstructive pulmonary disease) patients who sleep poorly have distinct structural abnormalities visible on CT scans compared to COPD patients who sleep well. Specifically, patients with poor sleep (defined as a score of 5 or higher on a standard sleep quality questionnaire) had narrower airways, thicker airway walls, a thinner diaphragm muscle, and an enlarged pulmonary artery relative to the aorta. More than half of the 190 patients in the study had impaired sleep quality, and these patients also had worse COPD symptoms and more impaired lung function overall. Among the CT measurements examined, the ratio of the pulmonary artery diameter to the aorta diameter (dPA/A) was the strongest single predictor of poor sleep quality, with an area under the ROC curve of 0.688. This ratio is a known marker of pulmonary hypertension (high blood pressure in the lungs), suggesting that cardiovascular complications of COPD may play a role in sleep disturbances. Diaphragm thinning and airway wall thickening were also independently associated with poor sleep, pointing to multiple overlapping mechanisms including respiratory muscle weakness and airway remodeling. This research suggests that standard lung CT scans, which COPD patients routinely receive, may provide useful information beyond lung structure — potentially flagging patients at higher risk of sleep problems. Identifying these imaging markers could help clinicians recognize patients who may benefit from further sleep evaluation and targeted management, without requiring additional testing beyond what is already performed.
Zhang P, Li T, Song Q, Liu C, Zeng Y, Chen S, et al.. (2026). Lung computed tomography (CT) imaging findings of chronic obstructive pulmonary disease patients with impaired sleep quality.. Clinical radiology. https://doi.org/10.1016/j.crad.2025.107215