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

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/.

Exploring the Link between Social Support and Patient-Reported Outcomes in Chronic Obstructive Pulmonary Disease Patients: A Cross-Sectional Study in Primary Care

“…Sleep disturbances are prevalent in these patients and have been found to be associated with unfavorable clinical outcomes and reduced quality of life [ 14 ]. The results of our study indicated a high prevalence of poor sleep quality (69%) and symptoms of insomnia (75.5%), mirroring findings from prior studies [ 9 , 13 , 111 , 112 , 113 , 114 ]. Our study also revealed a higher prevalence of poor sleep quality and insomnia symptoms in patients with lower social support.…”

Circadian Disruption in Night Shift Work and Its Association with Chronic Pulmonary Diseases

“…[23] Although studies assessing the temporality between COPD and NSW are lacking, the detrimental effects of sleep deprivation on COPD are well documented. [61][62][63] Sleep-deprived adults were associated with almost a 5-fold higher chance of COPD exacerbation and more than 11-fold emergency visits for respiratory-related complaints. Additional evidence suggests that insomnia predicted COPD exacerbations and worse survival during follow-ups.…”

Combined Lifestyle Interventions in the Prevention and Management of Asthma and COPD: A Systematic Review

“…An extensive search of the existing literature yielded no studies describing CLIs for the prevention of the onset of asthma or COPD. The primary focus of the CLIs was on secondary and tertiary prevention, even though the existing literature suggests an optimal lifestyle not only slows lung function decline in patients but can also play a role in reducing asthma and COPD risk [13][14][15][16][17][18][19][20][21][22][23]. As this review showed that CLIs are effective in asthma and COPD management, one could question whether the implementation of CLIs would not already be beneficial at an earlier stage.…”

“…Additionally, excessive alcohol use has been associated with pulmonary function decline and increased risk of asthma [17,19]. Furthermore, psychological stress and poor sleep quality have been associated with worse outcomes in asthma and COPD [20][21][22][23], making them important targets for intervention.…”