Abstract
BACKGROUND: Sleep behaviors influence the development of chronic obstructive pulmonary disease (COPD) and coronary heart disease (CHD), but their role in the dynamic transitions of COPD and CHD and their interaction with genetic susceptibility on the comorbidity remain unclear.
METHODS: Using UK Biobank data, Cox proportional hazard models and multistate survival models were used to examine the associations of sleep patterns with the risk of dynamic transitions of COPD and CHD, and their interaction with polygenic risk score for comorbidity of COPD and CHD. Four-way decomposition models were performed to explore the potential mediating roles of inflammatory biomarkers and metabolites.
RESULTS: During a median follow-up of 13.8 years, 10 481 and 30 194 new-onset cases of CODP and CHD were recorded among 388 972 participants, respectively. A healthy sleep pattern was associated with a lower risk of transition from COPD to comorbid CHD (hazard ratio [HR], 0.72 [95% CI, 0.59-0.88]), and from CHD to comorbid COPD (HR, 0.81 [95% CI, 0.67-0.99]). Compared with participants having low genetic risk for comorbidity of COPD and CHD and a healthy sleep pattern, participants with high genetic risk and a poor sleep pattern had the highest risk of comorbidity of COPD and CHD (HR, 2.81 [95% CI, 1.50-5.30]). Additionally, C-reactive protein and glycoprotein acetyls were the strongest mediators, explaining 12.40% and 7.00% of the associations between sleep patterns and the incident comorbidity of COPD and CHD, respectively.
CONCLUSIONS: Our findings revealed that a healthy sleep pattern played an important role in the dynamic transitions of COPD and CHD, partially through inflammatory pathways.