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 ris...
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Veröffentlicht in: | Sleep (New York, N.Y.) N.Y.), 2022-08, Vol.45 (8) |
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creator | Baugh, Aaron Buhr, Russell G Quibrera, Pedro Barjaktarevic, Igor Barr, R Graham Bowler, Russell Han, Meilan King Kaufman, Joel D Koch, Abigail L Krishnan, Jerry Labaki, Wassim Martinez, Fernando J Mkorombindo, Takudzwa Namen, Andrew Ortega, Victor Paine, Robert Peters, Stephen P Schotland, Helena Sundar, Krishna Zeidler, Michelle R Hansel, Nadia N Woodruff, Prescott G Thakur, Neeta |
description | 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/. |
doi_str_mv | 10.1093/sleep/zsac107 |
format | Article |
fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9366643</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/sleep/zsac107</oup_id><sourcerecordid>2701652458</sourcerecordid><originalsourceid>FETCH-LOGICAL-c448t-687ef896a878f090986664ad4f873f16af2e10eee5a30c04a41bbf4fbbadbc8d3</originalsourceid><addsrcrecordid>eNqFkc1r3DAQxUVpaDbbHHstgl5ycSOtZVm-BMLmo4XAhtIegxjLo1aJ1_JK9tLNXx8luwnJKadhmB_vDe8R8oWz75xV-XFsEfvj-wiGs_IDmfCiYFmVTh_JhHHJM8VZsU8OYrxlaRdV_ons54WUhZrJCbn55eId9ZbOF9dnFP-DwVDD4HxHXaSuMwEhYkPrDe29D_TJjq5GaN2wodA1dOkbZ90Wid44aCk0awwxAZ_JnoU24uFuTsmfi_Pf8x_Z1eLy5_z0KjNCqCGTqkSrKgmqVJZVrFJSSgGNsKrMLZdgZ8gZIhaQM8MECF7XVti6hqY2qsmn5GSr24_1EhuD3RCg1X1wSwgb7cHpt5fO_dN__VpX-aNTngS-7QSCX40YB33rx9Cln_WsTLEVM1GoRGVbygQfY0D74sCZfmxDP8Wjd20k_uvrt17o5_gTcLQF_Ni_o_UA4UCX8A</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2701652458</pqid></control><display><type>article</type><title>Risk of COPD exacerbation is increased by poor sleep quality and modified by social adversity</title><source>MEDLINE</source><source>Oxford University Press Journals All Titles (1996-Current)</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Baugh, Aaron ; Buhr, Russell G ; Quibrera, Pedro ; Barjaktarevic, Igor ; Barr, R Graham ; Bowler, Russell ; Han, Meilan King ; Kaufman, Joel D ; Koch, Abigail L ; Krishnan, Jerry ; Labaki, Wassim ; Martinez, Fernando J ; Mkorombindo, Takudzwa ; Namen, Andrew ; Ortega, Victor ; Paine, Robert ; Peters, Stephen P ; Schotland, Helena ; Sundar, Krishna ; Zeidler, Michelle R ; Hansel, Nadia N ; Woodruff, Prescott G ; Thakur, Neeta</creator><creatorcontrib>Baugh, Aaron ; Buhr, Russell G ; Quibrera, Pedro ; Barjaktarevic, Igor ; Barr, R Graham ; Bowler, Russell ; Han, Meilan King ; Kaufman, Joel D ; Koch, Abigail L ; Krishnan, Jerry ; Labaki, Wassim ; Martinez, Fernando J ; Mkorombindo, Takudzwa ; Namen, Andrew ; Ortega, Victor ; Paine, Robert ; Peters, Stephen P ; Schotland, Helena ; Sundar, Krishna ; Zeidler, Michelle R ; Hansel, Nadia N ; Woodruff, Prescott G ; Thakur, Neeta</creatorcontrib><description>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/.</description><identifier>ISSN: 0161-8105</identifier><identifier>EISSN: 1550-9109</identifier><identifier>DOI: 10.1093/sleep/zsac107</identifier><identifier>PMID: 35665826</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Chronic obstructive pulmonary disease ; Disease Progression ; Humans ; Lung ; Medicine ; Mortality ; Pulmonary Disease, Chronic Obstructive - complications ; Pulmonary Disease, Chronic Obstructive - diagnosis ; Pulmonary Disease, Chronic Obstructive - epidemiology ; Severity of Illness Index ; Sleep ; Sleep Quality ; Sleep Wake Disorders - complications ; Sleep Wake Disorders - epidemiology ; Sleep, Health, and Disease ; Socioeconomic factors</subject><ispartof>Sleep (New York, N.Y.), 2022-08, Vol.45 (8)</ispartof><rights>The Author(s) 2022. Published by Oxford University Press on behalf of Sleep Research Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 2022</rights><rights>The Author(s) 2022. Published by Oxford University Press on behalf of Sleep Research Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.</rights><rights>The Author(s) 2022. Published by Oxford University Press on behalf of Sleep Research Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c448t-687ef896a878f090986664ad4f873f16af2e10eee5a30c04a41bbf4fbbadbc8d3</citedby><cites>FETCH-LOGICAL-c448t-687ef896a878f090986664ad4f873f16af2e10eee5a30c04a41bbf4fbbadbc8d3</cites><orcidid>0000-0002-9527-691X ; 0000-0001-6159-7435 ; 0000-0003-4174-9037</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,1584,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35665826$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Baugh, Aaron</creatorcontrib><creatorcontrib>Buhr, Russell G</creatorcontrib><creatorcontrib>Quibrera, Pedro</creatorcontrib><creatorcontrib>Barjaktarevic, Igor</creatorcontrib><creatorcontrib>Barr, R Graham</creatorcontrib><creatorcontrib>Bowler, Russell</creatorcontrib><creatorcontrib>Han, Meilan King</creatorcontrib><creatorcontrib>Kaufman, Joel D</creatorcontrib><creatorcontrib>Koch, Abigail L</creatorcontrib><creatorcontrib>Krishnan, Jerry</creatorcontrib><creatorcontrib>Labaki, Wassim</creatorcontrib><creatorcontrib>Martinez, Fernando J</creatorcontrib><creatorcontrib>Mkorombindo, Takudzwa</creatorcontrib><creatorcontrib>Namen, Andrew</creatorcontrib><creatorcontrib>Ortega, Victor</creatorcontrib><creatorcontrib>Paine, Robert</creatorcontrib><creatorcontrib>Peters, Stephen P</creatorcontrib><creatorcontrib>Schotland, Helena</creatorcontrib><creatorcontrib>Sundar, Krishna</creatorcontrib><creatorcontrib>Zeidler, Michelle R</creatorcontrib><creatorcontrib>Hansel, Nadia N</creatorcontrib><creatorcontrib>Woodruff, Prescott G</creatorcontrib><creatorcontrib>Thakur, Neeta</creatorcontrib><title>Risk of COPD exacerbation is increased by poor sleep quality and modified by social adversity</title><title>Sleep (New York, N.Y.)</title><addtitle>Sleep</addtitle><description>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/.</description><subject>Chronic obstructive pulmonary disease</subject><subject>Disease Progression</subject><subject>Humans</subject><subject>Lung</subject><subject>Medicine</subject><subject>Mortality</subject><subject>Pulmonary Disease, Chronic Obstructive - complications</subject><subject>Pulmonary Disease, Chronic Obstructive - diagnosis</subject><subject>Pulmonary Disease, Chronic Obstructive - epidemiology</subject><subject>Severity of Illness Index</subject><subject>Sleep</subject><subject>Sleep Quality</subject><subject>Sleep Wake Disorders - complications</subject><subject>Sleep Wake Disorders - epidemiology</subject><subject>Sleep, Health, and Disease</subject><subject>Socioeconomic factors</subject><issn>0161-8105</issn><issn>1550-9109</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkc1r3DAQxUVpaDbbHHstgl5ycSOtZVm-BMLmo4XAhtIegxjLo1aJ1_JK9tLNXx8luwnJKadhmB_vDe8R8oWz75xV-XFsEfvj-wiGs_IDmfCiYFmVTh_JhHHJM8VZsU8OYrxlaRdV_ons54WUhZrJCbn55eId9ZbOF9dnFP-DwVDD4HxHXaSuMwEhYkPrDe29D_TJjq5GaN2wodA1dOkbZ90Wid44aCk0awwxAZ_JnoU24uFuTsmfi_Pf8x_Z1eLy5_z0KjNCqCGTqkSrKgmqVJZVrFJSSgGNsKrMLZdgZ8gZIhaQM8MECF7XVti6hqY2qsmn5GSr24_1EhuD3RCg1X1wSwgb7cHpt5fO_dN__VpX-aNTngS-7QSCX40YB33rx9Cln_WsTLEVM1GoRGVbygQfY0D74sCZfmxDP8Wjd20k_uvrt17o5_gTcLQF_Ni_o_UA4UCX8A</recordid><startdate>20220811</startdate><enddate>20220811</enddate><creator>Baugh, Aaron</creator><creator>Buhr, Russell G</creator><creator>Quibrera, Pedro</creator><creator>Barjaktarevic, Igor</creator><creator>Barr, R Graham</creator><creator>Bowler, Russell</creator><creator>Han, Meilan King</creator><creator>Kaufman, Joel D</creator><creator>Koch, Abigail L</creator><creator>Krishnan, Jerry</creator><creator>Labaki, Wassim</creator><creator>Martinez, Fernando J</creator><creator>Mkorombindo, Takudzwa</creator><creator>Namen, Andrew</creator><creator>Ortega, Victor</creator><creator>Paine, Robert</creator><creator>Peters, Stephen P</creator><creator>Schotland, Helena</creator><creator>Sundar, Krishna</creator><creator>Zeidler, Michelle R</creator><creator>Hansel, Nadia N</creator><creator>Woodruff, Prescott G</creator><creator>Thakur, Neeta</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>MBDVC</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-9527-691X</orcidid><orcidid>https://orcid.org/0000-0001-6159-7435</orcidid><orcidid>https://orcid.org/0000-0003-4174-9037</orcidid></search><sort><creationdate>20220811</creationdate><title>Risk of COPD exacerbation is increased by poor sleep quality and modified by social adversity</title><author>Baugh, Aaron ; Buhr, Russell G ; Quibrera, Pedro ; Barjaktarevic, Igor ; Barr, R Graham ; Bowler, Russell ; Han, Meilan King ; Kaufman, Joel D ; Koch, Abigail L ; Krishnan, Jerry ; Labaki, Wassim ; Martinez, Fernando J ; Mkorombindo, Takudzwa ; Namen, Andrew ; Ortega, Victor ; Paine, Robert ; Peters, Stephen P ; Schotland, Helena ; Sundar, Krishna ; Zeidler, Michelle R ; Hansel, Nadia N ; Woodruff, Prescott G ; Thakur, Neeta</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c448t-687ef896a878f090986664ad4f873f16af2e10eee5a30c04a41bbf4fbbadbc8d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Chronic obstructive pulmonary disease</topic><topic>Disease Progression</topic><topic>Humans</topic><topic>Lung</topic><topic>Medicine</topic><topic>Mortality</topic><topic>Pulmonary Disease, Chronic Obstructive - complications</topic><topic>Pulmonary Disease, Chronic Obstructive - diagnosis</topic><topic>Pulmonary Disease, Chronic Obstructive - epidemiology</topic><topic>Severity of Illness Index</topic><topic>Sleep</topic><topic>Sleep Quality</topic><topic>Sleep Wake Disorders - complications</topic><topic>Sleep Wake Disorders - epidemiology</topic><topic>Sleep, Health, and Disease</topic><topic>Socioeconomic factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Baugh, Aaron</creatorcontrib><creatorcontrib>Buhr, Russell G</creatorcontrib><creatorcontrib>Quibrera, Pedro</creatorcontrib><creatorcontrib>Barjaktarevic, Igor</creatorcontrib><creatorcontrib>Barr, R Graham</creatorcontrib><creatorcontrib>Bowler, Russell</creatorcontrib><creatorcontrib>Han, Meilan King</creatorcontrib><creatorcontrib>Kaufman, Joel D</creatorcontrib><creatorcontrib>Koch, Abigail L</creatorcontrib><creatorcontrib>Krishnan, Jerry</creatorcontrib><creatorcontrib>Labaki, Wassim</creatorcontrib><creatorcontrib>Martinez, Fernando J</creatorcontrib><creatorcontrib>Mkorombindo, Takudzwa</creatorcontrib><creatorcontrib>Namen, Andrew</creatorcontrib><creatorcontrib>Ortega, Victor</creatorcontrib><creatorcontrib>Paine, Robert</creatorcontrib><creatorcontrib>Peters, Stephen P</creatorcontrib><creatorcontrib>Schotland, Helena</creatorcontrib><creatorcontrib>Sundar, Krishna</creatorcontrib><creatorcontrib>Zeidler, Michelle R</creatorcontrib><creatorcontrib>Hansel, Nadia N</creatorcontrib><creatorcontrib>Woodruff, Prescott G</creatorcontrib><creatorcontrib>Thakur, Neeta</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Psychology Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Sleep (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Baugh, Aaron</au><au>Buhr, Russell G</au><au>Quibrera, Pedro</au><au>Barjaktarevic, Igor</au><au>Barr, R Graham</au><au>Bowler, Russell</au><au>Han, Meilan King</au><au>Kaufman, Joel D</au><au>Koch, Abigail L</au><au>Krishnan, Jerry</au><au>Labaki, Wassim</au><au>Martinez, Fernando J</au><au>Mkorombindo, Takudzwa</au><au>Namen, Andrew</au><au>Ortega, Victor</au><au>Paine, Robert</au><au>Peters, Stephen P</au><au>Schotland, Helena</au><au>Sundar, Krishna</au><au>Zeidler, Michelle R</au><au>Hansel, Nadia N</au><au>Woodruff, Prescott G</au><au>Thakur, Neeta</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk of COPD exacerbation is increased by poor sleep quality and modified by social adversity</atitle><jtitle>Sleep (New York, N.Y.)</jtitle><addtitle>Sleep</addtitle><date>2022-08-11</date><risdate>2022</risdate><volume>45</volume><issue>8</issue><issn>0161-8105</issn><eissn>1550-9109</eissn><abstract>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/.</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>35665826</pmid><doi>10.1093/sleep/zsac107</doi><orcidid>https://orcid.org/0000-0002-9527-691X</orcidid><orcidid>https://orcid.org/0000-0001-6159-7435</orcidid><orcidid>https://orcid.org/0000-0003-4174-9037</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Chronic obstructive pulmonary disease Disease Progression Humans Lung Medicine Mortality Pulmonary Disease, Chronic Obstructive - complications Pulmonary Disease, Chronic Obstructive - diagnosis Pulmonary Disease, Chronic Obstructive - epidemiology Severity of Illness Index Sleep Sleep Quality Sleep Wake Disorders - complications Sleep Wake Disorders - epidemiology Sleep, Health, and Disease Socioeconomic factors |
title | Risk of COPD exacerbation is increased by poor sleep quality and modified by social adversity |
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