Association between higher morning preference and better health-related quality of life in asthma

Background: Circadian preference for eveningness has been linked to a higher risk of asthma and allergies, but its association with health-related quality of life (HRQL) in asthma has not been studied yet. 

Objective: We aimed to investigate the associations between individual circadian preference and HRQL in asthma. 

Methods: Among 691 adult asthma patients from Canada, India, New Zealand, and the United Kingdom, a digital questionnaire was administered to capture demographic information, social and psychologic attributes, comorbidities, and medication adherence. Circadian preference and HRQL were assessed by the reduced version of the morningness–eveningness questionnaire (rMEQ) and the short form of the chronic respiratory questionnaire, respectively. We analyzed the association between chronotype and HRQL using mixed-effect linear regression models. 

Results: Of all participants, 59% were female with a mean (standard deviation) age of 49 (17) years. Median (interquartile range) rMEQ total score was 17 (14-19). Mean (standard deviation) dyspnea, fatigue, emotional function, and mastery scores were 5.94 (1.2), 4.38 (1.3), 5.05 (1.3), and 1.96 (1.1), respectively. In regression analysis, a higher rMEQ total score (higher morningness) was associated with less fatigue (β = 0.06; 95% confidence interval, 0.04 to 0.09) and better emotional function (β = 0.03; 95% confidence interval, 0.004 to 0.06), and these associations were mediated by less anxiety, depression, and alcohol abuse, and better sleep quality. 

Conclusion: Morning orientation is associated with better HRQL in patients with asthma. The results suggest that working with patients to promote schedules and habits related to morningness may be beneficial.