Insomnia Common with Asthma

More than one-third of patients with asthma have clinically significant insomnia that results in worse asthma control, depression and anxiety symptoms, and other quality of life and health issues, according to a new study.

Patients with asthma frequently report difficulty with sleep and often experience nighttime coughing, wheezing, and breathlessness that disturb their sleep. Circadian rhythm has been implicated as a potential factor for these nighttime disturbances. However, the prevalence of insomnia and its relationship with asthma burden and quality of life are unknown.

Researchers led by Faith Luyster, PhD, of the University of Pittsburgh set out to determine the prevalence of insomnia among a large sample of adults with asthma and to compare well-being, asthma control, and asthma-related health care utilization in patients with asthma and insomnia and those without insomnia. Insomnia was defined as combined sleep-specific complaints with associated daytime symptoms.

They analyzed baseline data from 714 adults with physician-confirmed asthma enrolled in the Severe Asthma Research Program III who completed the Insomnia Severity Index, Asthma Control Test, Asthma Quality of Life Questionnaire, and Hospital Anxiety and Depression Scale.

The data identified 263 patients with asthma (37%) who had insomnia. An estimated 22% to 47% of patients with asthma say they have problems getting to sleep and staying asleep, the researchers stated.

The presence of insomnia was associated with higher levels of depression and anxiety symptoms and poorer quality of life. Those with insomnia had a 2.4-fold increased risk for having not well-controlled asthma and a 1.5-fold increased risk for asthma-related health care utilization in the past year compared with those without insomnia.

The researchers also found:

• Those with insomnia had a higher body mass index, worse lung function, and lower annual household income than those without insomnia.

• Despite reporting no nighttime asthma symptoms that disturbed their sleep, almost 25% of participants met criteria for clinically significant insomnia.

• Compared with those without insomnia, participants with insomnia reported more frequent asthma-related health care use in the past 12 months.

• Participants with insomnia had worse asthma control and asthma-specific quality of life and higher levels of depression and anxiety symptoms. These results suggest that adults with asthma who have insomnia disorder may be at increased risk for adverse outcomes.

The researchers noted the significant impact of insomnia on asthma disease burden and well-being and stated that evaluation and treatment of insomnia should be considered among patients with asthma.

“Our results show that poor sleep may not be solely due to nighttime awakenings due to asthma symptoms but may represent comorbid insomnia, and that comorbid insomnia can significantly impact asthma outcomes including quality of life and healthcare utilization,” said Dr Luyster.

The researchers concluded that “insomnia is highly prevalent in those with asthma and is associated with adverse outcomes. Further studies are needed to better understand the relationship between insomnia and asthma control.”

Prospective and interventional asthma studies, including those implementing cognitive-behavioral treatment for insomnia, are moving forward.

The researchers published their results in the December 2016 Chest.