Less sleep associated with more risk for poorly controlled asthma, exacerbations
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Key takeaways:
- Patients with less than 6 hours of sleep had low total IgE and FeNO levels compared with patients who slept 6 to 8 hours.
- Patients with less than 6 hours of sleep also had increased IL-6 and TFN-alpha levels.
Patients with asthma who slept less than 6 hours a night experienced poorer asthma control and greater risk for moderate to severe exacerbations, according to a study published in The Journal of Allergy and Clinical Immunology: In Practice.
As a result, sleep duration may play a role in asthma management, Chang Yong Wang, MD, department of respiratory and critical care medicine, clinical research center for respiratory disease, West China Hospital, Sichuan University, and colleagues wrote.
The 1-year prospective cohort study enrolled 522 patients (median age, 45 years; 64.8% women) age 18 years and older with stable asthma treated at the Asthma Clinic of West China Hospital between January 2015 and September 2019.
These patients included 58 classified as short sleep duration, or less than 6 hours a night; 380 classified as normal sleep duration, or 6 to 8 hours; and 84 classified as long sleep duration, or more than 8 hours.
The patients in the short duration group were older with a median age of 53 years compared with the median age of 44 years in the normal group and 47.5 years in the long group (P < .001).
Also, patients in the long duration group had a greater proportion of atopy than the normal group (51.9% vs. 36.2%; P < .05) as well as a lower proportion of inhaled corticosteroids or long-acting beta agonist use (44% vs. 60.3%; P < .05).
However, the researchers said they did not see any statistically significant differences in FEV1 percentages predicted, BMI or health status based on Asthma Quality of Life Questionnaire scores between the three groups.
The groups also did not display any significant differences in counts or percentages of peripheral blood granulocytes including total cells, eosinophils, neutrophils, lymphocytes, monocytes or basophils.
The median serum total IgE levels were lower in the short duration group (76.63 IU/mL) compared with the normal (146 IU/mL) and long (103.34 IU/mL) groups. Median fractional exhaled nitric oxide (FeNO) levels were higher in the normal group (41 ppb) compared with the short (25 ppb; P = .006) and long (32 ppb; P = .048) groups.
But like the peripheral blood granulocytes, there were no significant differences in counts or percentages of sputum granulocytes such as total cells, eosinophils, neutrophils, lymphocytes or macrophages between the three groups, the researchers said.
The researchers additionally noted significant airway inflammation among the short duration group compared with the normal duration group based on IL-6 (53.52 pg/mL vs. 16.41 pg/mL; P = .006) and TNF-alpha (24.75 pg/mL vs. 8.9 pg/mL; P = .02) levels.
Proportions of patients with type 2 asthma included 44.8% in the short duration group, 69.7% in the normal duration group and 64.3% in the long duration group (P = .001), but there were no differences in proportions for eosinophilic or late-onset asthma or in the severity of asthma between the groups.
Additionally, there were no differences in Asthma Control Questionnaire scores between the groups, but the researchers noted a greater proportion of poorly controlled asthma among the short duration group compared with the normal duration group (41.4% vs. 23.7%; P < .017).
A logistic regression model also found a significant association between short sleep duration and poorly controlled asthma, the researchers said, with an odds ratio of 2.275 (95% CI, 1.282-4.036) and an adjusted odds ratio of 2.741 (95% CI, 1.379-5.447).
Further, the researchers followed up with 491 of these patients including 363 in the normal group, 53 in the short group and 75 in the long group a year later, with 26.9% (n = 132 experiencing moderate to severe asthma exacerbations. The groups did not have any significant differences in incidence or frequency of moderate to severe exacerbations, the researchers said.
But after controlling for sex, age, BMI, smoking status, atopic status, medication use, previous severe asthma exacerbations, FEV1 percentage predicted and severe asthma, the researchers said, the short duration group had an adjusted incidence rate of moderate to severe asthma exacerbations in the following 12 months of 1.798 (95% CI, 1.098-2.942) compared with the normal duration group.
IgE and FeNO levels and elevated IL-6 and TNF-alpha levels in their induced sputum as well as non-type 2 inflammation.
Calling the risk for poorly controlled asthma and moderate to severe exacerbations significantly increased among these patients, the researchers said that sleep duration may be a potentially treatable trait with therapeutic interventions in asthma management.
Perspective
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These findings are significant given that medical providers are always looking for possible interventions or therapies to help better control asthma and prevent asthma exacerbation. Short sleep duration is a common public health concern not only because insufficient sleep can cause excessive daytime sleepiness, but also because it has other detrimental effects on chronic conditions such as asthma. This study highlights, yet again, another negative effect of not getting adequate sleep.
Also, the added measures that the researchers collected looking at markers of inflammation was fascinating and further strengthens their argument that getting adequate sleep at night can improve overall asthma status and prevent asthma exacerbations.
I do not primarily follow patients with asthma. However, we do see that many of our patients who suffer from chronic medical conditions such as asthma, depression or headaches improve if we can get our patients to get enough sleep at night.
As doctors evaluate and manage patients with asthma, it will be important to ask them about their sleep habits and if they are getting enough sleep at night. Instructing them about the importance of getting at least 7 hours of sleep is best for optimal health, including their asthma.
In future research, it would be helpful to have better measures of sleep times reported by patients. Maybe sleep could be measured with consumer sleep trackers. Also, researchers should narrow down how much sleep each patient is getting, such as looking to see if there is a difference between 6, 7 and 8 hours. It would be also helpful to do a prospective randomized trial where patients were instructed to get more sleep and seeing if getting more sleep improved their asthma.
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