Sleep, mood disorders may negatively impact asthma control
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Key takeaways:
- Asthmatic patients with insomnia had more frequent exacerbations and poorer asthma control.
- This group also had more concurrent mood and sleep disorders compared with patients without insomnia.
People with asthma that also have underlying insomnia, depression and obstructive sleep apnea see a negative impact in asthma control, according to a study published in Journal of Asthma.
Increased asthma exacerbation rates in these populations suggest that underlying sleep and mood disorders negatively affect asthma control. These findings indicate a need to screen patients with asthma for sleep quality and mood disorders, Michael E. Wechsler, MD, MMSc, director, Cohen Family Asthma Institute, National Jewish Health, and colleagues wrote.
“We recognized the prevalence of asthma and how challenging it can be to manage without addressing comorbidities,” Wechsler told Healio. “We also recognized the prevalence of sleep-related issues and the epidemic of the mental health crisis. We thought it would be important to better understand the interaction of all of these.”
The study conducted a retrospective chart review of 659 adults diagnosed with asthma enrolled in a long-term study at National Jewish Health. Data were collected starting in October 2017 with ongoing enrollment.
The analysis cohort included patients with a diagnosis of insomnia (n = 89; 13.5%; mean age, 57 years) who were then matched with patients without the diagnosis (n = 89; mean age, 56.9 years) by age, sex, biologic therapy for asthma, and the Charlson Comorbidity Index score. In both groups, 76% were women and 35.9% were on a biologic therapy for asthma.
The data collected for each group included the presence of sleep apnea, mood disorders, and asthma control measured by Asthma Control Test (ACT) score, and the number of asthma exacerbations in the previous year.
Within the insomnia group, 57.3% had a coinciding diagnosis of obstructive sleep apnea vs. 18% of those in the non-insomnia group (P < .001). Half of the insomnia group used prescription medications for sleep, most often zolpidem (n = 13) or trazodone (n = 10).
The patients in the insomnia group also showed a significant likelihood for having a diagnosis of depression or anxiety (n = 61; 68.5%) compared with the non-insomnia group (n = 10; 11.4%; P < .001). Within the insomnia group with a coinciding diagnosis of depression or anxiety, the majority had a prescription for at least one antidepressant (n = 34; 55.7%). Half of the patients in the non-insomnia group with depression or anxiety had an antidepressant prescription (n = 5; 50%).
Additionally, patients in the insomnia group had a significant number of overlaps by having both obstructive sleep apnea and depression (n = 31; 34.8%) compared with only two patients (2.2%) in the non-insomnia group.
When analyzing asthma control, researchers found that patients in the insomnia group experienced on average 0.93 exacerbations in a year prior to data collection, compared with 0.59 in the non-insomnia group (P = .039). The insomnia group also had a lower ACT score at 16 vs. 18.9 in those without insomnia (P = .0029).
Among those patients with available data, those with insomnia also tended to have lower levels of biomarkers associated with Th2-type asthma, including IgE, blood eosinophil count and fractional exhaled nitric oxide, as well as acute phase reactant C-reactive protein.
“We were particularly surprised with the magnitude of the interactions, especially the impact of insomnia on asthma exacerbations,” Wechsler said. “Insomnia, depression, sleep apnea and asthma are all common problems. These are all significant in and of themselves. The fact that these could impact each other the way they did was significant.”
Study authors concluded that the demonstrated association between insomnia and increased asthma exacerbations and decreased ACT scores as well as the significant increase in the presence of mood disorders among those with concurrent asthma and insomnia should help providers assess and mitigate risks and improve disease management.
“These findings should prompt physicians to more thoroughly screen for the occurrence of sleep disorders and mental health issues in patients with asthma and address them proactively to prevent asthma deterioration,” Wechsler said.