Individuals who have poor sleep patterns and an increased genetic susceptibility experience an additive elevated risk for asthma, according to study findings published in BMJ Open Respiratory Research.
Prior research has shown that sleep disorders, including insomnia, short duration of sleep, snoring, evening chronotype, and excessive daytime sleepiness, are all related to specific inflammatory reactions. With asthma known to be a chronic inflammatory disorder, whether poor sleep reflects a higher risk for asthma remains to be elucidated.
For the study, researchers sought to prospectively evaluate the link between a combination of sleep traits (ie, healthy sleep scores) and risk for asthma in a large UK Biobank cohort of patients. Additionally, they assessed the combined effects of sleep patterns and genetic susceptibility on a person’s risk for asthma with the use of a multivariable Cox proportional hazards regression model to examine the combined effects of sleep pattern and genetic susceptibility (polygenic risk score [PRS]) on incidence of asthma. Further, they explored whether adherence to a healthy sleep pattern might be able to alleviate the risks of genetic susceptibility to developing asthma.
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Between 2006 and 2010, sleep traits of participants (455,405 adults; aged 38-73 years) were self-reported and recorded with the use of a touch screen questionnaire. A total of 5 sleep factors were defined, with a specific question for each included in the questionnaire:
- Chronotype
- Duration of sleep
- Insomnia
- Presence of snoring
- Excessive daytime sleepiness
Each of the 5 sleep traits was dichotomized into a binary variable, with a score of “1” indicative of a healthy sleep behavior and a score of “0” indicative of an unhealthy sleep behavior. Based on recommendations of the National Sleep Foundation, healthy sleep duration was defined as 7 to 9 hours of sleep per day. Thus, the 5 healthy sleep behaviors were defined as follows:
- Early chronotype
- Sleep duration of 7 to 9 hours per day
- Never experiencing or rarely experiencing insomnia
- No snoring
- Lack of frequent daytime sleepiness
Over 10 years of follow-up, a total of 17,836 individuals were diagnosed with asthma. Compared with the low-risk asthma group, the following values were reported in the highest PRS group (hazard ratio [HR], 1.47; 95% CI, 1.41-1.52) and the poor sleep pattern group (HR, 1.55; 95% CI, 1.45-1.65).
The combination of poor sleep plus high genetic susceptibility was associated with a
2-fold significantly increased risk for asthma compared with the low-risk combination (HR, 2.22; 95% CI 1.97-2.49; P <.001). Per additional analysis, a healthy sleep pattern was linked to a lower risk for asthma in the low (HR, 0.56; 95% CI, 0.50-0.64), intermediate (HR, 0.59; 95% CI, 0.53-0.67), and high (HR, 0.63; 95% CI, 0.57-0.70) genetic susceptibility arms.
Approximately 19% of cases of asthma in the general population could be prevented when the 5 sleep traits listed above were improved, based on a causal assumption using a population-attributable risk analysis.
Several limitations of the study should be noted. Since the UK Biobank provided information on adults between 38 and 73 years of age, the impact on children and younger adults remains unclear. Further, the repeated records for sleep were available for only a small subset of individuals; the impact of dynamic sleep patterns can be evaluated only after larger samples have been obtained. Additionally, the association between asthma and sleep cannot be interpreted as causality, because residual confounders remained to be elucidated.
“A healthy sleep pattern was beneficial in asthma prevention regardless of the genetic conditions,” the researchers explained. “Early detection and management of sleep disorders could be beneficial to reduce asthma incidence,” they concluded.
Reference
Xiang B, Hu M, Yu H, Zhang Y, Wang Q, Xue F. Highlighting the importance of healthy sleep patterns in the risk of adult asthma under the combined effects of genetic susceptibility: a large-scale prospective cohort study of 455 405 participants. BMJ Open Respir Res. Published online April 3, 2023. doi:10.1136/bmjresp-2022-001535
This article originally appeared on Neurology Advisor
