02/19/2026
New research from Riley Children’s Health and Indiana University School of Medicine suggests that sleep quality may hold the key to predicting severe asthma attacks in children.
A recent study led by researchers at Riley Children’s Health and Indiana University School of Medicine provides new evidence that sleep disturbances are independently associated with an increased risk of severe asthma exacerbations in children. The findings, published in Pediatric Allergy and Immunology, suggest that sleep quality may serve as a clinically meaningful marker for identifying pediatric patients at elevated risk for future asthma exacerbations.
The research team conducted an analysis of children with moderate to severe asthma, evaluating readily available electronic health record and sleep study data to create an algorithm to predict a child’s risk of severe asthma attacks. Objective and subjective sleep measures, including sleep fragmentation, difficulty initiating or maintaining sleep, and symptoms suggestive of sleep-disordered breathing were assessed in relation to subsequent exacerbation risk.
Key findings indicate poor sleep quality was significantly associated with higher rates of severe asthma exacerbations, independent of baseline asthma severity and other known risk factors. Male patients with asthma who slept poorly demonstrated the highest vulnerability for severe asthma attacks, indicating a potential interaction between sex, disease phenotype, and sleep physiology. Additionally, treatment of coexisting sleep disorders correlated with reduced exacerbation frequency, highlighting opportunities to study the role sleep-focused interventions may have in comprehensive asthma management.
These results reinforce the importance of evaluating sleep as part of routine asthma care, particularly for children with persistent symptoms or prior exacerbations.
Clinical implications
Nighttime symptoms are a well-recognized component of asthma complications, yet sleep quality itself is not consistently assessed in clinical practice. The study’s findings indicate that sleep disturbances may provide early warning of deteriorating disease control.
According to study co-author Anuja Bandyopadhyay, MD, “Difficulty falling asleep, staying asleep or snoring can be signs of other sleep disorders, while nighttime coughing can suggest suboptimal asthma control. This relationship between sleep and asthma may be bidirectional. While poor sleep is known to be associated with increased inflammation, poor asthma control may also alter sleep patterns. Thus sleep monitoring may be a critical step in identification of children at risk for asthma exacerbation which can lead to early targeted intervention and reduce disease morbidity.”
Structured sleep assessments can help clinicians identify high‑risk patients earlier, guide risk stratification, and support individualized treatment planning across pediatric specialties.
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