Breathing through the night: A meta-analysis of childhood asthma and obstructive sleep apnea in sleep-disordered contexts.

Background

The study was to systematically evaluate the correlation between childhood asthma and obstructive sleep apnea (OSA).

Methods

Several medical literature data bases were searched for studies published up to March 2025, by using the keywords "asthma" and "obstructive sleep apnea" and "child*." We included observational studies, children with OSA diagnosed via polysomnography, clinical criteria, or validated tools; and asthma confirmed by physician diagnosis, medication use, or validated questionnaires and international code.

Results

Eleven studies were included that covered populations in the United States, Europe, and Asia. The pooled odds ratio (OR) for the association between childhood asthma and OSA was 1.66 (95% confidence interval [CI], 1.21-2.26; p < 0.001). Subgroup analysis by study design showed significant associations in cohort (OR 2.00 [95% CI, 1.35-2.96]) and cross-sectional (OR 1.55 [95% CI, 0.69-3.44]) but not in case-control studies (OR 0.85 [95% CI, 0.32-2.28]). Geographically, the association was strongest in America (OR 1.99 [95% CI, 1.35-2.96]) and Asia (OR 1.64 [95% CI, 1.19-2.25]), with a nonsignificant trend in Europe (OR 0.91 [95% CI, 0.34-2.42]). Sensitivity analyses directionally consistent with the results, and Egger's test (p = .587) indicated no significant publication bias.

Conclusion

Childhood asthma is significantly associated with an increased risk of OSA, with sleep disorders likely exacerbating this relationship. Integrated screening and management strategies are warranted, particularly in high-risk regions such as America and Asia.