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Prevalence of self-reported sleep problems amongst adults with obstructive airway disease in the NHANES cohort in the United States



Sleep and respiratory problems are common in adults in the USA. However, sleep problems often remain undiagnosed in patients with obstructive airway diseases (OADs). This study was designed to examine the association between sleep problems and different categories of OAD amongst US adults.


We conducted an observational, cross-sectional study using a nationally representative sample of the US civilian non-institutionalized population from 2007 to 2008 National Health and Nutritional Examination Survey (NHANES). A total of 3204 study participants aged ≥35 years were stratified into four groups, using a self-reported history of asthma and data from spirometry: asthma-COPD overlap (ACO) (n = 70, 2.2%), asthma (n = 168, 5.2%), chronic obstructive pulmonary disease (COPD) (n = 412, 12.8%), and those without any OAD (normal) (n = 2554, 79.7%). After characterizing the baseline demographics and health status of the four groups, multivariate logistic regression analysis was performed to estimate the likelihood of sleep problems in adults after adjusting for age, gender, body mass index, smoking, alcohol, obstructive sleep apnea syndrome (OSAS), depression, and diabetes. The index sample was the normal group. Sleep problems were defined as any complaints which affect or involve sleep.


The participants with COPD were older (62.0 ± 11.7 years) as compared to ACO (59.1 ± 11.3 years), asthma (53.6 ± 11.3), and normal groups (53.8 ± 12.1) (p < 0.0001). Comparing baseline characteristics between the four groups, there were significant associations between OAD status and sleep problems including inadequate sleep, sleep-onset insomnia, snoring, frequent trouble sleeping, nocturnal arousals, early morning awakenings, fatigue, daytime sleepiness, use of prescription medication for sleep, leg jerks, leg cramps, difficulty in concentration, and difficulty in remembering things when tired. The multivariate logistic regression models evaluating the prevalence of sleep problems in individual OADs showed a stronger association between asthma and sleep problems as compared to COPD and ACO and sleep disorders.


All OADs are associated with a higher prevalence of sleep problems. There is a stronger association between asthma and sleep problems as compared to COPD and ACO. We speculate that the nocturnal burden of asthma contributes to sleep problems. Our results suggest that adults with OAD should be aggressively screened for sleep problems.

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Obstructive airway disease


Chronic obstructive pulmonary disease


National Health and Nutritional Examination Survey


Global Initiative for Chronic Obstructive Lung Disease


Global Initiative for Asthma


Body mass index


Odds ratio


Confidence interval


Center for Disease Control and Prevention


  1. Global surveillance, prevention and control of chronic respiratory diseases: a comprehensive approach. 2007(GARD_Manual. 2007)

  2. Vestbo J, Hurd SS, Agustí AG, Jones PW, Vogelmeier C, Anzueto A, Barnes PJ, Fabbri LM, Martinez FJ, Nishimura M, Stockley RA, Sin DD, Rodriguez-Roisin R (2013) Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 187(4):347–365

    CAS  PubMed  Google Scholar 

  3. Rennard S, Decramer M, Calverley PMA, Pride NB, Soriano JB, Vermeire PA, Vestbo J (2002) Impact of COPD in North America and Europe in 2000: subjects’ perspective of confronting COPD International Survey. Eur Respir J 20(4):799–805

    CAS  PubMed  Google Scholar 

  4. Agusti A, Hedner J, Marin JM, Barbé F, Cazzola M, Rennard S (2011) Night-time symptoms: a forgotten dimension of COPD. Eur Respir Rev 20(121):183–194

    CAS  PubMed  Google Scholar 

  5. Janssen DJ, Mullerova H, Agusti A et al (2014) Persistent systemic inflammation and symptoms of depression among patients with COPD in the ECLIPSE cohort. Respir Med 108(11):1647–1654

    PubMed  Google Scholar 

  6. Juniper EF, O′byrne PM, Guyatt G, Ferrie P, King D (1999) Development and validation of a questionnaire to measure asthma control. Eur Respir J 14(4):902–907

    CAS  PubMed  Google Scholar 

  7. Bercovitch RS, Tsai SC (2012) Respiratory medications and sleep. Curr Respir Care Rep 1(2):123–130

    CAS  Google Scholar 

  8. Global Initiative for Asthma. Global strategy for asthma management and prevention (Updated 2016). In. Global Initiative for Asthma; 2016:147

  9. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (updated 2016). 2016

  10. Zipf G, Chiappa M, Porter KS, Ostchega Y, Lewis BG, Dostal J (2013) National health and nutrition examination survey: plan and operations, 1999–2010. Vital and health statistics Ser 1, Programs and collection procedures. (56):1–37

  11. Curtin LR, Mohadjer LK, Dohrmann SM et al (2013) National Health and Nutrition Examination Survey: sample design, 2007-2010. Vital and health statistics series 2, data evaluation and methods research. (160):1–23

  12. Kroenke K, Spitzer RL, Williams JB (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 16(9):606–613

    CAS  PubMed  PubMed Central  Google Scholar 

  13. Unruh ML, Redline S, An MW, Buysse DJ, Nieto FJ, Yeh JL, Newman AB (2008) Subjective and objective sleep quality and aging in the sleep heart health study. J Am Geriatr Soc 56(7):1218–1227

    PubMed  Google Scholar 

  14. Chasens ER, Ratcliffe SJ, Weaver TE (2009) Development of the FOSQ-10: a short version of the functional outcomes of sleep questionnaire. Sleep. 32(7):915–919

    PubMed  PubMed Central  Google Scholar 

  15. Seicean S, Neuhauser D, Strohl K, Redline S (2011) An exploration of differences in sleep characteristics between Mexico-born US immigrants and other Americans to address the Hispanic paradox. Sleep. 34(8):1021–1031

    PubMed  PubMed Central  Google Scholar 

  16. Dement WC, Vaughn C (2009) The promise of sleep: a pioneer in sleep medicine explores the vital connection between health, happiness, and a good night’s sleep, New York (NY): Dell Trade Paperbacks, pp 58–59

  17. Nielsen M, Barnes CB, Ulrik CS (2015) Clinical characteristics of the asthma-COPD overlap syndrome--a systematic review. Int J Chron Obstruct Pulmon Dis 10:1443–1454

    CAS  PubMed  PubMed Central  Google Scholar 

  18. Mindus S, Malinovschi A, Ekerljung L, Forsberg B, Gíslason T, Jõgi R, Franklin KA, Holm M, Johannessen A, Middelveld R, Schlünssen V, Svanes C, Torén K, Lindberg E, Janson C (2018) Asthma and COPD overlap (ACO) is related to a high burden of sleep disturbance and respiratory symptoms: results from the RHINE and Swedish GA2LEN surveys. PLoS One 13(4):e0195055

    PubMed  PubMed Central  Google Scholar 

  19. Klink M, Quan SF (1987) Prevalence of reported sleep disturbances in a general adult population and their relationship to obstructive airways diseases. Chest 91(4):540–546

    CAS  PubMed  Google Scholar 

  20. Plantinga L, Rao MN, Schillinger D (2012) Prevalence of self-reported sleep problems among people with diabetes in the United States, 2005-2008. Prev Chronic Dis 9:E76

    PubMed  PubMed Central  Google Scholar 

  21. Rasche K, Keller T, Tautz B et al (2010) Obstructive sleep apnea and type 2 diabetes. Eur J Med Res 15(Suppl 2):152–156

    PubMed  PubMed Central  Google Scholar 

  22. Ayas NT, White DP, Al-Delaimy WK et al (2003) A prospective study of self-reported sleep duration and incident diabetes in women. Diabetes Care 26(2):380–384

    PubMed  Google Scholar 

  23. Kawakami N, Takatsuka N, Shimizu H (2004) Sleep disturbance and onset of type 2 diabetes. Diabetes Care 27(1):282–283

    CAS  PubMed  Google Scholar 

  24. Nilsson PM, Roost M, Engstrom G, Hedblad B, Berglund G (2004) Incidence of diabetes in middle-aged men is related to sleep disturbances. Diabetes Care 27(10):2464–2469

    PubMed  Google Scholar 

  25. Yaggi HK, Araujo AB, McKinlay JB (2006) Sleep duration as a risk factor for the development of type 2 diabetes. Diabetes Care 29(3):657–661

    PubMed  Google Scholar 

  26. Koren D, Taveras EM (2018) Association of sleep disturbances with obesity, insulin resistance and the metabolic syndrome. Metab Clin Exp 84:67–75

    CAS  PubMed  Google Scholar 

  27. Cukic V, Lovre V, Dragisic D (2011) Sleep disorders in patients with bronchial asthma. Materia Socio-Medica 23(4):235–237

    PubMed  PubMed Central  Google Scholar 

  28. Janson C, Gislason T, Boman G, Hetta J, Roos BE (1990) Sleep disturbances in patients with asthma. Respir Med 84(1):37–42

    CAS  PubMed  Google Scholar 

  29. Petty TL (1988) Circadian variations in chronic asthma and chronic obstructive pulmonary disease. Am J Med 85(1B):21–23

    CAS  PubMed  Google Scholar 

  30. Tirlapur VG (1984) Nocturnal deaths among patients with chronic bronchitis and emphysema. Br Med J (Clin Res Ed) 289(6457):1540

    CAS  Google Scholar 

  31. Stephenson R (2007) Circadian rhythms and sleep-related breathing disorders. Sleep Med 8(6):681–687

    PubMed  Google Scholar 

  32. Ballard RD, Saathoff MC, Patel DK, Kelly PL, Martin RJ (1989) Effect of sleep on nocturnal bronchoconstriction and ventilatory patterns in asthmatics. J Appl Physiol (Bethesda, Md : 1985) 67(1):243–249

    CAS  Google Scholar 

  33. Mohiuddin AA, Martin RJ (1990) Circadian basis of the late asthmatic response. Am Rev Respir Dis 142(5):1153–1157

    CAS  PubMed  Google Scholar 

  34. Barnes P, FitzGerald G, Brown M, Dollery C (1980) Nocturnal asthma and changes in circulating epinephrine, histamine, and cortisol. N Engl J Med 303(5):263–267

    CAS  PubMed  Google Scholar 

  35. Martin RJ, Cicutto LC, Smith HR, Ballard RD, Szefler SJ (1991) Airways inflammation in nocturnal asthma. Am Rev Respir Dis 143(2):351–357

    CAS  PubMed  Google Scholar 

  36. Denjean A, Roux C, Herve P, Bonniot JP, Comoy E, Duroux P, Gaultier C (1988) Mild isocapnic hypoxia enhances the bronchial response to methacholine in asthmatic subjects. Am Rev Respir Dis 138(4):789–793

    CAS  PubMed  Google Scholar 

  37. Chen WY, Chai H (1982) Airway cooling and nocturnal asthma. Chest. 81(6):675–680

    CAS  PubMed  Google Scholar 

  38. Storms WW, Bodman SF, Nathan RA, Byer P (1994) Nocturnal asthma symptoms may be more prevalent than we think. J Asthma 31(4):313–318

    CAS  PubMed  Google Scholar 

  39. Schroder CM, O'Hara R (2005) Depression and obstructive sleep apnea (OSA). Ann General Psychiatry 4:13

    Google Scholar 

  40. Mikkelsen RL, Middelboe T, Pisinger C, Stage KB (2004) Anxiety and depression in patients with chronic obstructive pulmonary disease (COPD). A review. Nord J Psychiatry 58(1):65–70

    PubMed  Google Scholar 

  41. Zielinski TA, Brown ES, Nejtek VA, Khan DA, Moore JJ, Rush AJ (2000) Depression in asthma: prevalence and clinical implications. Prim Care Companion J Clin Psychiatry 2(5):153–158

    PubMed  PubMed Central  Google Scholar 

  42. Stage KB, Middelboe T, Stage TB, Sorensen CH (2006) Depression in COPD--management and quality of life considerations. Int J Chron Obstruct Pulmon Dis 1(3):315–320

    PubMed  PubMed Central  Google Scholar 

  43. McNicholas WT (2016) Chronic obstructive pulmonary disease and obstructive sleep apnoea-the overlap syndrome. J Thorac Dis 8(2):236–242

    PubMed  PubMed Central  Google Scholar 

  44. Salles C, Terse-Ramos R, Souza-Machado A, Cruz AA (2013) Obstructive sleep apnea and asthma. J Bras Pneumol 39(5):604–612

    PubMed  PubMed Central  Google Scholar 

  45. Yigla M, Tov N, Solomonov A, Rubin AH, Harlev D (2003) Difficult-to-control asthma and obstructive sleep apnea. J Asthma 40(8):865–871

    PubMed  Google Scholar 

  46. Schwartz AR, Patil SP, Laffan AM, Polotsky V, Schneider H, Smith PL (2008) Obesity and obstructive sleep apnea: pathogenic mechanisms and therapeutic approaches. Proc Am Thorac Soc 5(2):185–192

    PubMed  PubMed Central  Google Scholar 

  47. Bergeron C, Kimoff J, Hamid Q (2005) Obstructive sleep apnea syndrome and inflammation. J Allergy Clin Immunol 116(6):1393–1396

    PubMed  Google Scholar 

  48. Marrone O, Salvaggio A, Insalaco G (2006) Respiratory disorders during sleep in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 1(4):363–372

    PubMed  PubMed Central  Google Scholar 

  49. Byun MK, Park SC, Chang YS, Kim YS, Kim SK, Kim HJ, Chang J, Ahn CM, Park MS (2013) Associations of moderate to severe asthma with obstructive sleep apnea. Yonsei Med J 54(4):942–948

    PubMed  PubMed Central  Google Scholar 

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Correspondence to Chitra Lal.

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Conflict of interest

Dr. Kumbhare does not have any conflicts of interest. Dr. Lal is a consultant for Jazz pharmaceuticals and Cipla pharmaceuticals. Dr. Charlie Strange has current, past, or pending grants in COPD from the Alpha-1 Foundation, Adverum, BTG, CSL Behring, Grifols, NIH, MatRx, Novartis, Pulmonx, Shire, and Vertex. He consults for AstraZeneca, Boehringer-Ingelheim, CSL Behring, Grifols, and Uptake Medical on COPD.

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This article does not contain any study with human subjects or animals performed by any of the authors.

IRB exemption

This study did not qualify as research on human subjects as determined by the Medical University of South Carolina’s Institutional Review Board (IRB), and hence IRB approval was not needed. Additionally, National Health and Nutrition Examination Survey (NHANES) is a publicly available database.

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Lal, C., Kumbhare, S. & Strange, C. Prevalence of self-reported sleep problems amongst adults with obstructive airway disease in the NHANES cohort in the United States. Sleep Breath 24, 985–993 (2020).

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  • COPD
  • Sleep
  • CDC