Poor sleep pattern tied to higher asthma risk in adults

A large prospective study shows that adults with unhealthy sleep patterns and higher genetic susceptibility have a higher risk of asthma.

“Our evidence shows that both sleep and genetic factors play an important role in asthma risk. A combination of poor sleep with high genetic susceptibility would lead to a more than twofold risk compared with a low-risk combination,” said the researchers.

Individuals with both poor sleep and high genetic susceptibility had a 122-percent increased risk compared with those with healthy sleep and low genetic risk (hazard ratio [HR], 2.22; p<0.001). [BMJ Open Resp Res 2023;10:e001535]

“Considering that poor sleep combined with high genetic susceptibility yielded a greater than twofold asthma risk, sleep patterns could be recommended as an effective lifestyle intervention to prevent future asthma, especially for individuals with high-risk genetics,” the researchers explained.

Compared with those with low PRS*, individuals with high PRS had a higher risk for asthma (HR, 1.47; p<0.001). The same was true for those with poor vs healthy sleep patterns (HR, 1.55; p<0.001).

Individuals with healthy sleep patterns in the high genetic risk group had a slightly lower risk than those with poor sleep patterns in the low genetic risk group (HR, 1.54 vs 1.68). This implies that a healthy sleep pattern could offset high genetic risk, they noted.

A healthy sleep pattern reduced asthma risk across all genetic risk subgroups (HRs, 0.56, 0.59, and 0.63 for low, intermediate, and high, respectively; p<0.001 for all). These suggest that the risk of asthma could drop substantially among those with healthy sleep patterns regardless of genetic susceptibility.

All five** sleep factors were independently associated with lower risks for asthma (p<0.001 for all). Moreover, an individual with all five healthy sleep factors would have a lower risk than other individuals (HR, 0.78; p<0.001). “Population-attributable risk analysis indicated that 19 percent of asthma cases could be prevented when the five sleep traits were improved,” said the researchers.

“[T]he role of all five sleep traits in asthma risk could be partly explained by the mechanism of inflammatory response. As a result, a healthier sleep pattern derived from the five specific sleep traits that presented a lower asthma risk may reflect a lower inflammation level,” they said.

Sleep a modifiable risk factor

This study involved over 450K participants from the UK Biobank cohort. Of these, 17,836 have been diagnosed with asthma during >10 years of follow-up. Mean age of participants was 56.5 years and more than half were female.

The team created a comprehensive sleep score and defined different sleep patterns as exposure to asthma for the first time in a large 10-year follow-up cohort. “Importantly, we also assessed the impact of sleep quality in terms of genetic predisposition on incident asthma risk,” they said.

However, the study was limited to older adults of European descent. Hence, the findings may not be extrapolated to children and younger adults, as well as other ethnicities.

“[Nonetheless,] sensitivity and subgroup analyses enhanced the robustness and practicality of our evidence. The use of repeated measurements of sleep behaviours as a sensitivity analysis also strengthened our evidence compared with similar research,” they explained.

“Our research showed the potential benefits of a healthy sleep pattern,” they said. “Although low genetic susceptibility could also theoretically decrease the incidence similarly, it is unmodifiable. As a modifiable risk factor, a healthy sleep pattern could decrease the excess risk for individuals with high genetic susceptibility.”

“Early detection and management of sleep disorders could be beneficial to reduce asthma incidence,” they concluded.