Sleep Quality in Asthmatic Patients with Obstructive Sleep Apnea Syndrome; A Descriptive Case Series

Sleep Quality in Asthmatic Patients


  • Fatima Waheed Jameel Health Care Center, Lahore, Pakistan
  • Roohi Abass Lahore College for Women University, Lahore, Pakistan
  • Fareeha Arshad College of Nursing, Fatima Memorial Hospital, Lahore, Pakistan
  • Khadija Arbab Ali Ahmad Khan Hospital, Jhang, Pakistan
  • Amna Masood Bakhtawar Amin Medical and Dental College, Multan, Pakistan
  • Eshal Asad Central Park Medical College, Lahore, Pakistan



asthma, obstructive sleep apnea syndrome, sleep quality


Background: Asthma is known as a chronic lung disease that results in airway blockages. Asthma includes the symptoms of dyspnea, wheezing and cough which worsen in the morning and at night and result in the production of excess mucus which results in the reduction of expiratory airflow. Various studies have shown a strong association of asthma being a risk factor for the onset of obstructive sleep apnea. Objective: To assess and evaluate the sleep quality in asthmatic patients with obstructive sleep apnea syndrome. Methods: This is a descriptive case series that was conducted in Gulab Devi Hospital, Sheikh Zayed Hospital and Ghurki Teaching Hospital, Lahore, Pakistan. A non-probability convenient sampling technique was employed. The sample size was calculated by using World Health Organization software. Patients who were diagnosed with asthma and obstructive sleep apnea, both males and females ages between 18 and 55 were recruited in this study. Pittsburgh sleep quality index was employed to assess the patients. Patients were subjectively rated regarding their sleep quality and were inquired about their usual sleeping habits and their scores were recorded using a Likert scale ranging from zero to three. Data was analyzed by using Statistical Package for Social Sciences version 23. The variable of the study was represented in the form of descriptive statistics using graphs, percentages and graphs. Results: The results of this study show us that moderate difficulty of sleep apnea lies between 57.6% and severe difficulty of sleep apnea lies between 42.4%. The results of this study also show us that age affects the global Pittsburgh sleep quality index score. Results show that middle-aged adults reported suffering more from moderate and severe sleeping difficulty due to sleep apnea as compared to young and older adults. Conclusion: This study concludes that patients who have asthma with obstructive sleep apnea have a disturbed sleep cycle, especially in middle age. It concludes that asthmatic patients with obstructive sleep apnea have moderate to severe difficulty in their sleep cycle.


Mukherjee M, Bakakos P, Loukides S. New paradigm in asthma management: Switching between biologics!: Wiley Online Library; 2020. p. 743-5.

Bousquet J, Mantzouranis E, Cruz AA, et al. Uniform definition of asthma severity, control, and exacerbations: document presented for the World Health Organization Consultation on Severe Asthma. Journal of Allergy and Clinical Immunology 2010; 126(5): 926-38.

Narumoto O. Adult bronchial asthma, definition, cause and severity assessment. Nihon rinsho Japanese Journal of Clinical Medicine 2016; 74(10): 1617-21.

Van Den Toorn LM, Overbeek SE, DE Jongste JC, Leman K, Hoogsteden HC, Prins J-B. Airway inflammation is present during clinical remission of atopic asthma. American journal of respiratory and critical care medicine 2001; 164(11): 2107-13.

Yanagisawa S, Ichinose M. Definition and diagnosis of asthma–COPD overlap (ACO). Allergology International 2018; 67(2): 172-8.

Becker K, Mueller JD, Schulmacher C, et al. Histomorphology and grading of regression in gastric carcinoma treated with neoadjuvant chemotherapy. Cancer: Interdisciplinary International Journal of the American Cancer Society 2003; 98(7): 1521-30.

Kong D-L, Qin Z, Shen H, Jin H-Y, Wang W, Wang Z-F. Association of obstructive sleep apnea with asthma: a meta-analysis. Scientific reports 2017; 7(1): 4088. DOI:

Dempsey J, Veasey S, Morgan B. O'Donnell CP pathophysiology of sleep apnea. Physiol Rev 2010; 90: 47-112.

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): 156-64. DOI:10.1001/jama.2014.17822

Ramagopal M, Scharf SM, Roberts DW, Blaisdell CJ. Obstructive sleep apnea and history of asthma in snoring children. Sleep and Breathing 2008; 12: 381-92.DOI:

Razak MRA, Chirakalwasan N. Obstructive sleep apnea and asthma. Asian Pacific Journal of Allergy and Immunology 2016; 34(4). DOI: 10.12932/AP0828

Miyahara LK, Stefanini R, Suguri VM, Wawginiak GH, de Andrade Balsalobre R, Haddad FLM. Evaluation of sleep quality and risk of obstructive sleep apnea in patients referred for aesthetic rhinoplasty. Sleep Science 2019; 12(3): 126. DOI: 10.5935/1984-0063.20190077

Organization WH. The world health report 2006: working together for health: World Health Organization; 2006.

Sarmukaddam S, Garad S. On Validty of Assumptions while Determining Sample Size. Indian journal of community medicine 2004; 29(2): 87.

Zhang C, Zhang H, Zhao M, et al. Reliability, validity, and factor structure of Pittsburgh sleep quality index in community-based centenarians. Frontiers in psychiatry 2020; 11: 573530.

Setyowati A, Chung MH. Validity and reliability of the Indonesian version of the Pittsburgh Sleep Quality Index in adolescents. International Journal of Nursing Practice 2021; 27(5): e12856.

Dixit R. Asthma and obstructive sleep apnea: More than an association! Lung India: Official Organ of Indian Chest Society 2018; 35(3): 191.

Miethe S, Karsonova A, Karaulov A, Renz H. Obesity and asthma. Journal of Allergy and Clinical Immunology 2020; 146(4): 685-93.

Mészáros D, Burgess J, Walters EH, et al. Domestic airborne pollutants and asthma and respiratory symptoms in middle age. Respirology 2014; 19(3): 411-8.

Menzella F. Baseline Characteristics of Patients Enrolled in Clinical Trials of Biologics for Severe Asthma as Potential Predictors of Outcomes. Journal of Clinical Medicine 2023; 12(4): 1546.

Liu D, Kahathuduwa C, Vazsonyi AT. The Pittsburgh Sleep Quality Index (PSQI): Psychometric and clinical risk score applications among college students. Psychological Assessment 2021; 33(9): 816.

Khosravi A, Emamian MH, Hashemi H, Fotouhi A. Components of Pittsburgh Sleep Quality Index in Iranian adult population: an item response theory model. Sleep Medicine: X 2021; 3: 100038.

Bataduwaarachchi V, Hansanie S, Karunathilake R. Breathing pattern disorders: A common presentation with less attention among asthma patients? THE JOURNAL OF THE SRI LAN COLLEGE OF PULMONOLOGISTS: 18.

Zhou Y, Tong L, Li M, et al. Recurrent wheezing and asthma after respiratory syncytial virus bronchiolitis. Frontiers in Pediatrics 2021; 9: 649003.

Wang R, Mihaicuta S, Tiotiu A, Corlateanu A, Ioan IC, Bikov A. Asthma and obstructive sleep apnoea in adults and children–an up-to-date review. Sleep Medicine Reviews 2022; 61: 101564.




How to Cite

Waheed, F., Abass, R., Arshad, F., Arbab, K., Masood, A., & Asad, E. (2023). Sleep Quality in Asthmatic Patients with Obstructive Sleep Apnea Syndrome; A Descriptive Case Series: Sleep Quality in Asthmatic Patients. The Healer Journal of Physiotherapy and Rehabilitation Sciences, 3(9), 833–839.