Multi-dimensional analyses of the associations between depression, nocturnal awakening and asthmatic outcomes.

BACKGROUND: Depression plays an important role in the occurrence and development of asthma. Nocturnal awakening secondary to asthma is a crucial sign of the deterioration of asthmatic outcomes. This study plans to determine the associations between depression, nocturnal awakening and asthmatic outcomes by using multi-dimensional analyses.

METHODS: Study population came from the Adult Asthma Call-Back Survey 2013-2017. Multivariable regression analysis with binomial or Poisson models, dose-dependent analysis and mediation analysis were used to explore the associations between depression and nocturnal awakening with asthmatic episodes/attacks, emergency room (ER) and hospital visits.

RESULTS: 18,684 physician-diagnosis asthmatics were included into this study. This population consisted of 31.4 % with nocturnal awakening and 37.6 % with depression. Multivariable binomial analyses suggested that nocturnal awakening and depression were positively associated with asthmatic episodes/attacks and ER visits. Dose-dependent analyses demonstrated that the increase of nocturnal awakening was positively associated with the increase of depression and three asthmatic outcomes. Asthmatics with depression had the higher prevalence (adjusted OR = 1.17, 95%CI: 1.08-1.27) and frequency (adjusted RR = 1.08, 95%CI: 1.07-1.10) of nocturnal awakening than those without depression. Mediation analyses suggested that clarification of verbiage denoted trivial effect of depression on the associations between nocturnal awakening with asthmatic outcomes, while nocturnal awakening mildly mediated these associations between depression with asthmatic episodes/attacks (15.26 %, 95%CI: 7.29 %-28.7 %) and ER visits (13.29 %, 95%CI: 5.33 %-44.12 %).

LIMITATION: The cross-sectional nature limited inferences on causality.

CONCLUSIONS: Our findings showed that depression and nocturnal awakening might affect asthmatic outcomes. Nocturnal awakening harbored the mediated effect in the correlations between depression and asthmatic outcomes.