Patients with asthma and a short sleep duration have a significantly increased risk for poorly controlled asthma and moderate-to-severe asthma exacerbations (AEs), researchers reported in the Journal of Allergy and Clinical Immunology: In Practice.
Investigators sought to explore the association between self-reported sleep duration and asthma control and exacerbations through a prospective cohort study. The study included adult participants with stable asthma from a hospital in Sichuan, China, from January 2015 to September 2019. Participants were classified into 3 groups according to their self-reported habitual sleep duration: short sleep duration group (<6 hours per night); normal sleep duration group (6 to 8 hours per night); and long sleep duration group (>8 hours per night).
Investigators conducted regular face-to-face or telephone interviews with participants during the 12-month follow-up period to obtain data on moderate to severe AEs. A moderate AE was defined as a deterioration in symptoms and lung function and increased rescue bronchodilator use for at least 2 days that was not severe enough for systemic corticosteroid use; a severe AE was defined as either (1) worsening asthma symptoms that led to temporary use of systemic corticosteroids or an increase from a stable maintenance dose of corticosteroids for at least 3 days, or (2) hospitalization, an emergency department (ED) visit, or intensive care unit visit for asthma requiring systemic corticosteroids.
A total of 522 patients (median age, 45 years; 64.8% female) were assessed for eligibility and stratified according to sleep duration, with 58 patients classified as short duration, 380 as normal duration, and 84 as long duration. The short sleep duration group had an older median age vs the normal sleep duration group (53.0 vs 44.0 years, P <.001).
The short sleep duration group had lower serum total immunoglobulin E levels compared with the normal sleep duration group (76.63 vs 146.00 IU/mL, P =.019). The normal sleep duration group had higher fractional exhaled nitric oxide levels vs the short and long sleep duration groups (41.00 vs 25.00 ppb, P =.006; 41.00 vs 32.00 ppb, P =.048, respectively). The short sleep duration group also had significant airway inflammation, including increased sputum levels of interleukin-6 and tumor necrosis factor-α, compared with the normal sleep duration group.
The short sleep duration group had a lower proportion of patients with type 2 asthma vs the normal and long sleep duration groups (44.8% vs 69.7% vs 64.3%, respectively; P = .001). A short sleep duration was significantly associated with poorly controlled asthma (odds ratio [OR], 2.275; 95% CI, 1.282-4.036; P =.005; adjusted OR [ORadj], 2.741; 95% CI, 1.379-5.447; P =.004).
The 1-year follow-up was completed by 491 patients (94.1%), with 363 patients in the normal duration group, 53 in the short duration group, and 75 in the long duration cohort. Among those completing the 1-year follow-up, 132 participants (26.9%) had moderate-to-severe AEs at 1 year. The adjusted incidence rate ratio of moderate-to-severe AEs was 1.742 (95% CI, 1.072-2.831) in the short sleep duration group vs the normal sleep duration group, after controlling for covariates including sex, age, body mass index, smoking status, and others.
Among several limitations, sleep duration was based on patient self-report, and data were not available for other potential confounders, including insomnia, sleep quality, and sleep hygiene. In addition, the sample size was relatively small and included only Chinese participants. Short sleep duration also may result from a cycle of poorly controlled asthma leading to insufficient sleep.
“This study suggests that sleep duration may be a potentially treatable trait for asthma management, which may benefit from tailored behavioral interventions to improve asthma control and reduce future AEs,” concluded the study authors.
This article originally appeared on Pulmonology Advisor
Wang CY, Wang J, Zhang L, et al. Self-reported insufficient sleep is associated with clinical and inflammatory features of asthma: a prospective cohort study. J Allergy Clin Immunol Pract. Published online December 26, 2022. doi:10.1016/j.jaip.2022.12.011