Too little sleep, and occasionally too much sleep, can negatively impact adults with asthma. This is according to a new article in Annals of Allergy, Asthma and Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology (ACAAI).

“Previous research revealed that poor sleep quality has a negative effect on asthma symptoms in adolescents,” says Faith Luyster, PhD, lead author of the study, in a release. “Our study shows that adults with asthma are equally affected by too little (or sometimes too much) sleep. Compared to normal sleepers, short and long sleepers had a higher proportion of people who reported having an asthma attack in the past year (45% versus 59% and 51%, respectively) and had more days with impaired health-related quality of life. Impaired quality of life was characterized by more days of poor physical and mental health.

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The study surveyed 1,389 adults who were 20 years and older who self-identified as having asthma. Of the group, 25.9% slept 5 hours or less, 65.9% slept 6-8 hours, and 8.2% slept 9 or more hours. Sleep duration was measured by a single question, “How much sleep do you usually get at night on weekdays or workdays?” “Short sleepers” were more likely to be younger and non-White, while “long sleepers” were more likely to be older, female, and a smoker.

Short sleepers, as compared to normal sleepers, had a greater likelihood of an asthma attack, dry cough, and an overnight hospitalization during the past year. Short sleepers also had significantly worse health related quality of life—including days of poor physical and mental health and inactive days due to poor health—and more frequent general healthcare use during the past year as compared to normal sleepers. The odds for long sleepers to have some activity limitation due to wheezing was higher when compared to normal sleepers. No significant differences in other patient-reported outcomes and healthcare use were observed between the long and normal sleepers.

“Disturbed sleep in an asthma patient can be a red flag indicating their asthma isn’t well-controlled,” says allergist Gailen D. Marshall, MD, PhD, ACAAI member and editor-in-chief of Annals, in a release. “This study adds solid evidence to the practice of asthma patients discussing sleep issues with their allergist to help determine if they need to change their asthma plan to achieve adequate sleep as a component of overall good asthma management. It also warns that consequences can be expected when sleep patterns are chronically inadequate.”