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

TitleRisk of COPD exacerbation is increased by poor sleep quality and modified by social adversity.
Publication TypePublication
Year2022
AuthorsBaugh A, Buhr RG, Quibrera P, Barjaktarevic I, R Barr G, Bowler R, Han MKing, Kaufman JD, Koch AL, Krishnan J, Labaki W, Martinez FJ, Mkorombindo T, Namen A, Ortega V, Paine R, Peters SP, Schotland H, Sundar K, Zeidler MR, Hansel NN, Woodruff PG, Thakur N
JournalSleep
Volume45
Issue8
Date Published2022 08 11
ISSN1550-9109
KeywordsDisease Progression, Humans, Lung, Pulmonary Disease, Chronic Obstructive, Severity of Illness Index, Sleep Quality, Sleep Wake Disorders
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/.

DOI10.1093/sleep/zsac107
Alternate JournalSleep
PubMed ID35665826
PubMed Central IDPMC9366643
Grant ListR01ES023500 / ES / NIEHS NIH HHS / United States
L30 HL134025 / HL / NHLBI NIH HHS / United States
U01 HL137880 / HB / NHLBI NIH HHS / United States
HHSN268200900013C / NH / NIH HHS / United States
KL2TR001882 / TR / NCATS NIH HHS / United States
KL2 TR001882 / TR / NCATS NIH HHS / United States
K24 HL138188 / HL / NHLBI NIH HHS / United States
HHSN268200900014C / HL / NHLBI NIH HHS / United States
HHSN268200900015C / HL / NHLBI NIH HHS / United States
HHSN268200900016C / HL / NHLBI NIH HHS / United States
HHSN268200900017C / HL / NHLBI NIH HHS / United States
HHSN268200900018C / HL / NHLBI NIH HHS / United States
HHSN268200900019C / HL / NHLBI NIH HHS / United States
HHSN268200900020C / HL / NHLBI NIH HHS / United States
MS#: 
MS217
Manuscript Full Title: 
Risk of COPD exacerbation is increased by poor sleep quality and modified by social adversity.
Manuscript Lead/Corresponding Author Affiliation: 
Clinical Center: San Francisco (University of California at San Francisco)
ECI: 
Manuscript Status: 
Published and Public