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The effect of sleep duration on exhaled nitric oxide levels in U.S. adults

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Poor sleep quality and duration are associated with systemic endothelial dysfunction. However, an association between poor sleep and pulmonary endothelial dysfunction has not been elucidated. We sought to determine if there is a relationship between sleep duration and fractional exhaled nitric oxide (FeNO) concentrations as a surrogate for pulmonary endothelial function.

Methods

We used three National Health and Nutrition Examination Survey (NHANES) cycles (2007–2012). Linear regression models were built with and without adjustment for age, sex, race, BMI, asthma/bronchitis, CRP, smoking, folate, renal function, respiratory infections, and steroid use. To examine a non-linear relationship, we introduced a spline, with single knot at mean sleep duration (7 h).

Results

Of 13,173 participants (50.8% male, 44.2% Caucasian), 78% slept 6–8 hours (h). FeNO was significantly higher in the group sleeping 6–8 h (17.3 ± 14.9 ppb) than in the other two groups (16.0 ± 13.0 ppb, 15.9 ± 12.7 ppb for <6 and >8 h respectively; P < 0.001). In unadjusted linear regression, FeNO increased by 1.1 ppb for each hour increase in sleep up to 7 h (P < 0.001). Increased sleep duration beyond 7 h saw a 0.96 ppb decrease in FeNO (P < 0.001). After adjustment for confounders, FeNO increased by 1.09 ppb for each hour of sleep up to 7 h (P = 0.001) and decreased by 0.71 ppb for each hour after (P = 0.02).

Conclusion

Sleeping less or more than 7 h is associated with pulmonary endothelial dysfunction as measured by FeNO. Further study is needed to evaluate mechanism(s) of this association and validity of FeNO as a marker of endothelial function.

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Authors and Affiliations

  1. Division of Hospital Medicine, Virginia Commonwealth University, Richmond, Virginia, USA

    Jensen H. Hyde & Rehan Qayyum

  2. Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA

    Rehan Qayyum

Authors
  1. Jensen H. Hyde
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  2. Rehan Qayyum
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Correspondence to Jensen H. Hyde.

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No funding was received for this research.

Conflicts of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study. There is no identifying information included in this article.

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Hyde, J.H., Qayyum, R. The effect of sleep duration on exhaled nitric oxide levels in U.S. adults. Sleep Breath 21, 809–813 (2017). https://doi.org/10.1007/s11325-017-1520-7

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  • DOI: https://doi.org/10.1007/s11325-017-1520-7

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