Abstract
Background: Asthma is one of the most prevalent chronic diseases of childhood. However, the relationships between asthma severity, sleep disturbances, and self‑esteem in acute care settings remain incompletely understood. This study aimed to evaluate sleep disturbances and self-esteem in children with asthma presenting to a pediatric emergency department, and examine the associations between asthma severity and these outcomes.
Methods: A descriptive cross-sectional study was conducted on 100 children aged 4 to 10 years with a diagnosis of asthma who were admitted to the emergency department of Hazrat Ali-Asghar Teaching Hospital. Asthma severity (mild, moderate, severe) was classified according to standard pediatric asthma guidelines (frequency of symptoms, nighttime awakenings, short‑acting β2‑agonist use, and activity limitation over the previous 4 weeks). Parents completed a demographic questionnaire, the Children’s Sleep Habits Questionnaire (CSHQ), and a validated locally adapted and psychometrically validated children’s self-esteem scale. All measures were parent-reported. Data were analyzed using Shapiro–Wilk tests, Levene’s test, one‑way ANOVA with post‑hoc pairwise comparisons, Welch’s t‑test when variances were unequal, Pearson correlation, and effect sizes.
Results: The mean sleep disturbance score was 12.4 (SD = 3.1) in children with mild asthma, 16.7 (SD = 2.8) in moderate asthma, and 20.5 (SD = 3.4) in severe asthma, differences across groups were statistically significant (F = 94.646, p < 0.001, eta-squared = 0.66). The mean self-esteem score was 28.6 (SD = 3.5) in mild asthma, 25.1 (SD = 3.0) in moderate asthma, and 21.4 (SD = 3.2) in severe asthma, group differences were statistically significant (F = 50.947, p < 0.001, eta-squared = 0.51). Pearson's correlation coefficient between sleep disturbance and self-esteem scores was r = -0.91 (p < 0.001), indicating a strong inverse relationship.
Conclusion: In this cross-sectional sample of children with asthma in a pediatric emergency department, higher asthma severity was strongly associated with more pronounced sleep disturbances and lower parent‑reported self-esteem. Although causality cannot be inferred, the findings highlight the importance of routine screening for sleep problems and psychosocial functioning in pediatric asthma, particularly in acute care settings.

Key words: Sleep disturbances, Self-esteem, Children, Asthma