Sleep Disorders Linked to Poorer Symptom Control in Severe Asthma

A new study found that, in severe asthma, sleep disorders are linked to more frequent exacerbations, poorer asthma control, reduced quality of life, and increased healthcare utilization, independent of lung function severity.1

“These data define a more difficult-to-treat asthma phenotype that need to be further investigated, and it might be indicative of the complex interplay between sleep and asthma control, suggesting that treatment for sleep disorders might be an overlooked therapeutic target to reduce the need for intensive asthma therapy and improve outcomes,” wrote study investigator Sebastian Ferri, from IRCCS Humanitas Research Hospital in Italy, and colleagues.1

Growing evidence has highlighted a bidirectional relationship between asthma and sleep disorders.2 Sleep disturbances, including snoring, frequent awakenings, and daytime sleepiness, are common among patients with asthma and are associated with worse asthma control, increased exacerbations, and impaired quality of life.3

The team sought to assess the link between sleep disorders and severe asthma. Using data from the Severe Asthma Network Italy (SANI) registry, this retrospective analysis assessed the prevalence and overall burden of sleep disorders in patients with severe asthma, while also identifying related clinical features, risk factors, and treatable traits.1 Participants were stratified based on the presence or absence of sleep disorders at baseline.

Among 1823 participants with severe asthma, approximately 1 in 4 suffered from a concomitant sleep disorder (26.1%), with 5.5% diagnosed with obstructive sleep apnea (OSA), and 20.5% reported to snore.1

“The high prevalence of sleep disorders in our cohort underscores the importance of considering sleep disorders as a comorbidity in patients with severe asthma,” investigators wrote.1

Investigators noted that polysomnography data were not available for all patients, which could explain the discrepancy between snoring and OSA. There may be undiagnosed cases of OSA or respiratory-related disorders.

In this study, sleep disorders were more common in overweight patients, which aligns with previous research that found that being overweight is a risk factor for sleep disorders, such as OSA.

Patients with severe asthma and a comorbid sleep disorder also had more frequent rhinitis, chronic rhinosinusitis with and without nasal polyps, gastroesophageal reflux disease (GERD), cardiovascular disease (CVD), and type II diabetes. Additionally, they had greater rates of intranasal corticosteroid use and a greater need for systemic corticosteroids due to increased exacerbation rates.

The study revealed that participants with severe asthma and a comorbid sleep disorder had less severe lung function but worse asthma control and quality of life. These patients also had increased asthma-related hospital admissions and unscheduled medical visits.

“The finding that these patients have worse asthma control and quality of life, despite less severe functional impairment based on FEV1, may indicate that sleep disturbances are an important factor in the overall management of asthma,” investigators wrote.1 “As found by Teodorescu et al, individuals with OSA are 3.6 times as likely to have uncontrolled asthma, [which] leads to a higher number of disease-related hospital admissions and the need [for] non-programmed medical visits.”

Investigators identified several risk factors for sleep disorders in this population: being overweight or having moderate-to-severe rhinitis, chronic rhinosinusitis with and without nasal polyps, GERD, and CVD.

“Considering the overall results of our study, we confirm and strengthen the concept that sleep disorders are a common and relevant clinical feature among patients with severe asthma, and physicians should consider investigating patients’ sleep quality in their daily clinical practice,” investigators concluded. “It is important to consider asthma and sleep disorders as two entities which can influence each other, and only treating properly both we could improve patient quality of life and reduce healthcare burden."

References

1. Ferri S, Marzio V, Cavaglià E, et al. Severe Asthma and Sleep Disorders: A Severe Asthma Network Italy (SANI) Registry Analysis. J Asthma Allergy. 2025;18:1661-1673. Published 2025 Dec 1. doi:10.2147/JAA.S558611

2. Ferreira NB, Ponte A, Grande AC, et al. Frequency of obstructive sleep apnea in patients with asthma or allergic rhinitis: a systematic review and meta-analysis. Sleep Med. 2025;134:106705. doi:10.1016/j.sleep.2025.106705

3. Dempsey JA, Veasey SC, Morgan BJ, O'Donnell CP. Pathophysiology of sleep apnea. Physiol Rev. 2010;90(1):47-112. doi:10.1152/physrev.00043.2008