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Asthma and Sleep Disturbances: Associations to Comorbidities and Asthma Control
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis aimed to investigate the associations between asthma control, asthma-related comorbidity, and sleep. Insomnia symptoms with asthma are common, and have commonly been explained by poor asthma control and asthma symptoms during the night, which affect most asthmatics to some degree. The impact of asthma-related comorbidity, however, is not fully known. Further aims were to analyze the effects of asthma control and comorbidities on asthma-related quality of life, and to analyze the effects of co-existing asthma and obstructive sleep apnea on objective sleep quality. 

Four different populations were investigated: the two large community-based cohorts GA2LEN (n=25,610) and LifeGene (n=23,875), a cohort of 369 young asthma patients (MIDAS), and a polysomnography study of 384 women (SHE).

The GA2LEN study confirmed that insomnia symptoms remain a common problem among asthmatics. Poor asthma control and nasal congestion were important risk factors for insomnia symptoms. Smoking and obesity were other risk factors for insomnia symptoms among asthmatics.

Asthma control, as assessed using the Asthma Control Test (ACT), was identified as the most important predictor of asthma-related quality of life in the MIDAS study. Combining the ACT score with data on insomnia, anxiety, and depression showed considerable additive effects of the conditions. 

In the SHE study, co-existing asthma and OSA were associated with worse objective sleep quality and more profound nocturnal hypoxemia than either of the conditions alone. The group with both asthma and OSA had the highest levels of the markers of systemic inflammation CRP and IL-6.  

Uncontrolled asthma was a risk factor for all insomnia symptoms in the LifeGene study. Asthma-related comorbidity had a great impact on sleep quality; in particular, the combination of uncontrolled asthma and any comorbidity was unfavorable. Chronic rhinosinusitis was a risk factor for both insomnia symptoms and uncontrolled asthma. 

These findings have a high clinical relevance and underline the importance of structured evaluation of asthma control and attention to comorbidity in asthma care, as insomnia symptoms are common and affect quality of life. Optimizing asthma control is crucial for sleep quality, but treating asthma-related comorbidity must not be overlooked.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2019. , p. 78
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1552
National Category
Respiratory Medicine and Allergy
Research subject
Lung Medicine
Identifiers
URN: urn:nbn:se:uu:diva-377945ISBN: 978-91-513-0596-7 (print)OAI: oai:DiVA.org:uu-377945DiVA, id: diva2:1296037
Public defence
2019-05-03, Enghoffsalen, Akademiska sjukhuset, ingång 50 bv, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2019-04-12 Created: 2019-03-13 Last updated: 2019-05-07
List of papers
1. Asthma symptoms and nasal congestion as independent risk factors for insomnia in a general population: Results from the GA 2 LEN survey
Open this publication in new window or tab >>Asthma symptoms and nasal congestion as independent risk factors for insomnia in a general population: Results from the GA 2 LEN survey
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2013 (English)In: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 68, no 2, p. 213-219Article in journal (Refereed) Published
Abstract [en]

Background Asthma and rhinitis have been related to insomnia. The aim of this study was to further analyse the association between asthma, nasal symptoms and insomnia and to identify risk factors for sleep disturbance among patients with asthma, in a large population-based set of material. Method In 2008, a postal questionnaire was sent to a random sample of 45 000 adults in four Swedish cities. The questionnaire included questions on insomnia, asthma, rhinitis, weight, height, tobacco use and physical activity. Results Twenty-five thousand six hundred and ten subjects participated. Asthma was defined as either current medication for asthma or at least one attack of asthma during the last 12 months, and 1830 subjects (7.15%) were defined as asthmatics. The prevalence of insomnia symptoms was significantly higher among asthmatics than non-asthmatics (47.3% vs 37.2%, <0.0001). In the subgroup reporting both asthma and nasal congestion, 55.8% had insomnia symptoms compared with 35.3% in subjects without both asthma and nasal congestion. The risk of insomnia increased with the severity of asthma, and the adjusted OR for insomnia was 2.65 in asthmatics with three symptoms compared with asthmatics without symptoms. Nasal congestion (OR 1.50), obesity (OR 1.54) and smoking (OR 1.71) also increased the risk of insomnia. Conclusion Insomnia remains a common problem among asthmatics. Uncontrolled asthma and nasal congestion are important, treatable risk factors for insomnia. Lifestyle factors, such as smoking and obesity, are also risk factors for insomnia among asthmatics.

Keywords
asthma, epidemiology, rhinitis, sleep
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-194860 (URN)10.1111/all.12079 (DOI)000313727300010 ()
Available from: 2013-02-20 Created: 2013-02-19 Last updated: 2019-03-13Bibliographically approved
2. Effects of poor asthma control, insomnia, anxiety and depression on quality of life in young asthmatics
Open this publication in new window or tab >>Effects of poor asthma control, insomnia, anxiety and depression on quality of life in young asthmatics
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2016 (English)In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 53, no 4, p. 398-403Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Asthma-related quality of life has previously been shown to be associated with asthma control. The aims of the present study were to further analyze this correlation, identify other variables with impact on asthma-related quality of life, and investigate the covariance among these variables.

METHODS: Information was retrieved from a cohort of 369 patients, aged 12-35, with physician-diagnosed asthma requiring anti-inflammatory treatment for at least 3 months per year. Questionnaire data [including the mini Asthma Quality of Life Questionnaire (mAQLQ), Asthma Control Test (ACT), and Hospital Anxiety and Depression Scale (HADS)], quality of sleep, lung function data and blood samples were analyzed. Linear regression models with the mAQLQ score as the dependent scalar variable were calculated.

RESULTS: ACT was the single variable that had the highest explanatory value for the mAQLQ score (51.5%). High explanatory power was also observed for anxiety and depression (17.0%) and insomnia (14.1%). The population was divided into groups depending on presence of anxiety and depression, uncontrolled asthma, and insomnia. The group that reported none of these conditions had the highest mean mAQLQ score (6.3 units), whereas the group reporting all of these conditions had the lowest mAQLQ score (3.8 units).

CONCLUSIONS: The ACT score was the single most important variable in predicting asthma-related quality of life. Combining the ACT score with the data on insomnia, anxiety and depression showed considerable additive effects of the conditions. Hence, we recommend the routine use of the ACT and careful attention to symptoms of insomnia, anxiety or depression in the clinical evaluation of asthma-related quality of life.

Keywords
Asthma; epidemiology; asthma control; ACT; mAQLQ; quality of life; sleep; HADS; anxiety; depression
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-270378 (URN)10.3109/02770903.2015.1126846 (DOI)000374991200009 ()26666333 (PubMedID)
Funder
VINNOVA
Available from: 2015-12-27 Created: 2015-12-27 Last updated: 2019-03-13Bibliographically approved
3. Effects of Coexisting Asthma and Obstructive Sleep Apnea on Sleep Architecture, Oxygen Saturation, and Systemic Inflammation in Women
Open this publication in new window or tab >>Effects of Coexisting Asthma and Obstructive Sleep Apnea on Sleep Architecture, Oxygen Saturation, and Systemic Inflammation in Women
2018 (English)In: Journal of Clinical Sleep Medicine (JCSM), ISSN 1550-9389, E-ISSN 1550-9397, Vol. 14, no 2, p. 253-259Article in journal (Refereed) Published
Abstract [en]

STUDY OBJECTIVES: Both asthma and obstructive sleep apnea (OSA) are strongly associated with poor sleep. Asthma and OSA also have several features in common, including airway obstruction, systemic inflammation, and an association with obesity. The aim was to analyze the effect of asthma, OSA, and the combination of asthma and OSA on objectively measured sleep quality and systemic inflammation.

METHODS: Sleep and health in women is an ongoing community-based study in Uppsala, Sweden. Three hundred eighty-four women ages 20 to 70 years underwent overnight polysomnography and completed questionnaires on airway diseases and sleep complaints. C-reactive protein (CRP), interleukin 6 (IL-6), and tumor necrosis factor α were analyzed.

RESULTS: = .04) than the group with OSA alone. The results were consistent after adjusting for age, body mass index, and smoking status. Asthma was independently associated with lower oxygen saturation, whereas OSA was not.

CONCLUSIONS: Our data indicate that coexisting asthma and OSA are associated with poorer sleep quality and more profound nocturnal hypoxemia than either of the conditions alone. The results are similar to earlier findings related to OSA and chronic obstructive pulmonary disease, but they have not previously been described for asthma.

Place, publisher, year, edition, pages
American Academy of Sleep Medicine, 2018
Keywords
OSA, asthma, inflammation, polysomnography
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-343517 (URN)10.5664/jcsm.6946 (DOI)000425136900013 ()29394961 (PubMedID)
Available from: 2018-02-27 Created: 2018-02-27 Last updated: 2019-03-13Bibliographically approved
4. Insomnia symptoms and asthma control – interrelations and importance of comorbidities
Open this publication in new window or tab >>Insomnia symptoms and asthma control – interrelations and importance of comorbidities
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background

 

Insomnia symptoms are common with asthma. The aim of the study was to analyze the associations between insomnia symptoms and asthma control, asthma severity, and asthma-related comorbidity in a community-based population.

 

Methods

Adults (n=23,875, ages 18-45) from the community-based LifeGene study answered a questionnaire on insomnia symptoms, airway symptoms, asthma diagnosis, asthma medication, and asthma-related comorbidities (chronic rhinosinusitis, gastro-esophageal reflux, anxiety, depression, or obesity).

 

Results

Of the participants, 1,272 (5.3%) had asthma. The prevalence of any insomnia symptom was higher in participants with uncontrolled asthma (n=201) than with controlled or partially controlled asthma (32.2% vs. 19.9% and 20.1%, respectively, p<0.01). There was no significant difference in the prevalence of insomnia symptoms between subjects with controlled asthma and subjects without asthma. 

 

Subjects with asthma and any asthma-related comorbidity reported more insomnia symptoms (29.0% vs. 22.4%, p<0.01) compared to asthmatics without comorbidity. Moreover, the prevalence was highest among subjects reporting both uncontrolled asthma and any asthma-related comorbidity (45.1%, p<0.01).

 

Uncontrolled asthma remained significantly associated with insomnia symptoms (OR 1.72 (1.15-2.56)) after adjusting for age, sex, BMI, smoking history, comorbidities, physical activity, and educational level, while medication level was not. Among asthma-related comorbidities, chronic rhinosinusitis (OR 1.62 (1.20-2.19)), obesity (1.87 (1.07-3.25)), and depression (OR 1.85 (1.34-2.55)) were independently associated with insomnia symptoms. 

 

Conclusion

 

Uncontrolled asthma was significantly associated with insomnia symptoms, while controlled or partially controlled asthma was not. Asthma-related comorbidity is of great importance, and asthma control seems to be more important than asthma severity for sleep quality.

National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-379139 (URN)
Available from: 2019-03-12 Created: 2019-03-12 Last updated: 2019-03-13

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