Poor sleep can be a good predictor of COPD flare-ups

Poor sleep is associated with a significantly increased risk of life-threatening flare-ups in people with chronic obstructive pulmonary disease, or COPD, according to a new study supported by the National Institutes of Health. The risk of these flare-ups — sudden attacks of worsening breathing — was 25% to 95% higher in people who slept poorly than in people who got a good night’s sleep. The findings suggest that poor sleep may be a better predictor of flare-ups than even a person’s smoking history.

The observational study, one of the largest to look at the links between sleep quality and COPD flare-ups, was funded in large part by the National Heart, Lung and Blood Institute (NHLBI), part of the NIH. The findings appear online June 6 in the journal sleep.

COPD, a progressive, incurable lung disease that makes breathing difficult, affects more than 16 million adults in the United States and is a leading cause of death. Flare-ups of COPD, also called exacerbations, can last for days or even weeks and are caused by a variety of factors, ranging from pollutants to cold and flu viruses. Poor sleep can weaken a healthy person’s immune system and make them more susceptible to colds and flu; and this vulnerability may increase in people with COPD.

While scientists have long known that people with COPD often experience sleep disturbances, the role of poor sleep as a cause of COPD exacerbations has been under-researched, with large-scale research on the subject providing conflicting evidence. The current study fills an important knowledge gap, researchers say.

For those who already have COPD, knowing how they sleep at night will tell me a lot more about their risk of a flare-up than knowing whether they’ve smoked for 40 or 60 years. That is very surprising and is not necessarily what I expected in this study. Smoking is such a central process in COPD that I predicted it would be the most important predictor in the case of exacerbations.”

Aaron Baugh, MD, lead study author, practicing pulmonologist, clinical fellow at the University of California San Francisco Medical School

For the study, the researchers followed 1,647 people with confirmed COPD who participated in the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS), a multicenter US longitudinal study funded by the NHLBI and the COPD Foundation and designed to evaluate COPD subpopulations, outcomes. and biomarkers. All participants in this particular study were current or former tobacco smokers with a confirmed diagnosis of COPD, and they underwent at least one initial sleep evaluation at enrollment.

The researchers recorded COPD flare-ups over a three-year follow-up period and compared these measurements with the participants’ sleep quality. The researchers used a common tool for analyzing self-reported sleep quality – a combination of seven measures of sleep, including sleep duration, time of sleep and frequency of disturbances. The scores ranged from poorer sleep quality to best sleep. The researchers reported their results after looking at how a person’s risk of flare-ups changed after a year.

They found that poor sleep quality in general was strongly associated with a higher total of COPD flare-ups. Compared to the participants with the best possible sleep, those who were at the threshold or baseline level of poor sleep had a 25% increased chance of a COPD flare-up within the following year. Those with the worst sleep had an almost 95% increased risk of a COPD exacerbation within the following year.

While the findings apply to all races and ethnicities, the study is especially relevant to black Americans, Baugh said. That’s because previous studies have shown that this group tends to have poorer sleep quality than other races and ethnicities. Because worse sleep is now linked to worse COPD outcomes, the current study may help explain why black Americans as a group do worse when they have COPD, compared to other racial and ethnic groups, the researchers suggested.

“Our work provides a strong rationale for paying more attention to sleep than we have in the past, both from a clinical and research perspective,” said Baugh, who has a special interest in studying COPD differences. “While we now know that sleep quality can predict future exacerbations, we don’t know whether improving sleep quality will provide direct improvements in COPD outcomes. We encourage future studies that can look at the impact of interventions, both at an individual and community level. “

Marishka Brown, Ph.D., director of the NHLBI’s National Center on Sleep Disorders Research, agreed that this study is an important milestone. “Sleep has not been extensively studied as a modifier of COPD outcomes,” Brown said. “This study adds to a growing knowledge base showing the deleterious effects of poor sleep on health in general, but may be particularly harmful in people with devastating pre-existing conditions, such as COPD.”


Reference magazine:

Baugh, A., et al. (2022) The risk of worsening COPD is increased by poor sleep quality and modified by social adversity. sleep doi.org/10.1093/sleep/zsac107

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