Advertisement

Prevalence of self-reported sleep problems amongst adults with obstructive airway disease in the NHANES cohort in the United States

  • Chitra LalEmail author
  • Suchit Kumbhare
  • Charlie Strange
Sleep Breathing Physiology and Disorders • Original Article
  • 25 Downloads

Abstract

Rationale

Sleep and respiratory problems are common in adults in the USA. However, sleep problems often remain undiagnosed in patients with obstructive airway diseases (OADs). This study was designed to examine the association between sleep problems and different categories of OAD amongst US adults.

Methods

We conducted an observational, cross-sectional study using a nationally representative sample of the US civilian non-institutionalized population from 2007 to 2008 National Health and Nutritional Examination Survey (NHANES). A total of 3204 study participants aged ≥35 years were stratified into four groups, using a self-reported history of asthma and data from spirometry: asthma-COPD overlap (ACO) (n = 70, 2.2%), asthma (n = 168, 5.2%), chronic obstructive pulmonary disease (COPD) (n = 412, 12.8%), and those without any OAD (normal) (n = 2554, 79.7%). After characterizing the baseline demographics and health status of the four groups, multivariate logistic regression analysis was performed to estimate the likelihood of sleep problems in adults after adjusting for age, gender, body mass index, smoking, alcohol, obstructive sleep apnea syndrome (OSAS), depression, and diabetes. The index sample was the normal group. Sleep problems were defined as any complaints which affect or involve sleep.

Results

The participants with COPD were older (62.0 ± 11.7 years) as compared to ACO (59.1 ± 11.3 years), asthma (53.6 ± 11.3), and normal groups (53.8 ± 12.1) (p < 0.0001). Comparing baseline characteristics between the four groups, there were significant associations between OAD status and sleep problems including inadequate sleep, sleep-onset insomnia, snoring, frequent trouble sleeping, nocturnal arousals, early morning awakenings, fatigue, daytime sleepiness, use of prescription medication for sleep, leg jerks, leg cramps, difficulty in concentration, and difficulty in remembering things when tired. The multivariate logistic regression models evaluating the prevalence of sleep problems in individual OADs showed a stronger association between asthma and sleep problems as compared to COPD and ACO and sleep disorders.

Conclusion

All OADs are associated with a higher prevalence of sleep problems. There is a stronger association between asthma and sleep problems as compared to COPD and ACO. We speculate that the nocturnal burden of asthma contributes to sleep problems. Our results suggest that adults with OAD should be aggressively screened for sleep problems.

Keywords

COPD Sleep NHANES CDC 

Abbreviations

OAD

Obstructive airway disease

COPD

Chronic obstructive pulmonary disease

NHANES

National Health and Nutritional Examination Survey

GOLD

Global Initiative for Chronic Obstructive Lung Disease

GINA

Global Initiative for Asthma

BMI

Body mass index

OR

Odds ratio

CI

Confidence interval

CDC

Center for Disease Control and Prevention

Notes

Funding information

This study received no funding.

Compliance with ethical standards

Conflict of interest

Dr. Kumbhare does not have any conflicts of interest. Dr. Lal is a consultant for Jazz pharmaceuticals and Cipla pharmaceuticals. Dr. Charlie Strange has current, past, or pending grants in COPD from the Alpha-1 Foundation, Adverum, BTG, CSL Behring, Grifols, NIH, MatRx, Novartis, Pulmonx, Shire, and Vertex. He consults for AstraZeneca, Boehringer-Ingelheim, CSL Behring, Grifols, and Uptake Medical on COPD.

Ethical approval

This article does not contain any study with human subjects or animals performed by any of the authors.

IRB exemption

This study did not qualify as research on human subjects as determined by the Medical University of South Carolina’s Institutional Review Board (IRB), and hence IRB approval was not needed. Additionally, National Health and Nutrition Examination Survey (NHANES) is a publicly available database.

References

  1. 1.
    Global surveillance, prevention and control of chronic respiratory diseases: a comprehensive approach. 2007(GARD_Manual. 2007)Google Scholar
  2. 2.
    Vestbo J, Hurd SS, Agustí AG, Jones PW, Vogelmeier C, Anzueto A, Barnes PJ, Fabbri LM, Martinez FJ, Nishimura M, Stockley RA, Sin DD, Rodriguez-Roisin R (2013) Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 187(4):347–365CrossRefGoogle Scholar
  3. 3.
    Rennard S, Decramer M, Calverley PMA, Pride NB, Soriano JB, Vermeire PA, Vestbo J (2002) Impact of COPD in North America and Europe in 2000: subjects’ perspective of confronting COPD International Survey. Eur Respir J 20(4):799–805CrossRefGoogle Scholar
  4. 4.
    Agusti A, Hedner J, Marin JM, Barbé F, Cazzola M, Rennard S (2011) Night-time symptoms: a forgotten dimension of COPD. Eur Respir Rev 20(121):183–194CrossRefGoogle Scholar
  5. 5.
    Janssen DJ, Mullerova H, Agusti A et al (2014) Persistent systemic inflammation and symptoms of depression among patients with COPD in the ECLIPSE cohort. Respir Med 108(11):1647–1654CrossRefGoogle Scholar
  6. 6.
    Juniper EF, O′byrne PM, Guyatt G, Ferrie P, King D (1999) Development and validation of a questionnaire to measure asthma control. Eur Respir J 14(4):902–907CrossRefGoogle Scholar
  7. 7.
    Bercovitch RS, Tsai SC (2012) Respiratory medications and sleep. Curr Respir Care Rep 1(2):123–130CrossRefGoogle Scholar
  8. 8.
    Global Initiative for Asthma. Global strategy for asthma management and prevention (Updated 2016). In. http://ginasthma.org/2016-gina-report-global-strategy-for-asthma-management-and-prevention/: Global Initiative for Asthma; 2016:147
  9. 9.
    Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (updated 2016). 2016Google Scholar
  10. 10.
    Zipf G, Chiappa M, Porter KS, Ostchega Y, Lewis BG, Dostal J (2013) National health and nutrition examination survey: plan and operations, 1999–2010. Vital and health statistics Ser 1, Programs and collection procedures. (56):1–37Google Scholar
  11. 11.
    Curtin LR, Mohadjer LK, Dohrmann SM et al (2013) National Health and Nutrition Examination Survey: sample design, 2007-2010. Vital and health statistics series 2, data evaluation and methods research. (160):1–23Google Scholar
  12. 12.
    Kroenke K, Spitzer RL, Williams JB (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 16(9):606–613CrossRefGoogle Scholar
  13. 13.
    Unruh ML, Redline S, An MW, Buysse DJ, Nieto FJ, Yeh JL, Newman AB (2008) Subjective and objective sleep quality and aging in the sleep heart health study. J Am Geriatr Soc 56(7):1218–1227CrossRefGoogle Scholar
  14. 14.
    Chasens ER, Ratcliffe SJ, Weaver TE (2009) Development of the FOSQ-10: a short version of the functional outcomes of sleep questionnaire. Sleep. 32(7):915–919CrossRefGoogle Scholar
  15. 15.
    Seicean S, Neuhauser D, Strohl K, Redline S (2011) An exploration of differences in sleep characteristics between Mexico-born US immigrants and other Americans to address the Hispanic paradox. Sleep. 34(8):1021–1031CrossRefGoogle Scholar
  16. 16.
    Dement WC, Vaughn C (2009) The promise of sleep: a pioneer in sleep medicine explores the vital connection between health, happiness, and a good night’s sleep, New York (NY): Dell Trade Paperbacks, pp 58–59Google Scholar
  17. 17.
    Nielsen M, Barnes CB, Ulrik CS (2015) Clinical characteristics of the asthma-COPD overlap syndrome--a systematic review. Int J Chron Obstruct Pulmon Dis 10:1443–1454Google Scholar
  18. 18.
    Mindus S, Malinovschi A, Ekerljung L, Forsberg B, Gíslason T, Jõgi R, Franklin KA, Holm M, Johannessen A, Middelveld R, Schlünssen V, Svanes C, Torén K, Lindberg E, Janson C (2018) Asthma and COPD overlap (ACO) is related to a high burden of sleep disturbance and respiratory symptoms: results from the RHINE and Swedish GA2LEN surveys. PLoS One 13(4):e0195055CrossRefGoogle Scholar
  19. 19.
    Klink M, Quan SF (1987) Prevalence of reported sleep disturbances in a general adult population and their relationship to obstructive airways diseases. Chest 91(4):540–546CrossRefGoogle Scholar
  20. 20.
    Plantinga L, Rao MN, Schillinger D (2012) Prevalence of self-reported sleep problems among people with diabetes in the United States, 2005-2008. Prev Chronic Dis 9:E76Google Scholar
  21. 21.
    Rasche K, Keller T, Tautz B et al (2010) Obstructive sleep apnea and type 2 diabetes. Eur J Med Res 15(Suppl 2):152–156Google Scholar
  22. 22.
    Ayas NT, White DP, Al-Delaimy WK et al (2003) A prospective study of self-reported sleep duration and incident diabetes in women. Diabetes Care 26(2):380–384CrossRefGoogle Scholar
  23. 23.
    Kawakami N, Takatsuka N, Shimizu H (2004) Sleep disturbance and onset of type 2 diabetes. Diabetes Care 27(1):282–283CrossRefGoogle Scholar
  24. 24.
    Nilsson PM, Roost M, Engstrom G, Hedblad B, Berglund G (2004) Incidence of diabetes in middle-aged men is related to sleep disturbances. Diabetes Care 27(10):2464–2469CrossRefGoogle Scholar
  25. 25.
    Yaggi HK, Araujo AB, McKinlay JB (2006) Sleep duration as a risk factor for the development of type 2 diabetes. Diabetes Care 29(3):657–661CrossRefGoogle Scholar
  26. 26.
    Koren D, Taveras EM (2018) Association of sleep disturbances with obesity, insulin resistance and the metabolic syndrome. Metab Clin Exp 84:67–75CrossRefGoogle Scholar
  27. 27.
    Cukic V, Lovre V, Dragisic D (2011) Sleep disorders in patients with bronchial asthma. Materia Socio-Medica 23(4):235–237CrossRefGoogle Scholar
  28. 28.
    Janson C, Gislason T, Boman G, Hetta J, Roos BE (1990) Sleep disturbances in patients with asthma. Respir Med 84(1):37–42CrossRefGoogle Scholar
  29. 29.
    Petty TL (1988) Circadian variations in chronic asthma and chronic obstructive pulmonary disease. Am J Med 85(1B):21–23CrossRefGoogle Scholar
  30. 30.
    Tirlapur VG (1984) Nocturnal deaths among patients with chronic bronchitis and emphysema. Br Med J (Clin Res Ed) 289(6457):1540CrossRefGoogle Scholar
  31. 31.
    Stephenson R (2007) Circadian rhythms and sleep-related breathing disorders. Sleep Med 8(6):681–687CrossRefGoogle Scholar
  32. 32.
    Ballard RD, Saathoff MC, Patel DK, Kelly PL, Martin RJ (1989) Effect of sleep on nocturnal bronchoconstriction and ventilatory patterns in asthmatics. J Appl Physiol (Bethesda, Md : 1985) 67(1):243–249CrossRefGoogle Scholar
  33. 33.
    Mohiuddin AA, Martin RJ (1990) Circadian basis of the late asthmatic response. Am Rev Respir Dis 142(5):1153–1157CrossRefGoogle Scholar
  34. 34.
    Barnes P, FitzGerald G, Brown M, Dollery C (1980) Nocturnal asthma and changes in circulating epinephrine, histamine, and cortisol. N Engl J Med 303(5):263–267CrossRefGoogle Scholar
  35. 35.
    Martin RJ, Cicutto LC, Smith HR, Ballard RD, Szefler SJ (1991) Airways inflammation in nocturnal asthma. Am Rev Respir Dis 143(2):351–357CrossRefGoogle Scholar
  36. 36.
    Denjean A, Roux C, Herve P, Bonniot JP, Comoy E, Duroux P, Gaultier C (1988) Mild isocapnic hypoxia enhances the bronchial response to methacholine in asthmatic subjects. Am Rev Respir Dis 138(4):789–793CrossRefGoogle Scholar
  37. 37.
    Chen WY, Chai H (1982) Airway cooling and nocturnal asthma. Chest. 81(6):675–680CrossRefGoogle Scholar
  38. 38.
    Storms WW, Bodman SF, Nathan RA, Byer P (1994) Nocturnal asthma symptoms may be more prevalent than we think. J Asthma 31(4):313–318CrossRefGoogle Scholar
  39. 39.
    Schroder CM, O'Hara R (2005) Depression and obstructive sleep apnea (OSA). Ann General Psychiatry 4:13CrossRefGoogle Scholar
  40. 40.
    Mikkelsen RL, Middelboe T, Pisinger C, Stage KB (2004) Anxiety and depression in patients with chronic obstructive pulmonary disease (COPD). A review. Nord J Psychiatry 58(1):65–70CrossRefGoogle Scholar
  41. 41.
    Zielinski TA, Brown ES, Nejtek VA, Khan DA, Moore JJ, Rush AJ (2000) Depression in asthma: prevalence and clinical implications. Prim Care Companion J Clin Psychiatry 2(5):153–158CrossRefGoogle Scholar
  42. 42.
    Stage KB, Middelboe T, Stage TB, Sorensen CH (2006) Depression in COPD--management and quality of life considerations. Int J Chron Obstruct Pulmon Dis 1(3):315–320Google Scholar
  43. 43.
    McNicholas WT (2016) Chronic obstructive pulmonary disease and obstructive sleep apnoea-the overlap syndrome. J Thorac Dis 8(2):236–242Google Scholar
  44. 44.
    Salles C, Terse-Ramos R, Souza-Machado A, Cruz AA (2013) Obstructive sleep apnea and asthma. J Bras Pneumol 39(5):604–612CrossRefGoogle Scholar
  45. 45.
    Yigla M, Tov N, Solomonov A, Rubin AH, Harlev D (2003) Difficult-to-control asthma and obstructive sleep apnea. J Asthma 40(8):865–871CrossRefGoogle Scholar
  46. 46.
    Schwartz AR, Patil SP, Laffan AM, Polotsky V, Schneider H, Smith PL (2008) Obesity and obstructive sleep apnea: pathogenic mechanisms and therapeutic approaches. Proc Am Thorac Soc 5(2):185–192CrossRefGoogle Scholar
  47. 47.
    Bergeron C, Kimoff J, Hamid Q (2005) Obstructive sleep apnea syndrome and inflammation. J Allergy Clin Immunol 116(6):1393–1396CrossRefGoogle Scholar
  48. 48.
    Marrone O, Salvaggio A, Insalaco G (2006) Respiratory disorders during sleep in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 1(4):363–372Google Scholar
  49. 49.
    Byun MK, Park SC, Chang YS, Kim YS, Kim SK, Kim HJ, Chang J, Ahn CM, Park MS (2013) Associations of moderate to severe asthma with obstructive sleep apnea. Yonsei Med J 54(4):942–948CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of MedicineMedical University of South CarolinaCharlestonUSA

Personalised recommendations