African American race is associated with worse sleep quality in heavy smokers

Aaron D. Baugh, Megan Acho, Abraham Arhin, Igor Barjaktarevic, David Couper, Gerard Criner, Meilan Han, Nadia Hansel, Jerry Krishnan, Katherine Malcolm, Andrew Namen, Stephen Peters, Helena Schotland, Mudiaga Sowho, Michelle Zeidler, Prescott Woodruff, Neeta Thakur

Research output: Contribution to journalArticlepeer-review


Study Objectives: To examine the association of self-identified race with sleep quality in heavy smokers. Methods: We studied baseline data from 1965 non-Hispanic White and 462 African American participants from SPIROMICS with ≥ 20 pack-years smoking history. We first examined the Pittsburgh Sleep Quality Index’s (PSQI) internal consistency and item-total correlation in a population with chronic obstructive pulmonary disease. We then used staged multivariable regression to investigate the association of race and sleep quality as measured by the PSQI) The first model included demographics, the second added measures of health status, and the third, indicators of socioeconomic status. We next explored the correlation between sleep quality with 6-minute walk distance and St. George’s Respiratory Questionnaire score as chronic obstructive pulmonary disease-relevant outcomes. We tested for interactions between self-identified race and the most important determinants of sleep quality in our conceptual model. Results: We found that the PSQI had good internal consistency and item-total correlation in our study population of heavy smokers with and without chronic obstructive pulmonary disease. African American race was associated with increased PSQI in univariable analysis and after adjustment for demographics, health status, and socioenvironmental exposures (P = .02; 0.44 95%CI: .06 to .83). Increased PSQI was associated with higher postbronchodilator forced expiratory volume in 1 second and lower household income, higher depressive symptoms, and female sex. We identified an interaction wherein depressive symptoms had a greater impact on PSQI score for non-Hispanic White than African American participants (P for interaction = .01). Conclusions: In heavy smokers, self-reported African American race is independently associated with worse sleep quality.

Original languageEnglish (US)
Pages (from-to)1523-1532
Number of pages10
JournalJournal of Clinical Sleep Medicine
Issue number8
StatePublished - Aug 1 2023


  • COPD
  • PSQI
  • SES
  • health disparities
  • sleep
  • socioeconomic status
  • validation

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Pulmonary and Respiratory Medicine


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