Researchers Find Higher Risk of Insomnia With Undiagnosed Asthma

Researchers of a new study have identified significant association between going undiagnosed for asthma and having symptoms of insomnia.¹

The community-based study, published in the Journal of Sleep Research, offers new insights into the relationship between obstructive airway disease (OAD) and sleep disorders, say the researchers, noting that previous research has primarily remained in clinical settings.

Based on their findings, the researchers suggest a potential need for screening for coexisting sleep disorder symptoms in patients with respiratory symptoms. | Image Credit: ©- terovesalainen stock.adobe.com

“There is a lack of consensus on the association between symptoms of sleep disorders and objective measures of lung function,” wrote the researchers. “While some studies demonstrate reduced lung function is associated with greater subjective sleep disturbances, others show an association with fewer objective indicators of sleep disorders. Adding to this contradiction, some studies have found no association between lung function and sleep disturbances, measured subjectively or objectively.”

Based on their findings, the researchers suggest a potential need for screening for coexisting sleep disorder symptoms in patients with respiratory symptoms. Symptoms were reported through the Global Sleep Assessment Questionnaire (GSAQ) questionnaire, the 11-item questionnaire that screens for insomnia and other sleep disorder symptoms.

Among 2093 adults with respiratory symptoms, 9.13% met criteria for undiagnosed asthma with the Asthma Screening Questionnaire. These patients were more likely to report insomnia symptoms (OR, 2.58; 95% CI, 1.27-6.19; P = .02) than those without the condition.

“This is consistent with other studies demonstrating a high prevalence of insomnia in patients with asthma, with more insomnia symptoms amongst those with worse asthma control,” detailed the researchers. “Asthma symptom burden, particularly nocturnal symptoms, and immune modulation with activation of shared inflammatory pathways have been posited as reasons for this association. Interestingly, two recent genetic epidemiology studies showed unidirectional causality between asthma and insomnia, with genetically predicted insomnia as a risk factor for developing asthma.”

One of these studies was the HUNT study, which found that patients with chronic insomnia had a 3-fold risk (OR, 3.16; 95% CI, 1.37-6.40) of developing asthma compared with those without chronic insomnia.²

A study published earlier this year also showed indications that issues with sleeping negatively impact asthma control in patients. The study including 659 patients with diagnosed asthma, finding that those with insomnia had a higher average of yearly asthma exacerbations compared to those without insomnia (0.93 vs 0.59; P = .039).³

Another 9.79% of the patients included in the current study met criteria for undiagnosed chronic obstructive pulmonary disease (COPD). While a significant univariate association was seen between undiagnosed COPD and insomnia symptoms, the association did not remain once controlling for other factors.

In addition to insomnia, patients reported the presence, or absence, of daytime sleepiness, bothersome daytime sleepiness, snoring, apneas, restless leg syndrome, periodic limb movement disorder, and parasomnias.

The researchers found no other sleep disorder symptoms associated with COPD or asthma, conflicting with previous research. The group outlined several reasons potentially accounting for the difference in findings, including that the small number of patients with either condition in their study, which limited the statistical power for identifying associations between OAD and other sleep disorder symptoms.

The researchers also noted that by nature of including patients with undiagnosed asthma or COPD, generally associated with lower severity of OAD and better respiratory control, those with worse symptoms, who would likely have more sleep disorder symptoms, were excluded from the study.

Among patients with a recorded diagnosis of asthma or COPD, the researchers found no association with symptoms of insomnia or other sleep disorders.

References

1. Mazzola R, Aaron SD, Vandemheen KL, et al. Association between lung function and sleep disorder symptoms in a community-based multi-site case-finding study. J Sleep Res. Published online September 25, 2024. doi:10.1111/jsr.14356
2. Brumpton B, Mai XM, Langhammer A, Laugsand LE, Janszky I, Strand LB. Prospective study of insomnia and incident asthma in adults: the HUNT study. Eur Respir J. 2017;49(2):1601327. doi:10.1183/13993003.01327-2016
3. Rhoads SL, Edinger J, Khatiwada A, Zimmer J, Zelarney P, Wechsler ME. The impact of insomnia and depression on asthma control. J Asthma. 2024;61(10):1248-1251. doi:10.1080/02770903.2024.2335367