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

被引:16
作者
Baugh, Aaron [1 ]
Buhr, Russell G. [2 ]
Quibrera, Pedro [3 ]
Barjaktarevic, Igor [2 ]
Barr, R. Graham [4 ]
Bowler, Russell [5 ]
Han, Meilan King [6 ]
Kaufman, Joel D. [7 ]
Koch, Abigail L. [8 ]
Krishnan, Jerry [9 ]
Labaki, Wassim [6 ]
Martinez, Fernando J. [10 ]
Mkorombindo, Takudzwa [11 ]
Namen, Andrew [12 ]
Ortega, Victor [13 ]
Paine, Robert [14 ]
Peters, Stephen P. [12 ]
Schotland, Helena [6 ]
Sundar, Krishna [14 ]
Zeidler, Michelle R. [2 ]
Hansel, Nadia N. [15 ]
Woodruff, Prescott G. [1 ]
Thakur, Neeta [1 ]
机构
[1] Univ Calif San Francisco, Dept Med, San Francisco, CA 94143 USA
[2] Univ Calif Los Angeles, Dept Med, Los Angeles, CA 90024 USA
[3] Univ N Carolina, Gillings Sch Global Publ Hlth, Collaborat Studies Coordinat Ctr, Chapel Hill, NC 27515 USA
[4] Columbia Univ, Dept Med, New York, NY USA
[5] Natl Jewish Hlth, Dept Med, Denver, CO USA
[6] Univ Michigan, Dept Med, Ann Arbor, MI 48109 USA
[7] Univ Washington, Dept Med, Seattle, WA USA
[8] Vet Adm Miami Healthcare, Dept Med, Miami, FL USA
[9] Univ Illinois, Dept Med, Chicago, IL USA
[10] Cornell Univ, Dept Med, Ithaca, NY USA
[11] Univ Alabama Birmingham, Dept Med, Birmingham, AL 35294 USA
[12] Wake Forest Baptist Hlth, Dept Med, Winston Salem, NC USA
[13] Mayo Clin, Dept Med, Phoenix, AZ USA
[14] Univ Utah, Dept Med, Salt Lake City, UT 84112 USA
[15] Johns Hopkins Univ, Dept Med, Baltimore, MD USA
关键词
sleep quality; PSQI; exacerbations; COPD; health disparities; OBSTRUCTIVE PULMONARY-DISEASE; SOCIOECONOMIC-STATUS; ALLOSTATIC LOAD; OCCUPATIONAL EXPOSURES; DISTURBANCES; ASSOCIATIONS; BIOMARKERS; MORTALITY; DURATION; INSOMNIA;
D O I
10.1093/sleep/zsac107
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
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 predetermined 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.
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页数:10
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