Back to Search Start Over

Risk of COPD exacerbation is increased by poor sleep quality and modified by social adversity

Authors :
Aaron Baugh
Russell G Buhr
Pedro Quibrera
Igor Barjaktarevic
R Graham Barr
Russell Bowler
Meilan King Han
Joel D Kaufman
Abigail L Koch
Jerry Krishnan
Wassim Labaki
Fernando J Martinez
Takudzwa Mkorombindo
Andrew Namen
Victor Ortega
Robert Paine
Stephen P Peters
Helena Schotland
Krishna Sundar
Michelle R Zeidler
Nadia N Hansel
Prescott G Woodruff
Neeta Thakur
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/.

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