From the Research
A sleep study is indicated for a patient with bronchial asthma complaining of unrefreshing sleep, particularly if there are additional symptoms suggesting sleep-disordered breathing. The presence of symptoms like snoring, witnessed apneas, excessive daytime sleepiness, morning headaches, or difficulty controlling asthma despite appropriate medication adherence strengthens the indication 1.
Key Points to Consider:
- Patients with asthma have a higher prevalence of obstructive sleep apnea (OSA) compared to the general population, with estimates suggesting 40-60% of asthma patients may have comorbid OSA 2.
- Polysomnography is the gold standard diagnostic test, though home sleep apnea testing may be appropriate for some patients.
- Identifying and treating OSA in asthma patients is important as the conditions can exacerbate each other - OSA can worsen asthma control through increased airway inflammation and bronchial hyperresponsiveness, while untreated asthma can disrupt sleep architecture 3.
- Treatment of comorbid OSA with CPAP therapy has been shown to improve asthma symptoms, reduce rescue medication use, and enhance overall quality of life.
- Additionally, poor sleep quality in asthma patients may indicate nocturnal asthma symptoms requiring adjustment of controller medications such as inhaled corticosteroids or long-acting bronchodilators 4.
Relevant Findings:
- A study found that 46% of asthma patients had OSA, with 12% having mild OSA, 14% having moderate OSA, and 20% having severe OSA 1.
- Another study found that sleep disturbance in asthma may be related to circadian variation in airway inflammation, but may also be related to specific sleep disorders such as insomnia 2.
- The study also found that insomnia is highly prevalent in severe asthma patients, and is associated with a history of poor asthma control and increased healthcare utilization 2.