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

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

doi:10.1093/sleep/zsac107

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

Sleep. 2022 Aug 11;45(8):zsac107. doi: 10.1093/sleep/zsac107.

Authors

Aaron Baugh¹, Russell G Buhr², Pedro Quibrera³, Igor Barjaktarevic², R Graham Barr⁴, Russell Bowler⁵, Meilan King Han⁶, Joel D Kaufman⁷, Abigail L Koch⁸, Jerry Krishnan⁹, Wassim Labaki⁶, Fernando J Martinez¹⁰, Takudzwa Mkorombindo¹¹, Andrew Namen¹², Victor Ortega¹³, Robert Paine¹⁴, Stephen P Peters¹², Helena Schotland⁶, Krishna Sundar¹⁴, Michelle R Zeidler², Nadia N Hansel¹⁵, Prescott G Woodruff¹, Neeta Thakur¹

Affiliations

¹ Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
² Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
³ Collaborative Studies Coordination Center, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
⁴ Department of Medicine, Columbia University, New York, NY, USA.
⁵ Department of Medicine, National Jewish Health, Denver, CO, USA.
⁶ Department of Medicine, University of Michigan, Ann Arbor, MI, USA.
⁷ Department of Medicine, University of Washington, Seattle, WA, USA.
⁸ Department of Medicine, Veterans Administration Miami Healthcare, Miami, FL, USA.
⁹ Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA.
¹⁰ Department of Medicine, Cornell University, Ithaca, NY, USA.
¹¹ Department of Medicine, University of Alabama, Birmingham, AL, USA.
¹² Department of Medicine, Wake Forest Baptist Health, Winston-Salem, NC, USA.
¹³ Department of Medicine, Mayo Clinic, Phoenix, AZ, USA.
¹⁴ Department of Medicine, University of Utah, Salt Lake City, UA, USA.
¹⁵ Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.

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/.

Keywords: COPD; PSQI; exacerbations; health disparities; sleep quality.

Publication types

Clinical Study
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Disease Progression
Humans
Lung
Pulmonary Disease, Chronic Obstructive* / complications
Pulmonary Disease, Chronic Obstructive* / diagnosis
Pulmonary Disease, Chronic Obstructive* / epidemiology
Severity of Illness Index
Sleep Quality
Sleep Wake Disorders* / complications
Sleep Wake Disorders* / epidemiology

Associated data

ClinicalTrials.gov/NCT01969344

Abstract

Publication types

MeSH terms

Associated data

Grants and funding