Prevalence of self-reported sleep problems amongst adults with obstructive airway disease in the NHANES cohort in the United States

  • Chitra LalEmail author
  • Suchit Kumbhare
  • Charlie Strange
Sleep Breathing Physiology and Disorders • Original Article



Sleep and respiratory problems are common in adults in the USA. However, sleep problems often remain undiagnosed in patients with obstructive airway diseases (OADs). This study was designed to examine the association between sleep problems and different categories of OAD amongst US adults.


We conducted an observational, cross-sectional study using a nationally representative sample of the US civilian non-institutionalized population from 2007 to 2008 National Health and Nutritional Examination Survey (NHANES). A total of 3204 study participants aged ≥35 years were stratified into four groups, using a self-reported history of asthma and data from spirometry: asthma-COPD overlap (ACO) (n = 70, 2.2%), asthma (n = 168, 5.2%), chronic obstructive pulmonary disease (COPD) (n = 412, 12.8%), and those without any OAD (normal) (n = 2554, 79.7%). After characterizing the baseline demographics and health status of the four groups, multivariate logistic regression analysis was performed to estimate the likelihood of sleep problems in adults after adjusting for age, gender, body mass index, smoking, alcohol, obstructive sleep apnea syndrome (OSAS), depression, and diabetes. The index sample was the normal group. Sleep problems were defined as any complaints which affect or involve sleep.


The participants with COPD were older (62.0 ± 11.7 years) as compared to ACO (59.1 ± 11.3 years), asthma (53.6 ± 11.3), and normal groups (53.8 ± 12.1) (p < 0.0001). Comparing baseline characteristics between the four groups, there were significant associations between OAD status and sleep problems including inadequate sleep, sleep-onset insomnia, snoring, frequent trouble sleeping, nocturnal arousals, early morning awakenings, fatigue, daytime sleepiness, use of prescription medication for sleep, leg jerks, leg cramps, difficulty in concentration, and difficulty in remembering things when tired. The multivariate logistic regression models evaluating the prevalence of sleep problems in individual OADs showed a stronger association between asthma and sleep problems as compared to COPD and ACO and sleep disorders.


All OADs are associated with a higher prevalence of sleep problems. There is a stronger association between asthma and sleep problems as compared to COPD and ACO. We speculate that the nocturnal burden of asthma contributes to sleep problems. Our results suggest that adults with OAD should be aggressively screened for sleep problems.





Obstructive airway disease


Chronic obstructive pulmonary disease


National Health and Nutritional Examination Survey


Global Initiative for Chronic Obstructive Lung Disease


Global Initiative for Asthma


Body mass index


Odds ratio


Confidence interval


Center for Disease Control and Prevention


Funding information

This study received no funding.

Compliance with ethical standards

Conflict of interest

Dr. Kumbhare does not have any conflicts of interest. Dr. Lal is a consultant for Jazz pharmaceuticals and Cipla pharmaceuticals. Dr. Charlie Strange has current, past, or pending grants in COPD from the Alpha-1 Foundation, Adverum, BTG, CSL Behring, Grifols, NIH, MatRx, Novartis, Pulmonx, Shire, and Vertex. He consults for AstraZeneca, Boehringer-Ingelheim, CSL Behring, Grifols, and Uptake Medical on COPD.

Ethical approval

This article does not contain any study with human subjects or animals performed by any of the authors.

IRB exemption

This study did not qualify as research on human subjects as determined by the Medical University of South Carolina’s Institutional Review Board (IRB), and hence IRB approval was not needed. Additionally, National Health and Nutrition Examination Survey (NHANES) is a publicly available database.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of MedicineMedical University of South CarolinaCharlestonUSA

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