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Is insomnia a risk factor for new-onset asthma? A population-based study in Taiwan
  1. Yu-Chieh Lin1,
  2. Chih-Cheng Lai2,
  3. Chih-Chiang Chien3,
  4. Chin-Ming Chen4,5,
  5. Shyh-Ren Chiang3,5,
  6. Chung-Han Ho6,7,
  7. Shih-Feng Weng8,
  8. Kuo-Chen Cheng3,9
  1. 1 Department of Family Medicine, Jiannren Hospital, Kaohsiung, Taiwan
  2. 2 Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Taiwan
  3. 3 Department of Internal Medicine, Chi Mei Medical Center, Yung Kang, Tainan, Taiwan
  4. 4 Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan
  5. 5 Department of Recreation and Healthcare Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
  6. 6 Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
  7. 7 Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
  8. 8 Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
  9. 9 Department of Safety, Health, and Environmental Engineering, Chung Hwa University of Medical Technology, Tainan, Taiwan
  1. Correspondence to Dr Kuo-Chen Cheng; kcg.cheng{at}


Objectives To determine whether insomnia at baseline is a risk factor for new-onset asthma.

Methods We recruited 48 871 patients with insomnia (insomnia group) newly diagnosed between 2002 and 2007, and 97 742 matched controls without insomnia (control group) from Taiwan’s Longitudinal Health Insurance Database 2000. All of the patients were followed up for 4 years to see whether new-onset asthma developed. Patients with previous asthma or insomnia were excluded. The Poisson regression was used to estimate the incidence rate ratios (IRRs) and 95% CIs of asthma. Cox proportional hazard regression was used to calculate the risk of asthma between the two groups.

Results After a 4-year follow-up, 424 patients in the insomnia group and 409 in the control group developed asthma. The incidence rate of asthma was significantly higher in the insomnia group (22.01vs10.57 per 10 000 person-years). Patients with insomnia have a higher risk of developing new-onset asthma during the 4-year follow-up (HR: 2.08, 95% CI 1.82 to 2.39). The difference remained significant after adjustment (adjusted HR: 1.89, 95% CI 1.64 to 2.17).

Conclusions This large population-based study suggests that insomnia at baseline is a risk factor for developing asthma.

  • insomnia
  • asthma
  • comorbid
  • medical disorders
  • risk

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • Y-CL and C-CL contributed equally.

  • Contributors Y-CL, C-CL and K-CC designed the study, interpreted the data and drafted and revised the article. C-CC, C-MC and S-RC contributed to interpreting the data and revising the article. C-HH and S-FW contributed to the statistical analysis. K-CC critically reviewed and revised the article. All of the authors read and agreed with the final version of the manuscript.

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval Institutional review board of Chi Mei Medical Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data on the study population that were obtained from the NHIRD ( are maintained in the NHRI ( The NHIRD is limited for research purposes only. Applicants must follow the Computer-Processed Personal Data Protection Law ( and related regulations of National Health Insurance Administration. All applications are reviewed for approval of data release. Interested researchers may submit queries related to data access to