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

Abstract

BackgroundIndividuals with asthma usually have comorbid sleep disturbances; however, whether sleep quality affects asthma risk is still unclear. We aimed to determine whether poor sleep patterns could increase the risk of asthma and whether healthy sleep patterns could mitigate the adverse effect of genetic susceptibility.MethodsA large-scale prospective study was performed in the UK Biobank cohort involving 455 405 participants aged 38–73 years. Polygenic risk scores (PRSs) and comprehensive sleep scores, including five sleep traits, were constructed. A multivariable Cox proportional hazards regression model was used to investigate the independent and combined effects of sleep pattern and genetic susceptibility (PRS) on asthma incidence. Subgroup analysis across sex and sensitivity analysis, including a 5-year lag, different covariate adjustments and repeat measurements were performed.ResultsA total of 17 836 individuals were diagnosed with asthma during over 10 years of follow-up. Compared with the low-risk group, the HRs and 95% CIs for the highest PRS group and the poor sleep pattern group were 1.47 (95% CI: 1.41 to 1.52) and 1.55 (95% CI: 1.45 to 1.65), respectively. A combination of poor sleep and high genetic susceptibility led to a twofold higher risk compared with the low-risk combination (HR (95% CI): 2.22 (1.97 to 2.49), p<0.001). Further analysis showed that a healthy sleep pattern was associated with a lower risk of asthma in the low, intermediate and high genetic susceptibility groups (HR (95% CI): 0.56 (0.50 to 0.64), 0.59 (0.53 to 0.67) and 0.63 (0.57 to 0.70), respectively). Population-attributable risk analysis indicated that 19% of asthma cases could be prevented when these sleep traits were improved.ConclusionsIndividuals with poor sleep patterns and higher genetic susceptibility have an additive higher asthma risk. A healthy sleep pattern reflected a lower risk of asthma in adult populations and could be beneficial to asthma prevention regardless of genetic conditions. Early detection and management of sleep disorders could be beneficial to reduce asthma incidence.

Sleep and allergic diseases among young Chinese adults from the Singapore/Malaysia Cross-Sectional Genetic Epidemiology Study (SMCGES) cohort

“…The effects of various factors—physiological changes and physical posture associated with sleep, circadian clock regulation of immune function, and environmental conditions—have yet to be comprehensively teased apart [ 80 ]. Among the few studies assessing the influence of sleep on asthma, a prospective study found that adults with poor sleep habits had a higher risk of asthma within a follow-up period of at least 10 years, while experimental manipulation of sleep duration among asthma patients resulted in a decreased in peak expiratory flow rates and increased interference of activities by asthma symptoms [ 38 , 81 ]. Nonetheless, while the directionality of the relationship between sleep and asthma remains unclear, the association of poor sleep with asthma has been well documented, with short sleep and poor sleep quality being associated with nocturnal respiratory symptoms [ 82 , 83 ].…”

“…Conversely, a recent systematic review found that sleep duration was not significantly associated with AR, while sleep quality score, sleep disturbance scores, and sleep latency scores were higher among AR patients; sleep efficiency was nonetheless decreased among AR patients [ 37 ]. Finally, poor sleep patterns have been found to increase asthma risk [ 38 ]. While asthma has been associated with poor sleep quality, this was likely the result of asthma symptoms affecting sleep, or comorbid AR resulting in AR-related sleep disturbances in asthmatics [ 39 , 40 ].…”

Pre-asthma: a useful concept? A EUFOREA paper. Part 2—late onset eosinophilic asthma

“…Healthy sleep lowered the risk of asthma in all genetic susceptibility groups, HR being 0.63 (0.57–0.70) in the high-risk group. Risk analysis suggests that 19% of asthma cases could be prevented by improved sleep traits ( 75 ).…”

Nasal polyp syndrome: a patient-centred term for CRSwNP by EUFOREA

“…Apart from sinonasal symptoms, CRSwNP is associated with an increased risk of asthma, otitis media, depression and social dysfunction (6). Similarly important is the extensively studied association between CRSwNP and sleep disturbance, which is linked to cardiovascular and cerebrovascular disease and reduced quality of life for both the patient and their partner (7)(8)(9). The impact of CRSwNP on quality of life (QoL) has been observed to be equivalent to other chronic conditions such as chronic obstructive pulmonary disease (COPD), congestive heart failure, and diabetes (10,11).…”