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. 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/.
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/.
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