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
References
- World Health Organization. Asthma [Internet]. Geneva: WHO; 2023.[cited 2025 Mar]. Available from: https://www.who.int/news-room/fact-sheets/detail/asthma
- 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
- Global Initiative for Asthma. Global strategy for asthma management and prevention. Updated 2025. Available from: https://ginasthma.org
- United Nations. Sustainable development goal 3: good health and well-being. New York: UN; 2023. Available from: https://sdgs.un.org/goals/goal3
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- Qiao YX, Xiao Y. Asthma and obstructive sleep apnea. Chinese Medical Journal. 2015;128(20): 2798-2804. doi:10.4103/0366-6999.167361
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- Lamberti JP. Respiratory monitoring in general care units. Respiratory Care. 2020;65(6): 870-881. doi:10.4187/respcare.07405
- 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
- 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
- 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
- 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
- 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
- Mims JW. Asthma: definitions and pathophysiology. International Forum of Allergy and Rhinology. 2015;5(S1): S2-S6. doi:10.1002/alr.21609
- 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
- 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
- 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.
- 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
- 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
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:
Related subjects:
© 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.