Health-related quality of life as associated with asthma control, psychological status and insomnia
Keywords:
Health-related quality of life, asthma symptoms, anxiety, depression, insomnia
Abstract
Background: Asthma is associated not only with lower health-related quality of life (HRQL) but also with psychological health and insomnia. The aim of this study was to investigate associations between HRQL, asthma symptoms, psychological status and insomnia in adults from three Nordic countries.
Methods: This study comprised 2,270 subjects aged 29–55 from Sweden, Iceland and Norway. HRQL was measured with the 36-Item Short Form Health Survey (SF-36). The physical (PCS) and mental health (MCS) component scores were calculated with higher values, indicating better health status. Symptoms of depression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS). Insomnia was assessed with the Basic Nordic Sleep Questionnaire. An asthma score consisting of a sum of the positive answers to five respiratory symptoms was used in the analysis. Spirometry and allergy tests were also performed.
Results: High HADS and sleep disturbance scores were both related to a low PCS and MCS, respectively, after adjusting for confounders. High age and high body mass index (BMI) were associated with low scores on the PCS, whilst the opposite was found for the MCS. A higher asthma score was related to a low PCS. An interaction between the HADS and the asthma symptom score was observed for the PCS (P = 0.0002), where associations between psychological status and the PCS were more pronounced for individuals with more symptoms than for individuals without symptoms.
Conclusions: In this study, we found that HRQL of life was independently related to the HADS, insomnia and asthma symptoms. Further prospective studies to identify the most efficient target for intervention in order to improve asthma control are needed.
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References
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2. Siroux V, Boudier A, Anto JM, Cazzoletti L, Accordini S, Alonso J, et al. Quality-of-life and asthma-severity in general population asthmatics: results of the ECRHS II study. Allergy. 2008;5:547–54. doi: 10.1111/j.1398-9995.2008.01638.x
3. Di Marco F, Verga M, Santus P, Giovannelli F, Busatto P, Neri M, et al. Close correlation between anxiety, depression, and asthma control. Respir Med. 2010;1:22–8. doi: 10.1016/j.rmed.2009.08.005
4. Siroux V, Boudier A, Bousquet J, Vignoud L, Gormand F, Just J, et al. Asthma control assessed in the EGEA epidemiological survey and health-related quality of life. Respir Med. 2012;6:820–8. doi: 10.1016/j.rmed.2012.01.009
5. Wijnhoven HA, Kriegsman DM, Hesselink AE, Penninx BW, de Haan M. Determinants of different dimensions of disease severity in asthma and COPD: pulmonary function and health-related quality of life. Chest. 2001;4:1034–42. doi: 10.1378/chest.119.4.1034
6. Ek A, Middelveld RJ, Bertilsson H, Bjerg A, Ekerljung L, Malinovschi A, et al. Chronic rhinosinusitis in asthma is a negative predictor of quality of life: results from the Swedish GA(2)LEN survey. Allergy. 2013;10:1314–21. doi: 10.1111/all.12222
7. Sundh J, Wireklint P, Hasselgren M, Montgomery S, Stallberg B, Lisspers K, et al. Health-related quality of life in asthma patients – a comparison of two cohorts from 2005 and 2015. Respir Med. 2017;132:154–60. doi: 10.1016/j.rmed.2017.10.010
8. Chen H, Gould MK, Blanc PD, Miller DP, Kamath TV, Lee JH, et al. Asthma control, severity, and quality of life: quantifying the effect of uncontrolled disease. J Allergy Clin Immunol. 2007;2:396–402. doi: 10.1016/j.jaci.2007.04.040
9. Leander M, Lampa E, Rask-Andersen A, Franklin K, Gislason T, Oudin A, et al. Impact of anxiety and depression on respiratory symptoms. Respir Med. 2014;11:1594–600. doi: 10.1016/j.rmed.2014.09.007
10. Nejtek VA, Brown ES, Khan DA, Moore JJ, Van Wagner J, Perantie DC. Prevalence of mood disorders and relationship to asthma severity in patients at an inner-city asthma clinic. Ann Allergy Asthma Immunol. 2001;2:129–33. doi: 10.1016/S1081-1206(10)62206-5
11. Goodwin RD, Bandiera FC, Steinberg D, Ortega AN, Feldman JM. Asthma and mental health among youth: etiology, current knowledge and future directions. Expert Rev Respir Med. 2012;4:397–406. doi: 10.1586/ers.12.34
12. Puhan MA, Gaspoz JM, Bridevaux PO, Schindler C, Ackermann-Liebrich U, Rochat T, et al. Comparing a disease-specific and a generic health-related quality of life instrument in subjects with asthma from the general population. Health Qual Life Outcomes. 2008;6:15. doi: 10.1186/1477-7525-6-15
13. Sastre J, Crespo A, Fernandez-Sanchez A, Rial M, Plaza V, Investigators of the CSG. Anxiety, depression, and asthma control: changes after standardized treatment. J Allergy Clin Immunol Pract. 2018;6:1953–9. doi: 10.1016/j.jaip.2018.02.002
14. Fernandes L, Fonseca J, Martins S, Delgado L, Pereira AC, Vaz M, et al. Association of anxiety with asthma: subjective and objective outcome measures. Psychosomatics. 2010;1:39–46. doi: 10.1176/appi.psy.51.1.39
15. Janson C, Gislason T, De Backer W, Plaschke P, Bjornsson E, Hetta J, et al. Prevalence of sleep disturbances among young adults in three European countries. Sleep. 1995;7:589–97.
16. Sundbom F, Lindberg E, Bjerg A, Forsberg B, Franklin K, Gunnbjornsdottir M, et al. Asthma symptoms and nasal congestion as independent risk factors for insomnia in a general population: results from the GA(2)LEN survey. Allergy. 2013;2:213–19. doi: 10.1111/all.12079
17. Sundbom F, Malinovschi A, Lindberg E, Almqvist C, Janson C. Insomnia symptoms and asthma control-interrelations and importance of comorbidities. Clin Exp Allergy. 2020;2:170–7. doi: 10.1111/cea.13517
18. Luyster FS, Teodorescu M, Bleecker E, Busse W, Calhoun W, Castro M, et al. Sleep quality and asthma control and quality of life in non-severe and severe asthma. Sleep Breath. 2012;4:1129–37. doi: 10.1007/s11325-011-0616-8
19. Brumpton B, Mai XM, Langhammer A, Laugsand LE, Janszky I, Strand LB. Prospective study of insomnia and incident asthma in adults: the HUNT study. Eur Respir J. 2017;49:1601327. doi: 10.1183/13993003.01327-2016
20. Riemann D, Berger M, Voderholzer U. Sleep and depression – results from psychobiological studies: an overview. Biol Psychol. 2001;57:67–103. doi: 10.1016/S0301-0511(01)00090-4
21. Burney PG, Luczynska C, Chinn S, Jarvis D. The European Community Respiratory Health Survey. Eur Respir J. 1994;5:954–60. doi: 10.1183/09031936.94.07050954
22. Jarvis D, Newson R, Janson C, Corsico A, Heinrich J, Anto JM, et al. Prevalence of asthma-like symptoms with ageing. Thorax. 2018;1:37–48. doi: 10.1136/thoraxjnl-2016-209596
23. Burney P, Chinn S. Developing a new questionnaire for measuring the prevalence and distribution of asthma. Chest. 1987;6:79S–83S. doi: 10.1378/chest.91.6_Supplement.79S
24. Sullivan M, Karlsson J. The Swedish SF-36 Health Survey III. Evaluation of criterion-based validity: results from normative population. J Clin Epidemiol. 1998;11:1105–13. doi: 10.1016/S0895-4356(98)00102-4
25. Ware JE, Kosinski MA, Keller SD. SF-36 physical and mental health summary scales: a user’s manual. Boston, MA: Health Assessment Lab, New England Medical Center; 1994.
26. Fu V, Weatherall M, McNaughton H. Estimating the minimal clinically important difference for the physical component summary of the short form 36 for patients with stroke. J Int Med Res. 2021;12:3000605211067902. doi: 10.1177/03000605211067902
27. Pekkanen J, Sunyer J, Anto JM, Burney P, European Community Respiratory Health Study. Operational definitions of asthma in studies on its aetiology. Eur Respir J. 2005;1:28–35. doi: 10.1183/09031936.05.00120104
28. Sunyer J, Pekkanen J, Garcia-Esteban R, Svanes C, Kunzli N, Janson C, et al. Asthma score: predictive ability and risk factors. Allergy. 2007;2:142–8. doi: 10.1111/j.1398-9995.2006.01184.x
29. Sundberg R, Toren K, Franklin KA, Gislason T, Omenaas E, Svanes C, et al. Asthma in men and women: treatment adherence, anxiety, and quality of sleep. Respir Med. 2010;3:337–44. doi: 10.1016/j.rmed.2009.10.017
30. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;6:361–70. doi: 10.1111/j.1600-0447.1983.tb09716.x
31. Herrmann C. International experiences with the Hospital Anxiety and Depression Scale – a review of validation data and clinical results. J Psychosom Res. 1997;1:17–41. doi: 10.1016/S0022-3999(96)00216-4
32. Mitchell AJ, Meader N, Symonds P. Diagnostic validity of the Hospital Anxiety and Depression Scale (HADS) in cancer and palliative settings: a meta-analysis. J Affect Disord. 2010;3:335–48. doi: 10.1016/j.jad.2010.01.067
33. Harter M, Reuter K, Gross-Hardt K, Bengel J. Screening for anxiety, depressive and somatoform disorders in rehabilitation – validity of HADS and GHQ-12 in patients with musculoskeletal disease. Disabil Rehabil. 2001;16:737–44. doi: 10.1080/09638280110062176
34. Partinen M, Gislason T. Basic Nordic Sleep Questionnaire (BNSQ): a quantitated measure of subjective sleep complaints. J Sleep Res. 1995;S1:150–5. doi: 10.1111/j.1365-2869.1995.tb00205.x
35. Janson C, Norback D, Omenaas E, Gislason T, Nystrom L, Jogi R, et al. Insomnia is more common among subjects living in damp buildings. Occup Environ Med. 2005;2:113–18. doi: 10.1136/oem.2003.011379
36. Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC. Lung volumes and forced ventilatory flows. Eur Respir J. 1993;6:5–40. doi: 10.1183/09041950.005s1693
37. Bousquet PJ, Chinn S, Janson C, Kogevinas M, Burney P, Jarvis D, et al. Geographical variation in the prevalence of positive skin tests to environmental aeroallergens in the European Community Respiratory Health Survey I. Allergy. 2007;3:301–9. doi: 10.1111/j.1398-9995.2006.01293.x
38. Leander M, Lampa E, Janson C, Svardsudd K, Uddenfeldt M, Rask-Andersen A. Determinants for a low health-related quality of life in asthmatics. Ups J Med Sci. 2012;1:57–66. doi: 10.3109/03009734.2011.638730
39. Sundbom F, Malinovschi A, Lindberg E, Alving K, Janson C. Effects of poor asthma control, insomnia, anxiety and depression on quality of life in young asthmatics. J Asthma. 2016;4:398–403. doi: 10.3109/02770903.2015.1126846
40. Anastasia P, Eleni T, Eleftheria M, Xenia N, Eygenia P, Kyriakos S, et al. Depression levels influence the rate of asthma exacerbations in females. J Pers Med. 2021;11:586. doi: 10.3390/jpm11060586
41. Baiardini I, Braido F, Giardini A, Majani G, Cacciola C, Rogaku A, et al. Adherence to treatment: assessment of an unmet need in asthma. J Investig Allergol Clin Immunol. 2006;4:218–23.
42. Bateman ED, Bousquet J, Keech ML, Busse WW, Clark TJ, Pedersen SE. The correlation between asthma control and health status: the GOAL study. Eur Respir J. 2007;1:56–62. doi: 10.1183/09031936.00128505
43. Lisspers K, Stallberg B, Hasselgren M, Johansson G, Svardsudd K. Quality of life and measures of asthma control in primary health care. J Asthma. 2007;9:747–51. doi: 10.1080/02770900701645298
44. Katz PP, Yelin EH, Eisner MD, Blanc PD. Perceived control of asthma and quality of life among adults with asthma. Ann Allergy Asthma Immunol. 2002;3:251–8. doi: 10.1016/S1081-1206(10)61951-5
45. Kyle SD, Morgan K, Espie CA. Insomnia and health-related quality of life. Sleep Med Rev. 2010;1:69–82. doi: 10.1016/j.smrv.2009.07.004
46. Braido F, Baiardini I, Ferrando M, Scichilone N, Santus P, Petrone A, et al. The prevalence of sleep impairments and predictors of sleep quality among patients with asthma. J Asthma. 2021;4:481–7. doi: 10.1080/02770903.2019.1711391
47. LeBlanc M, Beaulieu-Bonneau S, Merette C, Savard J, Ivers H, Morin CM. Psychological and health-related quality of life factors associated with insomnia in a population-based sample. J Psychosom Res. 2007;2:157–66. doi: 10.1016/j.jpsychores.2007.03.004
48. Sivertsen B, Krokstad S, Overland S, Mykletun A. The epidemiology of insomnia: associations with physical and mental health. The HUNT-2 study. J Psychosom Res. 2009;2:109–16. doi: 10.1016/j.jpsychores.2009.05.001
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Published
2022-11-29
How to Cite
Rask-Andersen A., Leander M., Sundbom F., Lampa E., Oudin A., Leynaert B., Svanes C., Gislason T., Torén K., & Janson C. (2022). Health-related quality of life as associated with asthma control, psychological status and insomnia. Upsala Journal of Medical Sciences, 127(1). https://doi.org/10.48101/ujms.v127.8967
Section
Original Articles
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