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Meta-Analysis
. 2023 Sep;10(1):e001661.
doi: 10.1136/bmjresp-2023-001661.

Association of sleep disorders with asthma: a meta-analysis

Xueqian Liu #  1 , Cheng Hong #  2 , Zhiyu Liu  3 , Lihua Fan  2 , Moqing Yin  2 , Yunhu Chen  2 , Xiang Ren  4 , Xuefang Gu  5
Affiliations
Meta-Analysis

Association of sleep disorders with asthma: a meta-analysis

Xueqian Liu et al. BMJ Open Respir Res. 2023 Sep.

Abstract

Background: Animal experiments and clinical trials have revealed a potential relationship between sleep disorders and asthma. However, the associations between these factors remain unclear.

Material and methods: We searched PubMed, Embase, Web of Science and Cochrane Library databases for eligible studies published before 30 December 2022. Studies investigating the association between sleep disorders (insomnia, poor sleep quality and insufficient sleep time) and asthma were selected. Sleep disorders were assessed using questionnaires, interviews, or medical records. Asthma was diagnosed based on medical history and drug use. The Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality checklist were employed for quality assessment. We used OR with 95% CI as the effect measures and forest plots to display the results. Heterogeneity was evaluated using I2 statistics and subgroup analyses were performed for bias analysis. Publication bias was evaluated using the funnel plots and Egger's test.

Results: Twenty-three studies were included in the primary analysis, which suggested a positive association between sleep disorders and asthma (OR: 1.38, 95% CI 1.10 to 1.74). Subgroup analyses were conducted according to the study design, age, family history of asthma and type of sleep disorders. We did not find any association between sleep disorders and asthma in children aged ˂12 years (OR: 1.13, 95% CI 0.97 to 1.32). The association was insignificant in studies where the family history of asthma was adjusted for (OR: 1.16, 95% CI 0.94 to 1.42). Funnel plot and Egger's test indicated a significant publication bias.

Conclusion: Sleep disorders are associated with an increased prevalence and incidence of asthma. However, the quality of the evidence was low because of potential biases.

Prospero registration number: CRD42023391989.

Keywords: Asthma.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement flow chart of study selection.
Figure 2
Figure 2
Forest plot of the association between insomnia and asthma.
Figure 3
Figure 3
Forest plot of the association between insomnia and asthma in adults (>18 years), adolescent (12–18 years) and children (˂12 years).
Figure 4
Figure 4
Forest plot of the association between insomnia and asthma in studies where family history of asthma was adjusted and not adjusted.
Figure 5
Figure 5
Funnel plot for publication bias assessment.
See this image and copyright information in PMC

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