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The Manchester Respiratory-related Sleep Symptoms scale for patients with COPD: development and validation

Naimat Khan, Jørgen Vestbo, Adam Garrow, et al.

Intl J Chron Obstruct Pulmon Dis 2018;13:3885–94.


Disturbed sleep is associated with anxiety, depression and pain, and is predictive of exacerbations, emergency hospital visits and poor outcomes in people with COPD. A systematic review recently published by the authors on this paper highlighted a deficiency of validated measures for sleep disturbances. To date, sleep research in COPD has depended on generic PROM that are not specific for people with COPD and that have not been validated. The resulting estimates of prevalence and impact of sleep disturbances have been inconsistent and, in the absence of validation, the meaning of inconsistencies cannot be assessed. Existing instruments have not been developed specifically for patients with COPD, and therefore do not include items of potentially important respiratory significance, which may provide useful effectiveness data for COPD treatments.

The objective of the present study was to develop and test the reliability and validate a new PROM to assess respiratory symptoms-related sleep disturbances specifically in patients with COPD. To do this, two separate studies were performed, each approved by the relevant ethics research committee, and each having obtained signed consent from all participants.

A 26-item list was produced by 36 COPD patients and nine age-matched controls. The cross-sectional study involved 203 COPD patients and 50 age-matched controls. The final unidimensional scale covered breathlessness, chest tightness, cough, sputum production, lack of sleep and medication use. The MaRSS scores significantly correlated with sleep problems.

The findings of this study indicate that the MaRSS addresses the limitations of generic sleep measures highlighted in the authors’ previous systematic review. It is more responsive to change due to respiratory-related sleep problems because it focuses on respiratory-related symptoms. This tool opens up the possibility of classifying different phenotypes of patient based on disease-specific characteristics, which may respond to different treatment strategies and targeted sleep-based interventions.

A limitation of this study was that participants were recruited using a single database of COPD patients living in Greater Manchester. However, one of the study’s particular strengths was the inclusion on non-COPD control volunteers. More work is needed to confirm the usefulness of the MaRSS in intervention studies, to determine minimum important difference values and establish cross-cultural validity.

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