The Impact of Sleep Disorders on Severe Asthma Management

The SANI registry analysis found that sleep disorders degrade symptom control and raise exacerbation frequency in patients with severe asthma, translating to poorer overall control, higher exacerbation burden, reduced quality of life, and greater healthcare use. The finding underscores sleep assessment as a key element of comprehensive severe asthma evaluation.

This retrospective analysis of the Severe Asthma Network Italy registry included 1,823 patients with severe asthma and examined prespecified outcomes: asthma control metrics, exacerbation frequency, and health-related quality of life.

Investigators reported that roughly one-quarter of the cohort had a sleep disorder. Prior studies have linked obstructive sleep apnea to an approximately 3.6-fold increase in the odds of uncontrolled asthma. SANI data notes a 26.1% prevalence of comorbid sleep disorders in this cohort, with insomnia (19.8%), obstructive sleep apnea (5.5%), and restless legs syndrome (7.2%) represented.

Fragmented sleep from nocturnal airway inflammation and symptom-driven awakenings degrades daytime respiratory control and lowers asthma-control-test scores and quality-of-life indices. Sleep-disordered breathing and persistent insomnia may, in turn, amplify airway hyperresponsiveness and systemic inflammatory pathways, increasing exacerbation susceptibility and destabilizing responses to standard therapies. The clinical and mechanistic data together support a reciprocal, biologically plausible relationship: sleep disturbance worsens airway inflammation, and airway pathology increases sleep disruption.