Insomnia: a possible treatable trait in Severe Asthma?

<bold>Background:</bold> Impaired sleep quality is frequent in asthmatic patients, particularly with severe asthma. Studies suggest a bidirectional complex relationship between the two, with a potential influence of insomnia in asthma control. <bold>Aims:</bold> To determine the prevalence of insomnia in patients with severe asthma and its impact in disease control. <bold>Methods:</bold> Cross-sectional study of adults with severe asthma recruited from a pulmonology clinic over a 6-month period. Participants completed the Asthma Control Test (ACT), Mini Asthma Quality of Life Questionnaire (mAQLQ), Control of Allergic Rhinitis and Asthma Test (CARAT), GINA assessment of asthma symptom control (GINA) and Sino-Nasal Outcome Test-22 (SNOT-22) to evaluate asthma control and asthma-related comorbidities. Insomnia severity was assessed using the Insomnia Severity Index (ISI). <bold>Results:</bold> Of the 68 patients included, 55 (81%) were female, with a mean age of 57 years. Based on the GINA score, 25 patients (37%) had partly controlled asthma and 27 (40%) had uncontrolled disease. Insomnia was identified in 48 patients (71%), including 31 cases (46%) of sub-threshold insomnia and 17 cases (25%) of clinical insomnia (moderate n=13; severe n=4). 17 patients (25%) were taking hypnotic medication, of which 65% maintained some degree of insomnia (sub-threshold n=6, moderate n=5). Higher ISI scores were associated with lower ACT (β=-0.50, p=0.002), mAQLQ (β=-1.77, p=0.001) and CARAT (β=-0.39, p<0.001) scores, as well as higher GINA (β=1.15, p=0.018) and SNOT-22 (β=0.14, p<0.001) scores. <bold>Conclusion:</bold> Insomnia was frequent in patients with severe asthma and was associated with uncontrolled disease. Increasing sleep quality may be an important domain for clinical intervention in severe asthma.