2026/02/11 by Min Seong Kim, Kyeongeun Kim, Seungjae Byun +6 · 1 voice
Medicine · Psychology · #Asthma and respiratory diseases #Sleep and Work-Related Fatigue #Sleep and related disorders
paper · pdf · doi:10.1111/all.70257
openalex publication_date 2026/02/11 · openalex created_date 2026/02/12 · openalex updated_date 2026/08/01
Allergic diseases such as asthma and allergic rhinitis (AR) are among the most prevalent chronic inflammatory diseases influenced by genetic, environmental, and behavioral factors [1]. Sleep duration may modulate immune function and airway inflammation. However, population-based evidence addressing both insufficient and excessive sleep remains limited. Herein, we aimed to examine the association between sleep duration and the prevalence of asthma and AR. This cross-sectional study utilized data from the Korea National Health and Nutrition Examination Survey (KNHANES), a nationwide health survey conducted annually by the Korea Disease Control and Prevention Agency (KDCA) from 2007 to 2023. Sleep duration was categorized as short (< 7 h), normal (7–9 h), and long sleep duration (> 9 h) according to recommendations by the National Sleep Foundation and similar expert guidelines [2]. Allergic outcomes included self-reported physician diagnoses of asthma and AR. Weighted multivariable logistic regression estimated adjusted odds ratio (aOR) with 95% confidence interval (CI), controlling for socio-demographic, behavioral, and health-related covariates. Additionally, generalized additive models were employed to explore potential dose–response relationships. The research protocol was approved by the Institutional Review Boards of the KDCA. Written informed consent was obtained from all participants before their participation. Please see the detailed methods in the Supporting Information. A total of 83,298 participants (55.9% female) were included in the final analysis (Table S1). Compared with normal sleep, both short sleep (aOR, 1.11 [95% CI, 1.01–1.23]) and long sleep (1.33 [1.07–1.66]) were associated with higher odds of asthma, with the dose–response curve showing elevated risks at both shorter and longer durations (Figure 1 and Figure S1). For AR, a significant association was observed only with short sleepers (1.08 [1.03–1.14]; Figure 1). Stratification analyses indicated more pronounced asthma associations in females (short: 1.11 [0.98–1.26]; long sleepers: 1.32 [1.01–1.73]) and in individuals aged ≥ 60 years (1.28 [1.11–1.48]; 1.27 [0.93–1.74]). In contrast, AR exhibited a reversed age-related pattern, with an association observed in individuals aged ≤ 19 years (1.11 [0.93–1.31]; 1.53 [1.16–2.01]; Figure 2). We found that abnormal sleep duration was significantly associated with asthma, exhibiting a U-shaped pattern at the population level, where short and long sleep had higher odds of asthma. These relationships were most pronounced in females and individuals aged ≥ 60 years. In contrast, short sleep was generally associated with higher odds of AR, and long sleep emerged as the predominant risk factor among individuals aged ≤ 19 years. These findings suggest that the associations between sleep duration and AR were age-specific. Prior studies have primarily focused on short sleep or specific age groups, with far less attention to long sleep duration [3]. Our findings refine existing evidence by illustrating that both curtailed and prolonged sleep are linked to asthma in the general population, consistent with the role of sleep in immune and neuroendocrine regulation. Dysregulated sleep can alter pro-inflammatory cytokine signaling, shift cortisol rhythms, and disrupt circadian control, all of which may heighten airway inflammation [4]. Age-related differences in airway remodeling may partly explain the stronger associations observed in older adults, whereas hormonal modulation, particularly estrogen-related enhancement of Th2 pathways, may contribute to the more pronounced associations among females [5]. For AR, younger individuals may exhibit greater susceptibility to long sleep due to heightened Th2 polarity and allergen sensitization during adolescence, although this pattern did not extend to other sleep categories or older age groups [5]. Additional factors, including metabolic dysregulation and psychological stress, may further interact with abnormal sleep duration to influence allergic disease risk [6]. Despite the nationally representative sample and consistent stratification findings that strengthen the reliability of our results, this study has several limitations. As we used cross-sectional data from the South Korean population, a causal relationship cannot be inferred, and generalizability to global populations may be limited. The reliance on self-reported physician diagnoses of asthma and AR can underestimate or overestimate the actual prevalence of allergic conditions. Sleep duration was self-reported and may not reflect actual patterns. Therefore, future studies using objective measures are warranted. Although AR data were absent from the KNHANES 2010–2012, the 14-year observations likely mitigated this gap. The absence of several important comorbidities may have introduced residual confounding. This nationwide study identified a U-shaped association between sleep duration and allergic diseases, particularly asthma, with similar age-dependent trends observed for AR. Given that sleep duration is a modifiable behavior, incorporating sleep health into allergic disease prevention and management strategies may provide an accessible approach to reducing disease burden. J.K. and D.K.Y. had full access to all of the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis, contributed to the study supervision, and contributed equally as corresponding authors. The corresponding author attests that all listed authors meet the authorship criteria and that no one meeting the criteria has been omitted. M.S.K., K.K., J.K., and D.K.Y. contributed to the study concept and design, acquisition, analysis, or interpretation of data, drafting of the manuscript, and statistical analysis. J.K. and D.K.Y. supervised the study and served as guarantors. M.S.K. and K.K. contributed equally as first authors. All authors approved the final version of the manuscript before submission and contributed to the critical revision of the manuscript for important intellectual content. The authors have nothing to report. This research was supported by the Ministry of Science and ICT (RS-2024-00509257 and IITP-2024-RS-2024-00438239) and the Ministry of Health & Welfare (RS-2025-02220492), Republic of Korea. The funders had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The research protocol was approved by the Institutional Review Boards of the KDCA (2007-02CON-04-P, 2008-04EXP-01-C, 2009-01CON-03-2C, 2010-02CON-21-C, 2011-02CON-06-C, 2012-01EXP-01-2C, 2013-07CON-03-4C, and 2013-12EXP-035C). Written informed consent was obtained from all participants prior to their participation. Furthermore, the KNHANES provides public access to its data, which can be utilized as a valuable resource for diverse epidemiological investigations. The authors declare no conflicts of interest. The data are available upon reasonable request. Study protocol, statistical code: available from DKY (email: [email protected]). Data set: available from the Korea Disease Control and Prevention Agency (KDCA) and the Ministry of Education through a data use agreement. Figure S1: Nonlinear associations of sleep duration with the odds of (A) asthma and (B) allergic rhinitis based on generalized additive models. The solid lines represent the estimated odds ratios, and the shaded areas indicate the 95% confidence intervals. Table S1: General characteristics of Korean regarding sleep duration based on data obtained from the KNHANES, 2007–2023. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.