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BMC Geriatrics

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Open Access 01-12-2022 | Insomnia | Research

The effect and relative importance of sleep disorders for all-cause mortality in middle-aged and older asthmatics

Authors: Zhigang Hu, Yufeng Tian, Xinyu Song, Fanjun Zeng, Ke Hu, Ailan Yang

Published in: BMC Geriatrics | Issue 1/2022

Abstract

Background

Previous studies observed that sleep disorders potentially increased the risk of asthma and asthmatic exacerbation. We aimed to examine whether excessive daytime sleepiness (EDS), probable insomnia, objective short sleep duration (OSSD), and obstructive sleep apnea (OSA) affect all-cause mortality (ACM) in individuals with or without asthma.

Methods

We extracted relevant data from the Sleep Heart Health Study established in 1995–1998 with an 11.4-year follow-up. Multivariate Cox regression analysis with a proportional hazards model was used to estimate the associations between ACM and four sleep disorders among asthmatic patients and individuals without asthma. Dose-response analysis and machine learning (random survival forest and CoxBoost) further evaluated the impact of sleep disorders on ACM in asthmatic patients.

Results

A total of 4538 individuals with 990 deaths were included in our study, including 357 asthmatic patients with 64 deaths. Three multivariate Cox regression analyses suggested that OSSD (adjusted HR = 2.67, 95% CI: 1.23–5.77) but not probable insomnia, EDS or OSA significantly increased the risk of ACM in asthmatic patients. Three dose-response analyses also indicated that the extension of objective sleep duration was associated with a reduction in ACM in asthmatic patients compared to very OSSD patients. Severe EDS potentially augmented the risk of ACM compared with asthmatics without EDS (adjusted HR = 3.08, 95% CI: 1.11–8.56). Machine learning demonstrated that OSSD of four sleep disorders had the largest relative importance for ACM in asthmatics, followed by EDS, OSA and probable insomnia.

Conclusions

This study observed that OSSD and severe EDS were positively associated with an increase in ACM in asthmatic patients. Periodic screening and effective intervention of sleep disorders are necessary for the management of asthma.

Cappuccio FP, D'Elia L, Strazzullo P, Miller MA. Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies. Sleep. 2010;33(5):585–92. https://doi.org/10.1093/sleep/33.5.585.CrossRefPubMedPubMedCentral

Itani O, Jike M, Watanabe N, Kaneita Y. Short sleep duration and health outcomes: a systematic review, meta-analysis, and meta-regression. Sleep Med. 2017;32:246–56. https://doi.org/10.1016/j.sleep.2016.08.006.CrossRefPubMed

Tobaldini E, Fiorelli EM, Solbiati M, Costantino G, Nobili L, Montano N. Short sleep duration and cardiometabolic risk: from pathophysiology to clinical evidence. Nat Rev Cardiol. 2019;16(4):213–24. https://doi.org/10.1038/s41569-018-0109-6.CrossRefPubMed

Grandner MA, Hale L, Moore M, Patel NP. Mortality associated with short sleep duration: the evidence, the possible mechanisms, and the future. Sleep Med Rev. 2010;14(3):191–203. https://doi.org/10.1016/j.smrv.2009.07.006.CrossRefPubMed

Ford ES, Cunningham TJ, Croft JB. Trends in self-reported sleep duration among US adults from 1985 to 2012. Sleep. 2015;38(5):829–32. https://doi.org/10.5665/sleep.4684.CrossRefPubMedPubMedCentral

Bin YS, Marshall NS, Glozier N. Sleeping at the limits: the changing prevalence of short and long sleep durations in 10 countries. Am J Epidemiol. 2013;177(8):826–33. https://doi.org/10.1093/aje/kws308.CrossRefPubMed

Vir R, Bhagat R, Shah A. Sleep disturbances in clinically stable young asthmatic adults. Ann Allergy Asthma Immunol. 1997;79(3):251–5. https://doi.org/10.1016/S1081-1206(10)63010-4.CrossRefPubMed

Alanazi TM, Alghamdi HS, Alberreet MS, Alkewaibeen AM, Alkhalefah AM, Omair A, et al. The prevalence of sleep disturbance among asthmatic patients in a tertiary care center. Sci Rep. 2021;11(1):2457. https://doi.org/10.1038/s41598-020-79697-x.CrossRefPubMedPubMedCentral

John M. The official website of the Epworth Sleepiness Scale (ESS) and the Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD). http://epworthsleepinessscale.com/about-the-ess/.

10.

Ford ES, Cunningham TJ, Giles WH, Croft JB. Trends in insomnia and excessive daytime sleepiness among U.S. adults from 2002 to 2012. Sleep Med. 2015;16:372–8.CrossRefPubMedPubMedCentral

11.

Hu Z, Song X, Hu K, Ruan Y, Zeng F. Association between sleep duration and asthma in different weight statuses (CHNS 2009-2015). Sleep Breath. 2021;25(1):493–502. https://doi.org/10.1007/s11325-020-02081-6.CrossRefPubMed

12.

Hu Z, Tian Y, Zeng F, Song X. The association between sleep duration, asthma-related episodes/attacks and emergency department visits. Nat Sci Sleep. 2020;12:253–62. https://doi.org/10.2147/NSS.S243882.CrossRefPubMedPubMedCentral

13.

Teodorescu M, Polomis DA, Gangnon RE, Consens FB, Chervin RD, Teodorescu MC. Sleep duration, asthma and obesity. J Asthma. 2013;50(9):945–53. https://doi.org/10.3109/02770903.2013.831871.CrossRefPubMed

14.

Hu Z, Zhang H, Hu K, Song X. Associations between sleep duration, lung function, FeNO and blood eosinophils among current asthmatics (NHANES 2007-12). J Breath Res. 2021;15:026008.CrossRefPubMed

15.

Teodorescu M, Broytman O, Curran-Everett D, Sorkness RL, Crisafi G, Bleecker ER, et al. Obstructive sleep apnea risk, asthma burden, and lower airway inflammation in adults in the severe asthma research program (SARP) II. J Allergy Clin Immunol Pract. 2015;3(4):566–75.e1. https://doi.org/10.1016/j.jaip.2015.04.002.CrossRefPubMedPubMedCentral

16.

Teodorescu M, Consens FB, Bria WF, Coffey MJ, McMorris MS, Weatherwax KJ, et al. Correlates of daytime sleepiness in patients with asthma. Sleep Med. 2006;7(8):607–13. https://doi.org/10.1016/j.sleep.2006.02.001.CrossRefPubMed

17.

Teodorescu M, Polomis DA, Hall SV, Teodorescu MC, Gangnon RE, Peterson AG, et al. Association of obstructive sleep apnea risk with asthma control in adults. Chest. 2010;138(3):543–50. https://doi.org/10.1378/chest.09-3066.CrossRefPubMedPubMedCentral

18.

Oka S, Goto T, Hirayama A, Faridi MK, Camargo CA Jr, Hasegawa K. Association of obstructive sleep apnea with severity of patients hospitalized for acute asthma. Ann Allergy Asthma Immunol. 2020;124(2):165–70.e4. https://doi.org/10.1016/j.anai.2019.11.002.CrossRefPubMed

19.

Sumino K, O’Brian K, Bartle B, Au DH, Castro M, Lee TA. Coexisting chronic conditions associated with mortality and morbidity in adult patients with asthma. J Asthma. 2014;51(3):306–14. https://doi.org/10.3109/02770903.2013.879881.CrossRefPubMedPubMedCentral

20.

Ioachimescu OC, Janocko NJ, Ciavatta MM, Howard M, Warnock MV. Obstructive lung disease and obstructive sleep apnea (OLDOSA) cohort study: 10-year assessment. J Clin Sleep Med. 2020;16(2):267–77. https://doi.org/10.5664/jcsm.8180.CrossRefPubMedPubMedCentral

21.

Kallin SA, Lindberg E, Sommar JN, Bossios A, Ekerljung L, Malinovschi A, et al. Excessive daytime sleepiness in asthma: what are the risk factors? J Asthma. 2018;55(8):844–50. https://doi.org/10.1080/02770903.2016.1263316.CrossRefPubMed

22.

Quan SF, Howard BV, Iber C, Kiley JP, Nieto FJ, O'Connor GT, et al. The sleep heart health study: design, rationale, and methods. Sleep. 1997;20(12):1077–85.PubMed

23.

Budhiraja P, Budhiraja R, Goodwin JL, Allen RP, Newman AB, Koo BB, et al. Incidence of restless legs syndrome and its correlates. J Clin Sleep Med. 2012;08(02):119–24. https://doi.org/10.5664/jcsm.1756.CrossRef

24.

Edinger JD, Bonnet MH, Bootzin RR, et al. Derivation of research diagnostic criteria for insomnia: report of an American Academy of sleep medicine work group. Sleep. 2004;2:1567–96.CrossRef

25.

Edinger JD, Bonnet MH, Bootzin RR, Doghramji K, Dorsey CM, Espie CA, et al. Objective but not subjective short sleep duration is associated with hypertension in obstructive sleep apnea. Hypertension. 2018;72:610–7.CrossRef

26.

Leary EB, Watson KT, Ancoli-Israel S, Redline S, Yaffe K, Ravelo LA, et al. Association of Rapid Eye Movement Sleep With Mortality in Middle-aged and Older Adults. JAMA Neurol. 2020;77(10):1241–51. https://doi.org/10.1001/jamaneurol.2020.2108.CrossRefPubMed

27.

Abuhelwa AY, Kichenadasse G, McKinnon RA, Rowland A, Hopkins AM, Sorich MJ. Machine learning for prediction of survival outcomes with immune-checkpoint inhibitors in urothelial Cancer. Cancers (Basel). 2021;13:2001.CrossRef

28.

Chen Z, Xu HM, Li ZX, Zhang Y, Zhou T, You WC, et al. Random survival forest: applying machine learning algorithm in survival analysis of biomedical data. Chinese journal of preventive medicine. 2021;55(1):104–9. https://doi.org/10.3760/cma.j.cn112150-20200911-01197.CrossRefPubMed

29.

Vgontzas AN, Liao D, Pejovic S, et al. Insomnia with short sleep duration and mortality: the Penn State cohort. Sleep. 2010;33:1159–64.CrossRefPubMedPubMedCentral

30.

Fernandez-Mendoza J, He F, Vgontzas AN, et al. Objective short sleep duration modifies the relationship between hypertension and all-cause mortality. J Hypertens. 2017;35:830–6.CrossRefPubMedPubMedCentral

31.

Fernandez-Mendoza J, He F, LaGrotte C, et al. Impact of the metabolic syndrome on mortality is modified by objective short sleep duration. J Am Heart Assoc. 2017;6:e005479.CrossRefPubMedPubMedCentral

32.

Fernandez-Mendoza J, He F, Vgontzas AN, et al. Interplay of objective sleep duration and cardiovascular and cerebrovascular diseases on cause-specific mortality. J Am Heart Assoc. 2019;8:e013043.CrossRefPubMedPubMedCentral

33.

Fernandez-Mendoza J, He F, Calhoun SL, et al. Objective short sleep duration increases the risk of all-cause mortality associated with possible vascular cognitive impairment. Sleep Health. 2020;6:71–8.CrossRefPubMed

34.

Bertisch SM, Pollock BD, Mittleman MA, et al. Insomnia with objective short sleep duration and risk of incident cardiovascular disease and all-cause mortality: sleep heart health study. Sleep. 2018;41:zsy047.CrossRefPubMedCentral

35.

Pite H, Aguiar L, Morello J, et al. Metabolic dysfunction and asthma: current perspectives. J Asthma Allergy. 2020;13:237–47.CrossRefPubMedPubMedCentral

36.

Wang L, Liu Q, Heizhati M, Yao X, Luo Q, Li N. Association between excessive daytime sleepiness and risk of cardiovascular disease and all-cause mortality: a systematic review and Meta-analysis of longitudinal cohort studies. J Am Med Dir Assoc. 2020;21:1979–85.CrossRefPubMed

37.

Lovato N, Lack L. Insomnia and mortality: a meta-analysis. Sleep Med Rev. 2019;43:71–83.CrossRefPubMed

38.

Ge L, Guyatt G, Tian J, et al. Insomnia and risk of mortality from all-cause, cardiovascular disease, and cancer: systematic review and meta-analysis of prospective cohort studies. Sleep Med Rev. 2019;48:101215.CrossRefPubMed

Title: The effect and relative importance of sleep disorders for all-cause mortality in middle-aged and older asthmatics
Authors: Zhigang Hu
Yufeng Tian
Xinyu Song
Fanjun Zeng
Ke Hu
Ailan Yang
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Insomnia
Bronchial Asthma
Published in: BMC Geriatrics / Issue 1/2022
Electronic ISSN: 1471-2318
DOI: https://doi.org/10.1186/s12877-022-03587-2

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