Which sleep-related factors matter most in asthma? A prospective study of sleep duration, sleep quality, and nocturia

Sleep disturbances are highly prevalent in asthma, but the relative importance of sleep duration, sleep quality, and nocturnal symptoms for asthma outcomes remains unclear.

We aimed to investigate the association between sleep duration and sleep quality with asthma control and subsequent clinical outcomes in adults with asthma.

We conducted a prospective cohort study of 53 adults with physician-diagnosed asthma who completed a 7-day sleep diary and the Pittsburgh Sleep Quality Index (PSQI) and were followed for 6 months. Short sleep duration was defined as <7 hours per night and poor sleep quality as PSQI ≥5. Asthma control was assessed using the Asthma Control Test (ACT), and asthma worsening during follow-up was defined as deterioration in ACT, increased exacerbations or hospitalizations, escalation of inhaled corticosteroids, or initiation of biologic therapy.

Of the participants, 42 (79.2%) were female and the median age was 42.0 years (range 18-71). Short sleep duration was common (41.5%) but was not significantly associated with asthma control or future worsening. In contrast, patients with uncontrolled asthma (ACT <20) had significantly higher PSQI scores, more nocturia, and greater sleep fragmentation. In multivariable analysis, nocturia was the only independent sleep-related predictor of uncontrolled asthma (OR 6.70, 95% CI 1.09-41.27). During follow-up, 47.2% of patients experienced asthma worsening, and chronic sinusitis was the only independent predictor of clinical deterioration (OR 6.54, 95% CI 1.23-34.75), whereas sleep parameters were not associated with future worsening.

These findings suggest that in adults with asthma, qualitative aspects of sleep, particularly nocturia, are more closely associated with asthma control than sleep duration, while chronic sinusitis appears to be the dominant factor associated with subsequent asthma worsening.