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The present investigation is aimed to assess the circadian rhythm of symptoms in pre-defined clinical COPD phenotypes and its association with health-related quality of life (HR-QoL), the quality of sleep and the level of depression\/anxiety in each clinical phenotype.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>The STORICO (NCT03105999) Italian observational prospective cohort study enrolled COPD subjects. A clinical diagnosis of either chronic bronchitis (CB), emphysema (EM) or mixed COPD-asthma (MCA) phenotype was made by clinicians at enrollment. Baseline early-morning, day-time and nocturnal symptoms (gathered via the <jats:italic>Night-time, Morning and Day-time Symptoms of COPD questionnaire<\/jats:italic>), HR-QoL (via the <jats:italic>St. George\u2019s Respiratory Questionnaire<\/jats:italic>), anxiety and depression levels (via the <jats:italic>Hospital Anxiety and Depression Scale<\/jats:italic>), quality of sleep (via <jats:italic>COPD and Asthma Sleep Impact Scale<\/jats:italic>), physical activity (via the <jats:italic>International Physical Activity Questionnaire<\/jats:italic>) as well as lung function were recorded.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>606 COPD subjects (age 71.4\u2009\u00b1\u20098.2\u2009years, male 75.1%) were studied. 57.9, 35.5 5.3 and 1.3% of the sample belonged to the CB, EM, MCA and EM\u2009+\u2009CB phenotypes respectively. The vast majority of subjects reported early-morning and day-time symptoms (79.5 and 79.2% in the CB and 75.8 and 77.7% in the EM groups); the proportion suffering from night-time symptoms was higher in the CB than in the EM group (53.6% vs. 39.5%, <jats:italic>p<\/jats:italic>\u2009=\u20090.0016). In both CB and EM, indiscriminately, the presence of symptoms during the 24-h\u2009day was associated with poorer HR-QoL, worse quality of sleep and higher levels of anxiety\/depression.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The findings highlight the primary classificatory role of nocturnal symptoms in COPD.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Trial registration<\/jats:title>\n<jats:p>Trial registration number: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT03105999\">NCT03105999<\/jats:ext-link>, date of registration: 10th April 2017.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12890-019-0935-2","type":"journal-article","created":{"date-parts":[[2019,9,9]],"date-time":"2019-09-09T13:04:31Z","timestamp":1568034271000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Circadian rhythm of COPD symptoms in clinically based phenotypes. 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Monasterio Pisa, Italy) and was conducted in accordance with the Declaration of Helsinki and the Good Clinical Practices guidelines for observational studies, complying with all requirements of local regulations. Patients provided written, informed consent before participation.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"B.F. reports grants and personal fees from ASTRAZENECA, grants and personal fees from BAYER, personal fees from CHIESI, personal fees from GSK, personal fees from GUIDOTTI, grants and personal fees from GRIFOLS, grants from INSMED, personal fees from MENARINI, personal fees from NOVARTIS, grants and personal fees from PFIZER, personal fees from TEVA, personal fees from ZAMBON, outside the scope of the work submitted.Z.A. and O.A. are employees of Medineos Observational Research.The other authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"171"}}