Multi-dimensional analyses of the associations between depression, nocturnal awakening and asthmatic outcomes

Approximately 1 % to 18 % of individuals suffer from asthma burdened with huge economic and mental issues around the world (Global Initiative for Asthma, 2020). National health interview survey reported that 44.7 % of asthmatics experienced acute episodes/attacks in the previous year, and 9.9 % of individuals with asthma had emergency room (ER) visits (Mazurek and Syamlal, 2018). Nocturnal awakening secondary to asthma is a crucial component of asthma control level (Global Initiative for Asthma, 2020). The emergence of nocturnal awakening not only is an important sign of asthmatic deterioration, but also indicates a need for possible adjustment or improvement in treatment (Global Initiative for Asthma, 2020). A large population- based longitudinal study found that frequent nocturnal awakening can be used to predict the development of depressive symptoms (Sivertsen et al., 2021). In addition, poor asthma control and the deterioration of asthmatic outcomes potentially decrease the quality of life and increase mental burden such as depression and anxiety.

The increasing evidence shows that depression plays a vital role in the occurrence and development of asthma. GINA 2020 clearly points out that depression is an independent risk factor for developing asthma and has a negative effect on asthmatic management and clinical outcomes such as acute exacerbation and death (Global Initiative for Asthma, 2020). A study from Patel and the colleagues suggested that depression seemingly increases the risk of sleep disturbances (prevalence ratio = 2.75, 95 %CI: 1.54–4.92) and activity limitation (prevalence ratio = 1.77, 95%CI: 1.00–3.18) secondary to asthma in asthmatics aged ≥55 years old (Patel et al., 2017). Another study found that depressive symptoms are associated with the significant reduction of sleep duration in teenagers with asthma (Johnson et al., 2018). However, two previous studies had some limitations, such as relatively small sample size (Johnson et al., 2018) or special study population (older adults aged ≥55 year) (Patel et al., 2017), that potentially limited their capability to determine the association between depression and nocturnal awakening in asthmatics.

The increased frequency of nocturnal awakening can be hypothesized to increase the risk of depression. Depression may affect sleep disturbances. The interactions between nocturnal awakening and depression may result in the increased risk of asthmatic clinical outcomes through direct and indirect effects. By using data from the Adult Asthma Call-Back Survey (ACBS) during 2013 to 2017, this study aims to provide new evidence to test the hypotheses about the associations among depression, nocturnal awakening and asthmatic outcomes.

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