Increased prevalence of sleep disturbances and daytime sleepiness in subjects with bronchial asthma: a population study of young adults in three European countries

Abstract

I In nc cr re ea as se ed d p pr re ev va al le en nc ce e o of f s sl le ee ep p d di is st tu ur rb ba an nc ce es s a an nd d d da ay yt ti im me e s sl le ee ep pi i--n ne es ss s i in n s su ub bj je ec ct ts s w wi it th h b br ro on nc ch hi ia al l a as st th hm ma a: : a a p po op pu ul la at ti io on n s st tu ud dy y o of f y yo ou un ng g a ad du ul lt ts s i in n t th hr re ee e E Eu ur ro op pe ea an n c co ou un nt tr ri ie es s ABSTRACT: The aim of this study was to investigate whether asthma is associated with decreased quality of sleep and increased daytime sleepiness. The study involved a random population of 2,202 subjects supplemented by 459 subjects with suspected asthma, aged 20-45 yrs. The subjects were from Reykjavik (Iceland), Uppsala and Göteborg (Sweden) and Antwerp (Belgium), and participated in the European Community Respiratory Health Survey. The investigation included a structured interview, methacholine challenge, skinprick tests and a questionnaire on sleep disturbances. Participants in Iceland and Sweden also estimated their sleep times and made peak expiratory flow (PEF) recordings during a period of 1 week. Asthma was defined as self-reported physician-diagnosed asthma with current asthma-related symptoms (n=267).Difficulties inducing sleep (DIS) and early morning awakenings (EMA) were about twice as common, and daytime sleepiness 50% more common, in asthmatics compared with subjects without asthma. After adjusting for possible confounders, a positive association was found between asthma and: DIS (odds ratio (OR)=1.8); EMA (OR=2.0); daytime sleepiness (OR=1.6); snoring (OR=1.7); and self reported apnoeas (OR=3.7). Allergic rhinitis, which was reported by 71% of subjects with asthma, was independently related to DIS (OR=2.0) and daytime sleepiness (OR=1.3). A significant correlation was found between the number of asthma-related symptoms and sleep disturbances (p<0.001).Asthma is associated with decreased subjective quality of sleep and increased daytime sleepiness. Concurrent allergic rhinitis may be an important underlying cause of sleep impairment in asthmatic patients.

Association Between Insomnia and Asthma Burden in the Severe Asthma Research Program (SARP) III

“…The high prevalence of insomnia in patients with asthma (37%) confirms prior reports of disturbed sleep in asthma. [7][8][9][10][11][12] A key strength of our study is that it assessed the prevalence of insomnia symptoms and associated daytime consequences that encapsulate the diagnostic criteria presented in the International Classification of Sleep Disorders-Third Edition. 27 Our findings indicate that poor sleep may not be entirely related to nocturnal awakenings resulting from asthma symptoms.…”

“…[7][8][9][10][11][12] Sleep difficulties are often considered a consequence of nocturnal awakenings resulting from nighttime asthma symptoms and/or the need for rescue inhaler medication, which will resolve with adequate control of asthma symptoms. Previous studies suggest that sleep difficulties persist even in those without asthma-related nocturnal awakenings, with 20% to 46% reporting moderate to severe difficulty staying asleep.…”

“…The prevalence of insomnia in asthma is unknown, because previous studies have only examined sleepspecific complaints without assessment of associated daytime symptoms. [7][8][9][10][11][12] The impact of insomnia on asthma control and asthmarelated health care utilization has not been examined. Limited studies have shown associations between difficulty falling asleep and frequent awakenings at night and nighttime asthma symptoms and rescue inhaler use, both of which are indications of poor asthma control.…”

“…Limited studies have shown associations between difficulty falling asleep and frequent awakenings at night and nighttime asthma symptoms and rescue inhaler use, both of which are indications of poor asthma control. [7][8][9]12,13 The aims of the present study were to determine the prevalence of insomnia, defined as combined sleep-specific complaints with associated daytime symptoms, among a large sample of adults with physician-diagnosed asthma, and to compare asthma control, well-being, and asthma-related health care utilization in those with asthma and insomnia and those without insomnia.…”

Asthma and Injury Risk: A Large Scale Population-Based Study

“…In 2004, it was estimated that asthma affected 300 million people worldwide, [4] and it caused around 250,000 deaths in 2007 [5]. Clinical data suggest that asthma impairs sleep quality and further impairs cognitive performance during the daytime, especially among those with serious night-time symptoms [6][7][8][9][10]. There is a causal relationship between impaired sleep quality and injuries [11,12].…”