title: Are sleep disorders associated with increased mortality in asthma patients?
abstract: South Korea has experienced problems regarding poor management of symptoms of asthma patients and remarkable increases in sleep disorders. However, few studies have investigated these issues. We examined the relationship between sleep disorders and mortality in asthma patients to suggest effective alternatives from a novel perspective.
  
  
  
  We used data from the National Health Insurance Service (NHIS) National Sample Cohort 2004-2013, which included medical claims filed for 186,491 patients who were newly diagnosed with asthma during the study period. We performed survival analyses using a Cox proportional hazards model with time-dependent covariates to examine the relationship between sleep disorders and mortality in asthma patients.
  
  
  
  There were 5179 (2.78%) patients who died during the study period. Sleep disorders in patients previously diagnosed with asthma were associated with a higher risk of mortality (hazard ratio [HR]: 1.451, 95% confidence interval [CI]: 1.253-1.681). In addition, significant interaction was found between sleep disorders and Charlson comorbidity index.
  
  
  
  Our findings suggest that an increased prevalence of sleep disorders in asthma patients increases the risk of mortality. Considering the worsening status of asthma management and the rapid growth of sleep disorders in South Korea, clinicians and health policymakers should work to develop interventions to address these issues.
authors.affiliation: Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.|Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Kyu-Tae
authors.initials: KT
authors.lastname: Han
authors.affiliation: Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.|Office of Communication, Korea Centers for Disease Control and Prevention, Cheongju, Republic of Korea.
authors.forename: Hong-Chul
authors.initials: HC
authors.lastname: Bae
authors.affiliation: Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea.|Department of Hospital Management, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea.
authors.forename: Sang Gyu
authors.initials: SG
authors.lastname: Lee
authors.affiliation: Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.|Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Seung Ju
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.|Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Woorim
authors.initials: W
authors.lastname: Kim
authors.affiliation: Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.|Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Hyo Jung
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.|Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Yeong Jun
authors.initials: YJ
authors.lastname: Ju
authors.affiliation: Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea. ecpark@yuhs.ac.|Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea. ecpark@yuhs.ac.|Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea. ecpark@yuhs.ac.
authors.forename: Eun-Cheol
authors.initials: EC
authors.lastname: Park
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D001249:Asthma / Q000401:mortality*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D056910:Republic of Korea; D012307:Risk Factors; D017678:Sex Distribution; D012893:Sleep Wake Disorders / Q000150:complications* / Q000453:epidemiology*; D016019:Survival Analysis; D013997:Time Factors; D055815:Young Adult
keywords: Asthma; Healthcare accessibility; Mortality; Sleep disorders; Vulnerable population