Sleep-disordered breathing and obstructive sleep apnoea in asthma: impact on disease control, exacerbation frequency and clinical outcomes – a systematic review and meta-analysis of observational studies

Jeevarathinam Thirumalai; Bhavadharani T; Muthupandi Sankar

doi:10.2478/pneum-2026-0013

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Sleep-disordered breathing and obstructive sleep apnoea in asthma: impact on disease control, exacerbation frequency and clinical outcomes – a systematic review and meta-analysis of observational studies

Pneumologia

Volume 75 (2026): Issue 1 (January 2026)

By: Jeevarathinam Thirumalai, Bhavadharani T and Muthupandi Sankar

Open Access

|Aug 2026

Abstract

Background

Sleep-disordered breathing (SDB), including obstructive sleep apnoea (OSA), is a common but underrecognised comorbidity in asthma that may worsen disease control and clinical outcomes. This systematic review and meta-analysis evaluated associations between OSA/SDB and asthma control, exacerbations, future-risk outcomes and treatment response.

Methods:

PubMed, Scopus, Embase, Web of Science and the Cochrane Library were searched from inception to March 2025. Observational studies reporting validated asthma outcomes in populations with OSA/SDB were included. Risk of bias was assessed using adapted ROBINS-I domains. Random-effects meta-analyses used restricted maximum likelihood estimation with Hartung-Knapp correction where appropriate.

Results

Twenty-one studies involving 922,748 participants from 12 countries were included. OSA was associated with persistent asthma symptoms in adults (OR 1.74, 95% CI 1.49-2.02), poor asthma control in children (OR 2.48, 95% CI 1.45-4.23), severe asthma (OR 3.49, 95% CI 1.49-8.15), hospital readmission (IRR 1.09, 95% CI 1.04-1.15), and mechanical ventilation in hospitalised children (OR 6.62, 95% CI 4.29-10.22). The pooled prevalence of OSA/SDB in asthma by objective sleep testing was 62.3% (95% CI 34.7%-83.7%). Asthma independently predicted incident OSA (OR/HR/RR 2.11, 95% CI 1.35-3.29). GRADE certainty was low to very low for most outcomes.

Conclusion

OSA/SDB is highly prevalent in asthma and consistently associated with poorer asthma control, greater exacerbation risk and increased healthcare utilisation. Routine SDB screening should be considered in poorly controlled asthma. Addressing this overlap supports Sustainable Development Goal 3.

References

World Health Organization. Asthma [Internet]. Geneva: WHO; 2023.[cited 2025 Mar]. Available from: https://www.who.int/news-room/fact-sheets/detail/asthma
Search in Google Scholar Back to article
Soriano JB, Abajobir AA, Abate KH, Abera SF, Agrawal A, et al. GBD 2015 Chronic Respiratory Disease Collaborators. Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet Respiratory Medicine. 2017;5(9): 691–706. doi:10.1016/S2213-2600(17)30293-X
Open DOI Search in Google Scholar Back to article
Global Initiative for Asthma. Global strategy for asthma management and prevention. Updated 2025. Available from: https://ginasthma.org
Search in Google Scholar Back to article
United Nations. Sustainable development goal 3: good health and well-being. New York: UN; 2023. Available from: https://sdgs.un.org/goals/goal3
Search in Google Scholar Back to article
Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proceedings of the American Thoracic Society. 2008;5(2): 136-143. doi:10.1513/pats.200709-155MG
Open DOI Search in Google Scholar Back to article
Mirzaei SM, Yousefi M, Nasehi MM, Soltantooyeh Z, Karav S, Sahebkar A. Obstructive sleep apnea and seizures: pathophysiological mechanisms and clinical implications: a narrative review. Sleep and Breathing. 2026;30(1): 71. doi:10.1007/s11325-026-03630-1
Open DOI Search in Google Scholar Back to article
Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. American Journal of Epidemiology. 2013;177(9): 1006-1014. doi:10.1093/aje/kws342
Open DOI Search in Google Scholar Back to article
Bhattacharjee R, Kheirandish-Gozal L, Pillar G, Gozal D. Cardiovascular complications of obstructive sleep apnea syndrome: evidence from children. Progress in Cardiovascular Diseases. 2009;51(5): 416-433. doi:10.1016/j.pcad.2008.03.002
Open DOI Search in Google Scholar Back to article
El Amine B, Fournier J, Minoves M, Baillieul S, Roche F, Perek N, et al. Cerebral oxidative stress, inflammation and apoptosis induced by intermittent hypoxia: a systematic review and meta-analysis of rodent data. European Respiratory Review. 2024;33(174): 240162. doi:10.1183/16000617.0162-2024
Open DOI Search in Google Scholar Back to article
Tamisier R, Pepin JL, Remy J, Baguet JP, Taylor JA, Weiss JW, et al. 14 nights of intermittent hypoxia elevate daytime blood pressure and sympathetic activity in healthy humans. European Respiratory Journal. 2011;37(1): 119-128. doi:10.1183/09031936.00204209
Open DOI Search in Google Scholar Back to article
Alkhalil M, Schulman E, Getsy J. Obstructive sleep apnea syndrome and asthma: what are the links? Journal of Clinical Sleep Medicine. 2009;5(1): 71-78. doi:10.5664/jcsm.27397
Open DOI Search in Google Scholar Back to article
Teodorescu M, Barnet JH, Hagen EW, Palta M, Young TB, Peppard PE. Association between asthma and risk of developing obstructive sleep apnea. JAMA. 2015;313(2): 156-164. doi:10.1001/jama.2014.17822
Open DOI Search in Google Scholar Back to article
Shen TC, Lin CL, Wei CC, Chen CH, Tu CY, Hsia TC, et al. Risk of obstructive sleep apnea in adult patients with asthma: a population-based cohort study in Taiwan. PLoS One. 2015;10(6): e0128461. doi:10.1371/journal.pone.0128461
Open DOI Search in Google Scholar Back to article
Davies SE, Bishopp A, Wharton S, Turner AM, Mansur AH. Does Continuous Positive Airway Pressure (CPAP) treatment of obstructive sleep apnoea (OSA) improve asthma-related clinical outcomes in patients with co-existing conditions? A systematic review. Respiratory Medicine. 2018;143: 18-30. doi:10.1016/j.rmed.2018.08.004
Open DOI Search in Google Scholar Back to article
Liu T, Qin H. Association of obstructive sleep apnea risk with allergic asthma: A systematic review and meta-analysis. Medicine. 2025;104(15): e41918. doi:10.1097/MD.0000000000041918
Open DOI Search in Google Scholar Back to article
Pardo-Manrique V, Ibarra-Enriquez CD, Serrano CD, Sanabria F, Fernandez-Trujillo L. Asthma and obstructive sleep apnea: unveiling correlations and treatable traits for comprehensive care. Chronic Respiratory Disease. 2024;21: 14799731241251827. doi:10.1177/14799731241251827
Open DOI Search in Google Scholar Back to article
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372: n71. doi:10.1136/bmj.n71
Open DOI Search in Google Scholar Back to article
Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283(15): 2008-2012. doi:10.1001/jama.283.15.2008
Open DOI Search in Google Scholar Back to article
Kheirandish-Gozal L, Dayyat EA, Eid NS, Morton RL, Gozal D. Obstructive sleep apnea in poorly controlled asthmatic children: effect of adenotonsillectomy. Pediatric Pulmonology. 2011;46(9): 913-918. doi:10.1002/ppul.21451
Open DOI Search in Google Scholar Back to article
Araujo AM, Duarte RL, Gozal D, Cardoso AP, Mello FC. Predictive factors for obstructive sleep apnea in adults with severe asthma receiving biologics: a single-center crosssectional study. Sleep and Breathing. 2023;27(3): 1091-1098. doi:10.1007/s11325-022-02710-2
Open DOI Search in Google Scholar Back to article
Byun MK, Park SC, Chang YS, Kim YS, Kim SK, Kim HJ, et al. Associations of moderate to severe asthma with obstructive sleep apnea. Yonsei Medical Journal. 2013;54(4): 942-948. doi:10.3349/ymj.2013.54.4.942
Open DOI Search in Google Scholar Back to article
Locci C, Puci MV, Saderi L, Sotgiu G, Zanza C, Antonucci R. The complex link between sleep-disordered breathing and asthma control in pediatric patients: a cross-sectional study. Respiratory Medicine. 2024;231: 107730. doi:10.1016/j.rmed.2024.107730
Open DOI Search in Google Scholar Back to article
Serrano-Pariente J, Plaza V, Soriano JB, Mayos M, L0pez-Vina A, Picado C, et al. Asthma outcomes improve with continuous positive airway pressure for obstructive sleep apnea. Allergy. 2017;72(5): 802-812. doi:10.1111/all.13070
Open DOI Search in Google Scholar Back to article
Teodorescu M, Polomis DA, Teodorescu MC, Gangnon RE, Peterson AG, Consens FB, et al. Association of obstructive sleep apnea risk or diagnosis with daytime asthma in adults. Journal of Asthma. 2012;49(6): 620-628. doi:10.3109/02770903.2012.689408
Open DOI Search in Google Scholar Back to article
Teodorescu M, Polomis DA, Gangnon RE, Fedie JE, Consens FB, Chervin RD, et al. Asthma control and its relationship with obstructive sleep apnea (OSA) in older adults. Sleep Disorders. 2013;2013(1): 251567. doi:10.1155/2013/251567
Open DOI Search in Google Scholar Back to article
Teodorescu M, Broytman O, Curran-Everett D, Sorkness RL, Crisafi G, Bleecker ER, et al. Obstructive sleep apnea risk, asthma burden, and lower airway inflammation in adults in the severe asthma research program (SARP) II. The Journal of Allergy and Clinical Immunology: In Practice. 2015;3(4): 566-575. doi:10.1016/j.jaip.2015.04.002
Open DOI Search in Google Scholar Back to article
Wang TY, Lo YL, Lin SM, Huang CD, Chung FT, Lin HC, et al. Obstructive sleep apnoea accelerates FEV1 decline in asthmatic patients. BMC Pulmonary Medicine. 2017;17(1): 55. doi:10.1186/s12890-017-0398-2
Open DOI Search in Google Scholar Back to article
Español I, Arismendi E, Martinez-Olondris P, Ruiz C, Embid C, Garcia J, et al. Asthma and obstructive sleep apnea: a complex but treatable relationship. Sleep Medicine Reviews. 2025;83: 102146. doi:10.1016/j.smrv.2025.102146
Open DOI Search in Google Scholar Back to article
Sakhamuri S, Rampersad C, Ramsingh C, Ivey MA, Pinto Pereira LM. Risk factors for poor asthma control and impaired quality of life in a Caribbean population. Journal of Asthma. 2021;58(9): 1261-1269. doi:10.1080/02770903.2020.1778026
Open DOI Search in Google Scholar Back to article
Hirayama A, Goto T, Faridi MK, Camargo CA Jr, Hasegawa K. Association of obstructive sleep apnea with all-cause readmissions after hospitalization for asthma exacerbation in adults aged 18-54 years: a population-based study, 2010-2013. Journal of Asthma. 2021;58(9): 1176-1185. doi:10.1080/02770903.2020.1781887
Open DOI Search in Google Scholar Back to article
Kauppi P, Bachour P, Maasilta P, Bachour A. Long-term CPAP treatment improves asthma control in patients with asthma and obstructive sleep apnoea. Sleep and Breathing. 2016;20(4): 1217-1224. doi:10.1007/s11325-016-1340-1
Open DOI Search in Google Scholar Back to article
Li L, Xu Z, Jin X, Yan C, Jiang F, Tong S, et al. Sleep-disordered breathing and asthma: evidence from a large multicentric epidemiological study in China. Respiratory Research. 2015;16(1): 56. doi:10.1186/s12931-015-0215-5
Open DOI Search in Google Scholar Back to article
Tsou PY, Cielo C, Xanthopoulos MS, Wang YH, Kuo PL, Tapia IE. Impact of obstructive sleep apnea on assisted ventilation in children with asthma exacerbation. Pediatric Pulmonology. 2021;56(5): 1103-1113. doi:10.1002/ppul.25247
Open DOI Search in Google Scholar Back to article
Wang Y, Liu K, Hu K, Yang J, Li Z, Nie M, et al. Impact of obstructive sleep apnea on severe asthma exacerbations. Sleep Medicine. 2016;26: 1-5. doi:10.1016/j.sleep.2016.06.013
Open DOI Search in Google Scholar Back to article
Zandieh SO, Cespedes A, Ciarleglio A, Bourgeois W, Rapoport DM, Bruzzese JM. Asthma and subjective sleep disordered breathing in a large cohort of urban adolescents. Journal of Asthma. 2017;54(1): 62-68. doi:10.1080/02770903.2016.1188942
Open DOI Search in Google Scholar Back to article
Tao M, Zhang Y, Ding L, Peng D. Risk factors of sleep-disordered breathing and poor asthma control in children with asthma. BMC Pediatrics. 2024;24(1): 288. doi:10.1186/s12887-024-04762-7
Open DOI Search in Google Scholar Back to article
Yigla M, Tov N, Solomonov A, Rubin AH, Harlev D. Difficult-to-control asthma and obstructive sleep apnea. Journal of Asthma. 2003;40(8): 865-871. doi:10.1081/JAS-120023577
Open DOI Search in Google Scholar Back to article
Kheirandish-Gozal L, Gozal D. Obesity, asthma, and sleep-disordered breathing. The Journal of Pediatrics. 2012;160(5): 713-714. doi:10.1016/j.jpeds.2011.11.036
Open DOI Search in Google Scholar Back to article
Marcus CL, Moore RH, Rosen CL, Giordani B, Garetz SL, Taylor HG, et al. A randomized trial of adenotonsillectomy for childhood sleep apnea. New England Journal of Medicine. 2013;368(25): 2366-2376. doi:10.1056/NEJMoa1215881
Open DOI Search in Google Scholar Back to article
Halawani M, Alsharif A, Alanazi OI, Awad B, Alsharif A, Alahmadi H, et al. Efficacy and safety of adenotonsillectomy for pediatric obstructive sleep apnea across various age groups: a systematic review. Pediatric Reports. 2025;17(4): 71. doi:10.3390/pediatric17040071
Open DOI Search in Google Scholar Back to article
Qiao YX, Xiao Y. Asthma and obstructive sleep apnea. Chinese Medical Journal. 2015;128(20): 2798-2804. doi:10.4103/0366-6999.167361
Open DOI Search in Google Scholar Back to article
Lavie L. Intermittent hypoxia: the culprit of oxidative stress, vascular inflammation and dyslipidemia in obstructive sleep apnea. Expert Review of Respiratory Medicine. 2008;2(1): 75-84. doi:10.1586/17476348.2.1.75
Open DOI Search in Google Scholar Back to article
Senaratna CV, Perret JL, Lodge CJ, Lowe AJ, Campbell BE, Matheson MC, et al. Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Medicine Reviews. 2017;34: 70-81. doi:10.1016/j.smrv.2016.07.002
Open DOI Search in Google Scholar Back to article
Prasad B, Nyenhuis SM, Imayama I, Siddiqi A, Teodorescu M. Asthma and obstructive sleep apnea overlap: what has the evidence taught us? American Journal of Respiratory and Critical Care Medicine. 2020;201(11): 1345-1357. doi:10.1164/rccm.201810-1838TR
Open DOI Search in Google Scholar Back to article
Goldbart AD, Goldman JL, Veling MC, Gozal D. Leukotriene modifier therapy for mild sleep-disordered breathing in children. American Journal of Respiratory and Critical Care Medicine. 2005;172(3): 364-370. doi:10.1164/rccm.200408-1064OC
Open DOI Search in Google Scholar Back to article
Goldbart AD, Greenberg-Dotan S, Tal A. Montelukast for children with obstructive sleep apnea: a double-blind, placebo-controlled study. Pediatrics. 2012;130(3): e575-580. doi:10.1542/peds.2012-0310
Open DOI Search in Google Scholar Back to article
La Verde M, Marrapodi MM, Molitierno R, Petillo A, Uzunçıbuk H, Di Blasio M, et al. Impact of obstructive sleep apnea on fetal heart rate: a systematic review. British Journal of Hospital Medicine. 2026;87(4): 53217. doi:10.31083/BJHM53217
Open DOI Search in Google Scholar Back to article
Al Mortadi N, Khasawneh L, Khassawneh B, Tabnjh AK, Alzoubi KH. Factors influencing the prediction of obstructive sleep apnea: an observational study from a developing country. Future Science OA. 2026;12(1): 2615969. doi:10.1080/20565623.2026.2615969
Open DOI Search in Google Scholar Back to article
Chung F, Abdullah HR, Liao P. STOP-Bang questionnaire: a practical approach to screen for obstructive sleep apnea. Chest. 2016;149(3): 631-638. doi:10.1378/chest.15-0903
Open DOI Search in Google Scholar Back to article
Gaffin JM, Castro M, Bacharier LB, Fuhlbrigge AL. The role of comorbidities in difficult-to-control asthma in adults and children. The Journal of Allergy and Clinical Immunology: In Practice. 2022;10(2): 397-408. doi:10.1016/j.jaip.2021.11.016
Open DOI Search in Google Scholar Back to article
Fitzpatrick AM, Teague WG, Meyers DA, Peters SP, Li X, Li H, et al. Heterogeneity of severe asthma in childhood: confirmation by cluster analysis of children in the National Institutes of Health/National Heart, Lung, and Blood Institute Severe Asthma Research Program. Journal of Allergy and Clinical Immunology. 2011;127(2): 382-389. doi:10.1016/j.jaci.2010.11.015
Open DOI Search in Google Scholar Back to article
Lamberti JP. Respiratory monitoring in general care units. Respiratory Care. 2020;65(6): 870-881. doi:10.4187/respcare.07405
Open DOI Search in Google Scholar Back to article
Zidan M, Daabis R, Gharraf H. Overlap of obstructive sleep apnea and bronchial asthma: Effect on asthma control. Egyptian Journal of Chest Diseases and Tuberculosis. 2015;64(2): 425-430. doi:10.1016/j.ejcdt.2015.01.007
Open DOI Search in Google Scholar Back to article
Lafond C, Series F, Lemiere C. Impact of CPAP on asthmatic patients with obstructive sleep apnoea. European Respiratory Journal. 2007;29(2): 307-311. doi:10.1183/09031936.00059706
Open DOI Search in Google Scholar Back to article
Adeagbo A, Muhammad T, Pai M. Breathlessness and beyond: cross-sectional associations between physician-diagnosed and symptom-based asthma, depression, loneliness, and sleep difficulties in older Indians. Clinical Gerontologist. 2026;49(2): 341-358. doi:10.1080/07317115.2025.2572798
Open DOI Search in Google Scholar Back to article
Garg R, Singh A, Prasad R, Saheer S, Jabeed P, Verma R. A comparative study on the clinical and polysomnographic pattern of obstructive sleep apnea among obese and non-obese subjects. Annals of Thoracic Medicine. 2012;7(1): 26-30. doi:10.4103/1817-1737.91561
Open DOI Search in Google Scholar Back to article
Marsland BJ, Trompette A, Gollwitzer ES. The gutlung axis in respiratory disease. Annals of the American Thoracic Society. 2015;12(Suppl_2): S150-156. doi:10.1513/AnnalsATS.201503-133AW
Open DOI Search in Google Scholar Back to article
Mims JW. Asthma: definitions and pathophysiology. International Forum of Allergy and Rhinology. 2015;5(S1): S2-S6. doi:10.1002/alr.21609
Open DOI Search in Google Scholar Back to article
Wang D, Zhou Y, Chen R, Zeng X, Zhang S, Su X, et al. The relationship between obstructive sleep apnea and asthma severity and vice versa: a systematic review and meta-analysis. European Journal of Medical Research. 2023;28(1): 139. doi:10.1186/s40001-023-01097-4
Open DOI Search in Google Scholar Back to article
Section on Pediatric Pulmonology, Subcommittee on Obstructive Sleep Apnea Syndrome, American Academy of Pediatrics. Clinical practice guideline: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2002;109(4): 704-712. doi:10.1542/peds.109.4.704
Open DOI Search in Google Scholar Back to article
Berry RB, Brooks R, Gamaldo CE, Harding SM, Marcus C, Vaughn BV. The AASM manual for the scoring of sleep and associated events. Rules, Terminology and Technical Specifications. Darien, Illinois: American Academy of Sleep Medicine. 2012.
Search in Google Scholar Back to article
Yalçın S, Bostanoğlu Karaçin A, Aydin Ö, Mungan D, Bavbek S, Çelebi Sözener Z. Redefining asthma through new immune response pattern: a clinically driven perspective. Respiratory Medicine. 2026;260: 108961. doi:10.1016/j.rmed.2026.108961
Open DOI Search in Google Scholar Back to article
Budhiraja R, Siddiqi TA, Quan SF. Sleep disorders in chronic obstructive pulmonary disease: etiology, impact, and management. Journal of Clinical Sleep Medicine. 2015;11(3): 259-270. doi:10.5664/jcsm.4540
Open DOI Search in Google Scholar Back to article

Articles in this issue

DOI: https://doi.org/10.2478/pneum-2026-0013 | Journal eISSN: 2247-059X | Journal ISSN: 2067-2993

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Language: English, Romanian

Page range: 94 - 119

Published on: Aug 18, 2026

Published by: Romanian Society of Pneumology

In partnership with: Paradigm Publishing Services

Publication frequency: Volume open

Keywords:

obstructive sleep apnoea,

asthma control,

asthma exacerbation,

chronic respiratory disease,

public health

Related subjects:

Medicine,

Clinical medicine,

Clinical medicine, other,

Internal medicine,

Pneumology

© 2026 Jeevarathinam Thirumalai, Bhavadharani T, Muthupandi Sankar, published by Romanian Society of Pneumology
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Volume 75 (2026): Issue 1 (January 2026)