Some lung patients are worse off than others. Can sleep explain it?

A study led by researchers from the University of California, San Francisco, showed that inadequate or interrupted sleep may have a greater effect than a history of smoking in patients with progressive lung disease.

Researchers have found that for patients with chronic obstructive pulmonary disease (COPD), inadequate sleep may increase the risk of seizures by up to 95% compared to those with good sleep. Over time, these attacks, which appear with worsening shortness of breath and cough, may cause irreversible lung damage, accelerating disease progression and mortality.

The results appear online in the journal Sleeps on June 6, 2022. They may partly explain why African-American patients with COPD tend to do worse than white patients, said first author Aaron Pugh, a clinical fellow in the division of pulmonology, critical care, allergy and sleep medicine at the University of California San Francisco, Cardiovascular Research Institute.

“African Americans are over-represented in lower-income neighborhoods, where people are less likely to get good sleep. They may live in crowded spaces with many roommates, have less comfortable sleeping conditions, such as a couch, and may work a job with a varying schedule that spoils himself for disturbed sleep,” Poe said, noting that research shows sleep deprivation is associated with a decrease in infection-fighting antibodies and protective cytokines.

The researchers followed 1,647 patients with confirmed COPD, who were enrolled in the multicenter national SPIROMICS study, designed to monitor disease progression and assess the effectiveness of treatments. Over a three-year period, the researchers recorded flare-ups, defined as short-term exacerbations of symptoms requiring treatment, and compared their incidence with self-reported data on sleep quality.

Lack of sleep increases the risk of seizures from 25% to 95%.

At the start of the study, the average age of the participants was 65 years and the middle stage of the disease was moderate. More than half (57%) of the participants were male. 80% were white and 14% were African American. All were current or former smokers, and underwent at least one sleep assessment at enrollment. The researchers found that compared to participants with optimal sleep, those with poor sleep had a 25% greater chance of a flare over the next year, rising to nearly 95% over the next year for those with the worst sleep. .

This may be a more pronounced effect of smoking over a 40-year period, as opposed to a 60-year period, Pugh said.

As expected, more African Americans reported less sleep than white participants: 63% versus 52%.

“While factors such as health insurance coverage or respiratory risk may play important roles in disease severity, lack of sleep may take on greater importance when the social status of African Americans improves,” Pugh said. This can lead to some kind of contradiction. In reducing one of the risk factors, it may be replaced by a new risk factor – lack of sleep.”

Poe said the as yet unpublished data will show that African Americans sleep worse even when socioeconomic factors and COPD severity are accounted for.

Senior author and pulmonologist Nita Thakur, MD, of the University of California, San Francisco School of Medicine, said questions about sleep are often overlooked by clinicians evaluating COPD patients. “Sleep hygiene and sleep aids may significantly improve their health,” she said. “Sleep should be considered both at the clinic and at the broader community/neighborhood level, where structural factors that contribute to poor sleep can be addressed.”

Co-authors: Please refer to the paper.

Financing: SPIROMICS has been supported by contracts from NIH/NHLBI (HHSN268200900013C, HHSN268200900014C, HHSN268200900015C, HHSN268200900016C, HHSN268200900017C, HHSN268200900018C, HHSN268200900019. Please refer to full paper. for disclosures).

About UCSF: The University of California, San Francisco (UCSF) focuses exclusively on the health sciences and is dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. UCSF Health, which serves as UCSF’s primary academic medical center, includes highly-rated specialty hospitals and other clinical programs, and has branches throughout the Gulf region. The University of California, San Francisco School of Medicine has a regional campus in Fresno. Learn more at https://www.ucsf.edu, or check out our fact sheet.

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2022-06-07 01:30:57

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