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Sleep problems and associations with cardiovascular disease and all-cause mortality in asthma-COPD overlap: analysis of the National Health and Nutrition Examination Survey (2007-2012).

STUDY OBJECTIVES
The impact of sleep problems (i.e. sleep duration and presence of sleep disorders) on cardiovascular morbidity and all-cause mortality in adults with asthma-COPD overlap (ACO) is unknown.


METHODS
Using the National Health and Nutrition Examination Survey (NHANES) database (2007-2012 cycles) and National Death Index data, we identified 398 persons with ACO. Data on self-reported physician-diagnosed sleep disorder and cardiovascular disease were collected. Sleep duration in hours was categorized as short (≤5), normal (6-8), and long (≥9). Associations between sleep duration and presence of sleep disorders and cardiovascular disease and all-cause mortality were analyzed in regression models adjusted for age, sex, race, smoking status, and body mass index.


RESULTS
Presence of sleep disorders was more commonly reported in the ACO group (24.7%) compared to all other groups. The ACO group had a higher proportion of short sleepers (27.6%) compared to controls (11.7%) and COPD (19.2%) and a higher proportion of long sleepers (6.9%) compared to COPD (5.5%). Presence of sleep disorders was associated with increased risk for CVD (OR = 2.48, 95% CI, 1.65 - 3.73) and death (HR = 1.44, 95% CI, 1.03 - 2.02); risk did not vary between groups. A stronger association existed between sleep duration and increased risk for CVD and all-cause mortality in ACO as compared to COPD and controls.


CONCLUSIONS
These results suggest that persons with ACO may represent a high-risk group that should be targeted for more aggressive intervention of sleep problems, a modifiable risk factor.