Peggy Peck

October 26, 2004

Oct. 26, 2004 (Seattle) — Results of the first large study examining sleep quality in patients with asthma found that almost half of asthma patients reported insomnia and increased daytime sleepiness, said lead investigator John G. Mastronarde, MD, associate professor at Ohio State University School of Medicine in Columbus.

The results were presented at CHEST 2004, the 70th annual meeting of the American College of Chest Physicians.

"The findings suggest that physicians treating asthma patients should inquire about sleep," Dr. Mastronarde told Medscape. "It is possible that better management of asthma could improve sleep, but if that fails the physician should address the sleep disturbances with appropriate therapy." Such therapy, he said, would include training about sleep hygiene, such as establishing a regular wake-up time, avoiding late-night eating, and confining the use of the bed to sleep.

The study was a prespecified subset analysis of a multicenter, randomized controlled trial of patients with mild to moderate asthma comparing treatment with low-dose theophylline to montelukast or placebo. "The results of that study, which was funded by the American Lung Association, were reported last year. The study found no difference in outcome between the treatments," Dr. Mastronarde said. "And in our study there was no difference in sleep quality among the treatment arms."

Dr. Mastronarde reported on data from 487 patients who had completed sleep symptom questionnaires at randomization and at six months after randomization. The questionnaires used were the Pittsburgh Sleep Quality Questionnaire (PSQI) and the Epworth Sleep Scale (ESS).

The mean age of patients was 40 years, and 74% were women. The average baseline FEV 1 was 79% of predicted, and the average Juniper Asthma Control Questionnaire score was 2.35.

Insomnia was reported by 45% of participants, "meaning that they reported difficulty sleeping more than three times a week," Dr. Mastronarde said. Moreover, 9.2% of the patients had ESS scores of more than 10 and reported snoring more than three times a week, "which are symptoms that suggest sleep apnea."

Nancy Collop, MD, an associate professor of medicine at Johns Hopkins University in Baltimore, Maryland, told Medscape, "It is most interesting to have data that confirm how prevalent insomnia is in patients with asthma and how this is really a public health concern because there are risks associated with daytime sleepiness — accidents, for example." Dr. Collop, who was not involved in the study, said the first therapeutic approach should be "asthma control. I really think that improved asthma control could help a number of these problems."

If improving asthma control does not improve sleep, Dr. Collop suggested referring patients to sleep specialists for "a program of cognitive behavioral therapy, which should be tried before any pharmacotherapy."

CHEST 2004: Abstract 540. Presented Oct. 25, 2004.

Reviewed by Gary D. Vogin, MD

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