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Benfante A, Tomasello A, Caponetto C, Battaglia S, Scichilone N. Are nighttime respiratory symptoms assessed by asthma control test affected by comorbidities? J Asthma 2024:1-6. [PMID: 38446620 DOI: 10.1080/02770903.2024.2327036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/03/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE Nocturnal symptoms are common in the asthmatic population, reflecting an exaggerated airway narrowing overnight due to several factors; it is questioned to what extent the awakenings documented in the clinical assessment of asthma control are due to the disease itself or to comorbidities. To answer this question, we aimed to evaluate to what proportion rhinitis, gastroesophageal reflux and the likelihood of being affected by OSAS were related to poor asthma control, by means of ACT evaluation. METHODS Asthmatics attending the outpatient clinic were enrolled and administered the following questionnaires: ACT, Total 5 Symptom Score, GERD Impact Scale, Pittsburgh Sleep Quality Index and the Sleep Disorders Questionnaire. RESULTS One-hundred consecutive patients (M/F: 42/58, mean age 52 ± 15 years) were recruited. According to the ACT findings, 14 asthmatics resulted as fully controlled (FC, ACT equal to 25), 55 partially controlled (PC, 25 < ACT >19) and 31 as uncontrolled (UC, ACT <19). GERD was not associated with the ACT score neither did rhinitic symptomatology. On the other hand, the PSQI scores appeared to significantly increase with the lack of symptom control: FC, 2.0 (1-4); PC, 3.5 (2-5); UC, 6.6 (4-8) (p = 0.002). The SA-SDQ questionnaire results significantly increased with the loss of asthma control: FC, 11.0 (9-12); PC, 12.5 (10-14); UC, 15.1 (14-16) (p = 0.005). CONCLUSIONS These results confirm and extend previous findings showing that there is a higher likelihood that underlying unknown sleep disturbances worsen asthma control, suggesting that a more comprehensive assessment is necessary to clarify the cause of nocturnal symptoms in asthma.
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Affiliation(s)
- Alida Benfante
- Division of Respiratory Medicine, "Paolo Giaccone" University Hospital, University of Palermo, Palermo, Italy
| | - Alessandra Tomasello
- Division of Respiratory Medicine, "Paolo Giaccone" University Hospital, University of Palermo, Palermo, Italy
| | - Chiara Caponetto
- Division of Respiratory Medicine, "Paolo Giaccone" University Hospital, University of Palermo, Palermo, Italy
| | - Salvatore Battaglia
- Division of Respiratory Medicine, "Paolo Giaccone" University Hospital, University of Palermo, Palermo, Italy
| | - Nicola Scichilone
- Division of Respiratory Medicine, "Paolo Giaccone" University Hospital, University of Palermo, Palermo, Italy
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2
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Maspero JF, Shafazand S, Cole J, Pavord ID, Busse WW, Msihid J, Gall R, Soler X, Radwan A, Khan AH, de Prado Gómez L, Jacob-Nara JA. Dupilumab efficacy in high sleep disturbance management among patients with type 2 asthma. Respir Med 2023; 218:107344. [PMID: 37659435 DOI: 10.1016/j.rmed.2023.107344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Patients with asthma often experience sleep disturbances. We assessed the 5-item Asthma Control Questionnaire (ACQ-5) score ≥2.5 as a useful threshold to identify patients with moderate-to-severe type 2 asthma and high sleep disturbance (HSD) and investigated dupilumab efficacy on clinical and sleep-related outcomes among patients with HSD. METHODS QUEST (NCT02414854) data were used in this post hoc analysis. A composite endpoint from validated patient-reported outcomes was developed to identify patients with HSD using sleep-related items from the ACQ-5, Asthma-Related Quality-of-Life Questionnaire, Rhino-Conjunctivitis Quality-of-Life Questionnaire, and Sino-Nasal Outcome Test-22. Impairment in at least 1 item was considered an indication of HSD. Change from baseline to Week 52 in nighttime symptoms, ACQ-5 score, lung function, annualized severe exacerbation rates (AER), and short-acting β-agonists use during treatment was used to assess dupilumab efficacy. RESULTS In type 2 asthma patients, 64% had HSD at baseline; of those with ACQ-5 ≥2.5 at baseline, 82% had HSD. In this population, dupilumab reduced nighttime symptoms and ACQ-5 score by 0.31 and 0.56 points, respectively, by Week 52 versus placebo, and led to a 66% reduction in AER during QUEST and 0.34 L improvement in pre-bronchodilator (pre-BD) forced expiratory volume in 1 s (FEV1) at Week 52. CONCLUSION A majority of patients with moderate-to-severe type 2 asthma with ACQ-5 ≥2.5 at baseline had HSD. Dupilumab reduced nighttime symptoms and exacerbations, and improved lung function, overall asthma control, and quality of life. Further studies are needed to confirm the association between ACQ-5 score ≥2.5 and higher sleep disturbance rates.
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Affiliation(s)
| | | | | | - Ian D Pavord
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - William W Busse
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Rebecca Gall
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA
| | - Xavier Soler
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA
| | - Amr Radwan
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA
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3
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Saxena D, Imayama I, Adrish M. Revisiting Asthma Obstructive Sleep Apnea Overlap: Current Knowledge and Future Needs. J Clin Med 2023; 12:6552. [PMID: 37892689 PMCID: PMC10607310 DOI: 10.3390/jcm12206552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Asthma and obstructive sleep apnea are highly prevalent conditions with a high cost burden. In addition to shared risk factors, existing data suggest a bidirectional relationship between asthma and OSA, where each condition can impact the other. Patients with asthma often complain of sleep fragmentation, nocturnal asthma symptoms, daytime sleepiness, and snoring. The prevalence of OSA increases with asthma severity, as evidenced by multiple large studies. Asthma may lower the threshold for arousal in OSA, resulting in the hypopnea with arousal phenotype. Epidemiologic studies in adults have shown that OSA is associated with worse asthma severity, increased frequency of exacerbation, and poor quality of life. The current literature assessing the relationship among OSA, asthma, and CPAP therapy is heavily dependent on observational studies. There is a need for randomized controlled trials to minimize the interference of confounding shared risk factors.
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Affiliation(s)
- Damini Saxena
- Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Ikuyo Imayama
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois, Chicago, IL 60607, USA
| | - Muhammad Adrish
- Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX 77030, USA
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4
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Heinsberg LW, Carlson JC, Pomer A, Cade BE, Naseri T, Reupena MS, Weeks DE, McGarvey ST, Redline S, Hawley NL. Correlates of daytime sleepiness and insomnia among adults in Samoa. SLEEP EPIDEMIOLOGY 2022; 2:100042. [PMID: 36338277 PMCID: PMC9635619 DOI: 10.1016/j.sleepe.2022.100042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objective To describe daytime sleepiness and insomnia among adults in Samoa and identify modifiable factors associated with these measures. Design/setting Cross-sectional analysis of data from the Soifua Manuia ("Good Health") study (n = 519, 55.1% female); Upolu island, Samoa. Methods Daytime sleepiness and insomnia were assessed with the Epworth Sleepiness Scale (ESS) and the Women's Health Initiative Insomnia Rating Scale (WHIIRS), respectively. Detailed physical, sociodemographic, and behavioral factors were collected. Sleep measures were characterized using multiple linear regression with backwards elimination and a bootstrap stability investigation. Results Excessive daytime sleepiness (ESS>10) and insomnia (WHIIRS>10) were reported by 20% and 6.3% of the sample, respectively. ESS scores were higher in individuals reporting more physical activity (Estimate=1.88; 95% CI=1.12 to 2.75), higher material wealth (0.18; 0.09 to 0.28), and asthma (2.85; 1.25 to 4.51). ESS scores were lower in individuals residing in periurban versus urban regions (-1.43; -2.39 to -0.41), reporting no work versus day shift work (-2.26; -3.07 to -1.41), and reporting greater perceived stress (-0.14; -0.23 to -0.06). WHIIRS scores were lower in individuals reporting "other" shift work (split/irregular/on-call/rotating) versus day shift work (-1.96; -2.89 to -1.14) and those who perceived their village's wealth to be poor/average versus wealthy (-0.94; -1.50 to -0.34). Conclusions Participants had a generally higher prevalence of excessive daytime sleepiness, but lower prevalence of insomnia, compared with individuals from high-income countries. Factors associated with sleep health differed compared with prior studies, emphasizing potential cultural/environmental differences and the need for targeted interventions to improve sleep health in this setting.
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Affiliation(s)
- Lacey W. Heinsberg
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Corresponding author at: Department of Human Genetics, School of Public Health, University of Pittsburgh, Public Health 3102A, 130 De Soto Street, Pittsburgh, PA 15261. (L.W. Heinsberg)
| | - Jenna C. Carlson
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alysa Pomer
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Brian E. Cade
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | | | | | - Daniel E. Weeks
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Stephen T. McGarvey
- International Health Institute and Department of Epidemiology, School of Public Health, and Department of Anthropology, Brown University, Providence, Rhode Island, USA
| | - Susan Redline
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Nicola L. Hawley
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut, USA
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5
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Belachew EA, Sendekie AK, Ayele EM, Netere AK. Prevalence and determinants of insomnia among patients living with asthma in Northwest Ethiopian University specialised hospitals: Multicentre cross-sectional study. BMJ Open 2022; 12:e066215. [PMID: 36400726 PMCID: PMC9677040 DOI: 10.1136/bmjopen-2022-066215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The study was aimed to determine the prevalence and contributing factors of insomnia among patients with bronchial asthma. DESIGN A multicentre cross-sectional survey was used. SETTING This study was carried out from January to March 2022 in three university comprehensive specialised hospitals in Northwest Ethiopia. PARTICIPANTS 422 patients with bronchial asthma were approached of which 93.8% completed the survey. OUTCOMES The degree of asthma control and the severity of insomnia were evaluated using the Asthma Control Test and Insomnia Severity Index (ISI), respectively. The characteristics of the participants were presented, arranged and summarised using descriptive statistical analysis, and correlations between predictors and outcome variables were examined using logistic regression. The cut-off point was a p value of 0.05. RESULTS Participants' ages ranged from 33.6 to 65.2 years on average. Just under three-fourths (71.4%) of the participants had at least one episode of insomnia as per the ISI measurement (score ≥10). The odds of insomnia episodes were about 5.4 and 1.93 times higher in patients with uncontrolled asthma and partially controlled asthma status, with adjusted OR (AOR)=5.4 (95% CI 4.4 to 6.79, p<0.001) and AOR=1.93 (95% CI 1.21 to 4.11, p<0.001), respectively. CONCLUSION Insomnia episodes were substantially higher in bronchial patients with asthma. Insomnia is accompanied by asthma severity, and uncontrolled asthma and partially controlled asthma status are the two most determining factors for experiencing sleep disturbance. Furthermore, a prospective follow-up study must determine the real association found between insomnia and asthma control.
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Affiliation(s)
- Eyayaw Ashete Belachew
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ashenafi Kibret Sendekie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Emneteab Mesfin Ayele
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adeladlew Kassie Netere
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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6
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Baek EJ, Jung HU, Ha TW, Kim DJ, Lim JE, Kim HK, Kang JO, Oh B. Genome-Wide Interaction Study of Late-Onset Asthma With Seven Environmental Factors Using a Structured Linear Mixed Model in Europeans. Front Genet 2022; 13:765502. [PMID: 35432474 PMCID: PMC9005993 DOI: 10.3389/fgene.2022.765502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 02/28/2022] [Indexed: 11/30/2022] Open
Abstract
Asthma is among the most common chronic diseases worldwide, creating a substantial healthcare burden. In late-onset asthma, there are wide global differences in asthma prevalence and low genetic heritability. It has been suggested as evidence for genetic susceptibility to asthma triggered by exposure to multiple environmental factors. Very few genome-wide interaction studies have identified gene-environment (G×E) interaction loci for asthma in adults. We evaluated genetic loci for late-onset asthma showing G×E interactions with multiple environmental factors, including alcohol intake, body mass index, insomnia, physical activity, mental status, sedentary behavior, and socioeconomic status. In gene-by-single environment interactions, we found no genome-wide significant single-nucleotide polymorphisms. However, in the gene-by-multi-environment interaction study, we identified three novel and genome-wide significant single-nucleotide polymorphisms: rs117996675, rs345749, and rs17704680. Bayes factor analysis suggested that for rs117996675 and rs17704680, body mass index is the most relevant environmental factor; for rs345749, insomnia and alcohol intake frequency are the most relevant factors in the G×E interactions of late-onset asthma. Functional annotations implicate the role of these three novel loci in regulating the immune system. In addition, the annotation for rs117996675 supports the body mass index as the most relevant environmental factor, as evidenced by the Bayes factor value. Our findings help to understand the role of the immune system in asthma and the role of environmental factors in late-onset asthma through G×E interactions. Ultimately, the enhanced understanding of asthma would contribute to better precision treatment depending on personal genetic and environmental information.
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Affiliation(s)
- Eun Ju Baek
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul, Korea
| | - Hae Un Jung
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul, Korea
| | - Tae-Woong Ha
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul, Korea
| | - Dong Jun Kim
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul, Korea
| | - Ji Eun Lim
- Department of Biochemistry and Molecular Biology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Han Kyul Kim
- Department of Biochemistry and Molecular Biology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Ji-One Kang
- Department of Biochemistry and Molecular Biology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Bermseok Oh
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul, Korea.,Department of Biochemistry and Molecular Biology, School of Medicine, Kyung Hee University, Seoul, Korea
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7
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Malek F, Khalil Sayah S, Kia NS, Ghods E. The Relationship Between Sleep Quality and Quality of Life Among Patients With Asthma. Cureus 2022; 14:e23402. [PMID: 35475092 PMCID: PMC9022950 DOI: 10.7759/cureus.23402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/11/2022] Open
Abstract
Background and objective Asthma is a chronic recurring respiratory disease, and its prevalence is on the rise. A drop in the quality of life (QoL), as well as sleep problems, has been reported in asthmatic patients in the literature. This study was conducted to determine the relationship between QoL and sleep quality in asthmatic patients. Methods This cross-sectional study recruited 76 diagnosed asthmatic outpatients from our university clinic. The subjects completed the self-administered 36-Item Short-Form Health Survey QoL questionnaire (SF-36) and the Pittsburgh Sleep Quality Index (PSQI) assessment. Results The study results revealed poor sleep quality in 55 (72.4%) of the subjects. The total sleep quality scores significantly and negatively correlated with the physical and mental components of QoL (moderate, p=0.00). All QoL subscales were significantly higher in patients with good sleep quality (PSQI: <5, p<0.00). Logistic regression analysis showed that good sleep quality (modified) could predict a mental component score (MCS) of more than 64. Conclusion Poor sleep quality can bring down the scores of all QoL components in asthma patients and is the best predictor of their QoL. Therefore, sleep quality and QoL indicators could be applied as part of a better approach to classification, management, and control of asthma.
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8
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Kruizinga MD, Essers E, Stuurman FE, Yavuz Y, de Kam ML, Zhuparris A, Janssens HM, Groothuis I, Sprij AJ, Nuijsink M, Cohen AF, Driessen GJA. Clinical validation of digital biomarkers for pediatric patients with asthma and cystic fibrosis - Potential for clinical trials and clinical care. Eur Respir J 2021; 59:13993003.00208-2021. [PMID: 34887326 DOI: 10.1183/13993003.00208-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 10/10/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Digital biomarkers are a promising novel method to capture clinical data in a home-setting. However, clinical validation prior to implementation is of vital importance. The aim of this study was to clinically validate physical activity, heart rate, sleep and FEV1 as digital biomarkers measured by a smartwatch and portable spirometer in children with asthma and cystic fibrosis (CF). METHODS This was a prospective cohort study including 60 children with asthma and 30 children with CF (age 6-16). Participants wore a smartwatch, performed daily spirometry at home and completed a daily symptom questionnaire for 28-days. Physical activity, heart rate, sleep and FEV1 were considered candidate digital endpoints. Data from 128 healthy children was used for comparison. Reported outcomes were compliance, difference between patients and controls, correlation with disease-activity and potential to detect clinical events. Analysis was performed with linear mixed effect models. RESULTS Median compliance was 88%. On average, patients exhibited lower physical activity and FEV1 compared to healthy children, whereas the heart rate of children with asthma was higher compared to healthy children. Days with a higher symptom score were associated with lower physical activity for children with uncontrolled asthma and CF. Furthermore, FEV1 was lower and (nocturnal) heart rate was higher for both patient groups on days with more symptoms. Candidate biomarkers and showed a distinct pattern before- and after a pulmonary exacerbation. CONCLUSION Portable spirometer- and smartwatch-derived digital biomarkers show promise as candidate endpoints for use in clinical trials or clinical care in pediatric lung disease.
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Affiliation(s)
- Matthijs D Kruizinga
- Centre for Human Drug Research, Leiden, the Netherlands .,Juliana Children's Hospital, Haga teaching Hospital, the Hague, the Netherlands.,Leiden University Medical Centre, Leiden, the Netherlands
| | - Esmée Essers
- Centre for Human Drug Research, Leiden, the Netherlands.,Juliana Children's Hospital, Haga teaching Hospital, the Hague, the Netherlands
| | - Frederik E Stuurman
- Centre for Human Drug Research, Leiden, the Netherlands.,Leiden University Medical Centre, Leiden, the Netherlands
| | - Yalçin Yavuz
- Centre for Human Drug Research, Leiden, the Netherlands
| | | | | | - Hettie M Janssens
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus Medical Centre/Sophia Children's Hospital, University Hospital Rotterdam, Rotterdam, The Netherlands
| | - Iris Groothuis
- Juliana Children's Hospital, Haga teaching Hospital, the Hague, the Netherlands
| | - Arwen J Sprij
- Juliana Children's Hospital, Haga teaching Hospital, the Hague, the Netherlands
| | - Marianne Nuijsink
- Juliana Children's Hospital, Haga teaching Hospital, the Hague, the Netherlands
| | - Adam F Cohen
- Centre for Human Drug Research, Leiden, the Netherlands.,Leiden University Medical Centre, Leiden, the Netherlands
| | - Gertjan J A Driessen
- Juliana Children's Hospital, Haga teaching Hospital, the Hague, the Netherlands.,Department of pediatrics, Maastricht University Medical Centre, Maastricht, the Netherlands
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9
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Ali A, Kumari D, Kataria D, Priyanka F, Nawaz MU, Pariya F, Kavuri RK, Naz S, Jamil A, Shaukat F. Impact of Asthma on the Quality of Sleep in Young People. Cureus 2021; 13:e16098. [PMID: 34345567 PMCID: PMC8325563 DOI: 10.7759/cureus.16098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Asthma has a negative impact on the quality of life of patients and their families. One of the factors responsible for the low quality of life is poor sleep quality in asthmatic patients. Sleep disturbances, such as difficulty initiating and maintaining sleep, are common in asthma. In this study, we aim to determine the quality of sleep in young asthmatic patients in a local setting. Method This case-control study was conducted in the pulmonology and internal medicine unit of a tertiary care hospital, Pakistan from January 2021 to May 2021. After seeking informed consent, 200 patients with a previously confirmed diagnosis of asthma were enrolled in the study. The control group also included 200 participants. Pittsburgh Sleep Quality Index (PSQI) is an efficient measure of the quality and pattern of sleep. A global PSQI score of ≥5 signifies “poor sleep quality.” Results The mean PSQI score was significantly higher in the asthmatic group compared to the control group (6.26 ± 2.01 vs. 3.41 ± 0.50; p-value: <0.0001). The percentage of participants with a PSQI score of ≥5 was significantly higher in the asthmatic group compared to the control group (54.5% vs. 17.0%; p-value: <0.0001). Conclusion Sleep disturbance is very common in young patients with asthma. Poor sleep may interfere with their daily performance, which may further have a negative impact on the quality of life in asthmatic patients. Management of asthma should also include improving sleep quality.
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Affiliation(s)
- Akhtar Ali
- Pulmonology and Critical Care, Services Hospital, Lahore, PAK
| | - Deepa Kumari
- Internal Medicine, Chandka Medical College, Larkana, PAK
| | - Deepak Kataria
- Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana, PAK
| | - Fnu Priyanka
- Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana, PAK
| | | | - Fnu Pariya
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Rama Kalyani Kavuri
- Internal Medicine, Dr. Vasantrao Pawar Medical College Hospital & Research Centre, Nashik, IND
| | - Sidra Naz
- Internal Medicine, University of Health Sciences, Lahore, PAK
| | - Amna Jamil
- Internal Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Faizan Shaukat
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
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10
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Ragnoli B, Pochetti P, Raie A, Malerba M. Interrelationship Between Obstructive Sleep Apnea Syndrome and Severe Asthma: From Endo-Phenotype to Clinical Aspects. Front Med (Lausanne) 2021; 8:640636. [PMID: 34277650 PMCID: PMC8278061 DOI: 10.3389/fmed.2021.640636] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 05/27/2021] [Indexed: 11/22/2022] Open
Abstract
Sleep-related breathing disorders (SBDs) are characterized by abnormal respiration during sleep. Obstructive sleep apnea (OSA), a common SBD increasingly recognized by physicians, is characterized by recurrent episodes of partial or complete closure of the upper airway resulting in disturbed breathing during sleep. OSA syndrome (OSAS) is associated with decreased patients' quality of life (QoL) and the presence of significant comorbidities, such as daytime sleepiness. Similarly to what seen for OSAS, the prevalence of asthma has been steadily rising in recent years. Interestingly, severe asthma (SA) patients are also affected by poor sleep quality—often attributed to nocturnal worsening of their asthma—and increased daytime sleepiness and snoring compared to the general population. The fact that such symptoms are also found in OSAS, and that these two conditions share common risk factors, such as obesity, rhinitis, and gastroesophageal reflux, has led many to postulate an association between these two conditions. Specifically, it has been proposed a bidirectional correlation between SA and OSAS, with a mutual negative effect in term of disease severity. According to this model, OSAS not only acts as an independent risk factor of asthma exacerbations, but its co-existence can also worsen asthma symptoms, and the same is true for asthma with respect to OSAS. In this comprehensive review, we summarize past and present studies on the interrelationship between OSAS and SA, from endo-phenotype to clinical aspects, highlighting possible implications for clinical practice and future research directions.
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Affiliation(s)
| | | | - Alberto Raie
- Respiratory Unit, Sant'Andrea Hospital, Vercelli, Italy
| | - Mario Malerba
- Respiratory Unit, Sant'Andrea Hospital, Vercelli, Italy.,Traslational Medicine Department, University of Eastern Piedmont, Novara, Italy
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11
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Wanberg L, Rottapel RE, Reid ML, Bertisch SM, Bron M, Kapur VK, Bujanover S, Harrington Z, Bakker JP, Javaheri S, Hanson M, Figetakis K, Page K, Hanes S, Villa KF, Redline S. Prevalence of sleepiness and associations with quality of life in patients with sleep apnea in an online cohort. J Clin Sleep Med 2021; 17:2363-2372. [PMID: 34170220 DOI: 10.5664/jcsm.9436] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Excessive daytime sleepiness (EDS) is a treatment target for many patients with obstructive sleep apnea (OSA). We aimed to understand the prevalence, risk factors and quality of life associated with EDS in a non-clinical, "real world" sample of patients with OSA. METHODS Cross-sectional survey of patients with OSA participating in an online peer support community, assessing demographics, comorbidities, treatment, and quality of life. Differences in those with and without EDS (Epworth Sleepiness Scale [ESS] > and ≤ 10) were assessed. RESULTS The sample (n=422) was 54.2% male, 65.9% were ≥ 55 years, and 43.3% reported sleeping ≤ 6 hours/night. EDS was identified among 31.0% of respondents and 51.7% reported sleepiness as a precipitating factor for seeking initial OSA treatment. EDS was more prevalent in individuals reporting asthma, insomnia symptoms, positive airway pressures (PAP) use less than 6 hours/night on ≥ 5 nights/week, or sleep duration < 6 hours/night. After adjusting for demographics and comorbidities, patients with EDS reported poorer mental and physical health and well-being, lower disease-specific functional status, more activity and work impairment, and more driving impairment (p values < 0.05). In the sub-sample (n=265) with high PAP adherence, 26.0% reported EDS, and similar associations between EDS and outcomes were observed. CONCLUSIONS These "real-world" data suggest that patients seeking online OSA support experience a high prevalence of EDS, which was associated with poorer quality of life and worse functional status. Associations persisted among respondents with high self-reported PAP-adherence, potentially driving these individuals to seek online support for sleepiness-related symptoms.
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Affiliation(s)
- Lindsay Wanberg
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital
| | | | - Michelle L Reid
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital
| | - Suzanne M Bertisch
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital.,Harvard Medical School, Boston, Massachusetts
| | | | - Vishesh K Kapur
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA
| | | | | | - Jessie P Bakker
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital.,Harvard Medical School, Boston, Massachusetts
| | - Sogol Javaheri
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital.,Harvard Medical School, Boston, Massachusetts
| | - Mark Hanson
- Sleep Apnea Patient-Centered Outcomes Network, Boston, MA
| | | | - Kathy Page
- Sleep Apnea Patient-Centered Outcomes Network, Boston, MA
| | - Sherry Hanes
- Sleep Apnea Patient-Centered Outcomes Network, Boston, MA
| | | | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital.,Harvard Medical School, Boston, Massachusetts
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12
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Daşdemir KA, Suner-Keklik S. Physical activity, sleep, and quality of life of patients with asthma during the COVID-19 pandemic. J Asthma 2021; 59:1484-1490. [PMID: 34000956 DOI: 10.1080/02770903.2021.1931303] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE There is limited information in literature on how coronavirus disease-2019 (COVID-19) pandemic period affects people with asthma. This study aimed to compare levels of physical activity, stress, and fear and quality of life and sleep quality between patients with asthma and healthy individuals during the pandemic. METHODS Twenty-two patients with asthma and 22 healthy individuals aged between 18 and 65 years were included. Physical activity level using "International Physical Activity Questionnaire"; stress level, using "Perceived Stress Scale-14"; fear level, using "Fear of COVID-19 Scale"; sleep quality, using "Pittsburgh Sleep Quality Index"; and quality of life, using "World Health Organization Quality of Life" were evaluated. RESULTS Total physical activity level, vigorous physical activity level, and walking score of patients with asthma were lower than healthy individuals (p < .05). Sitting time of patients with asthma was higher than healthy individuals (p < .05). Subjective sleep quality, latency, duration, efficiency, sleeping medication use, and daytime dysfunction of both were similar (p > .05). Only sleep disturbance score of patients with asthma were higher than healthy individuals (p < .05). Quality of life, stress, and fear levels of both were similar (p > .05). CONCLUSION During pandemic, patients with asthma are more inactive than healthy individuals regardless of the presence of a chronic disease; pandemic negatively affected stress, fear levels, sleep, and quality of life. To minimize the effects of restrictions and psychological burden caused by pandemic and to encourage patients with asthma to perform physical activities, conducting studies to control stress levels and increasing quality of life and sleep of all individuals are important.
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Affiliation(s)
- Kübra Ayşe Daşdemir
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Sivas Cumhuriyet University, Sivas, Turkey
| | - Sinem Suner-Keklik
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Sivas Cumhuriyet University, Sivas, Turkey
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13
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Pladeck T, Happel A, Mand N, Galetke W. Asthma bronchiale und Schlaf. SOMNOLOGIE 2020. [DOI: 10.1007/s11818-020-00249-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Luyster FS, Shi X, Baniak LM, Morris JL, Chasens ER. Associations of sleep duration with patient-reported outcomes and health care use in US adults with asthma. Ann Allergy Asthma Immunol 2020; 125:319-324. [PMID: 32389780 DOI: 10.1016/j.anai.2020.04.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/27/2020] [Accepted: 04/30/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Asthma contributes to considerable morbidity and health care utilization in adults. Insufficient and excessive sleep duration have known adverse effects on health. Little is known regarding the effect of sleep duration on health outcomes in adults with asthma. OBJECTIVE To examine associations between sleep duration, patient-reported outcomes, and health care use in adults with asthma from the National Health and Nutrition Examination Survey. METHODS Cross-sectional data from the 2007 to 2012 National Health and Nutrition Examination Survey were analyzed. Asthma was identified by self-report. Habitual hours of sleep duration were categorized as short (≤5), normal (6-8), and long (≥9). Multivariate regression analyses were used to examine the associations between sleep duration and patient-reported outcomes and health care use. RESULTS Of the 1389 adults with asthma, 26% reported short sleep duration, 66% reported normal sleep duration, and 8% reported long sleep duration. Those with short sleep duration had increased asthma attacks (adjusted odds ratio [aOR] 1.58; 95% confidence interval [CI] 1.13-2.21), coughing (aOR 1.95; 95% CI 1.32-2.87), and overnight hospitalizations (aOR 2.14; 95% CI 1.37-3.36) compared with those having normal sleep duration. They also reported worse health-related quality of life, including days of poor physical health, mental health, and inactivity because of poor health (P values < .05). Those with long sleep had more activity limitations because of wheezing compared with those with normal sleep (aOR 1.82; 95% CI 1.13-2.91). CONCLUSION Compared with adults having asthma and normal sleep duration, those having short sleep duration experience more frequent asthma attacks, increased health care use, and worse health-related quality of life, whereas those with long sleep duration experience more frequent activity limitation.
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Affiliation(s)
- Faith S Luyster
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Xiaojun Shi
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lynn M Baniak
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania; Veterans Administration Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Jonna L Morris
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Eileen R Chasens
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
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