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Risk of COPD exacerbation is increased by poor sleep quality and modified by social adversity
- Source :
- Sleep, vol 45, iss 8, Sleep
- Publication Year :
- 2022
- Publisher :
- Oxford University Press (OUP), 2022.
-
Abstract
- Study Objectives Sleep is an important dimension in the care of chronic obstructive pulmonary disease (COPD), but its relevance to exacerbations is unclear. We wanted to assess whether sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI) is associated with an increased risk of COPD exacerbations and does this differ by socio-environmental exposures. Methods We included 1647 current and former smokers with spirometrically confirmed COPD from the SPIROMICS cohort. We assessed incidence rate ratios for exacerbation using zero-inflated negative binomial regression adjusting for demographics, medical comorbidities, and multiple metrics of disease severity, including respiratory medications, airflow obstruction, and symptom burden. Our final model adjusted for socio-environmental exposures using the Area Deprivation Index, a composite measure of contemporary neighborhood quality, and Adversity–Opportunity Index, a composite measure of individual-level historic and current socioeconomic indicators. We used a pre-determined threshold of 20% missingness to undertake multiple imputation by chained equations. As sensitivity analyses, we repeated models in those with complete data and after controlling for prior exacerbations. As an exploratory analysis, we considered an interaction between socio-environmental condition and sleep quality. Results After adjustment for all co-variates, increasing PSQI scores (range 0–21) were associated with a 5% increased risk for exacerbation per point (p = .001) in the imputed dataset. Sensitivity analyses using complete cases and after controlling for prior exacerbation history were similar. Exploratory analysis suggested less effect among those who lived in poor-quality neighborhoods (p-for-interaction = .035). Conclusions Poor sleep quality may contribute to future exacerbations among patients with COPD. This represents one target for improving disease control. Clinical Trial Registration Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS). ClinicalTrials.gov Identifier# NCT01969344. Registry URL: https://clinicaltrials.gov/ct2/show/.
- Subjects :
- Sleep Wake Disorders
Chronic Obstructive
Chronic Obstructive Pulmonary Disease
Severity of Illness Index
Medical and Health Sciences
Pulmonary Disease
Pulmonary Disease, Chronic Obstructive
PSQI
exacerbations
Physiology (medical)
Behavioral and Social Science
Humans
COPD
Lung
health disparities
Neurology & Neurosurgery
Psychology and Cognitive Sciences
sleep quality
Biological Sciences
Sleep Quality
Good Health and Well Being
Disease Progression
Respiratory
Neurology (clinical)
Sleep Research
Sleep, Health, and Disease
Subjects
Details
- ISSN :
- 15509109 and 01618105
- Volume :
- 45
- Database :
- OpenAIRE
- Journal :
- Sleep
- Accession number :
- edsair.doi.dedup.....6f9c754df696220e6ee620084538b725
- Full Text :
- https://doi.org/10.1093/sleep/zsac107