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Published on: December 6, 2016
Obstructive sleep apnea in poorly controlled asthmatic children: effect of adenotonsillectomy
Leila Kheirandish-Gozal1, Ehab A Dayyat, Nemr S Eid
1Sections of Pediatric Pulmonology and Pediatric Sleep Medicine, Department of Pediatrics, University of Chicago, Chicago, Illinois 60637-1470, USA. lgozal@peds.bsd.uchicago.edu
Insights
Obstructive sleep apnea (OSA) is common in poorly controlled asthmatic children. Treating OSA significantly reduces asthma exacerbations and symptoms, improving overall asthma severity.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Pediatric Allergy
Background:
- Asthma and obstructive sleep apnea (OSA) share risk factors in children.
- Increased snoring in asthmatic children suggests a higher risk for OSA.
- Both conditions are inflammatory, prompting investigation into their relationship.
Purpose of the Study:
- To determine the prevalence of OSA in poorly controlled asthmatic children (PCA).
- To investigate if treating OSA improves asthma control and reduces exacerbations.
Main Methods:
- Children with PCA underwent overnight polysomnography (sleep studies).
- Adenotonsillectomy (T&A) was performed for diagnosed OSA.
- Asthma symptom and exacerbation frequencies were compared pre- and post-treatment.
Main Results:
- OSA was present in 63% of 92 PCA children studied (OR: 40.9).
- In a subgroup of 35 children treated with T&A, there was a significant decrease in acute asthma exacerbations (AAE) and symptoms after one year.
- Children without OSA showed no change in asthma parameters.
Conclusions:
- The prevalence of OSA is significantly elevated in children with poorly controlled asthma.
- Treatment of OSA, via T&A, appears to substantially improve asthma control and reduce exacerbations.
Background:
Asthma and obstructive sleep apnea (OSA) in children share multiple epidemiological risk factors and the prevalence of snoring is higher in asthmatic children, suggesting that the latter may be at increased risk for OSA. Since both asthma and OSA are inflammatory disorders, we hypothesized that polysomnographically demonstrated OSA would be more frequent among poorly controlled asthmatics (PCA), and that treatment of OSA, if present, would ameliorate the frequency of acute asthmatic exacerbations (AAE).
Methods:
Children with PCA were referred for an overnight sleep study, and adenotonsillectomy (tonsillectomy and adenoidectomy, T&A) was performed if OSA was present. Frequency of asthma symptoms and exacerbations were compared.
Results:
Ninety-two PCA children, ages 3-10 years, with a mean frequency of AAE of 3.4 ± 0.4/year were prospectively referred for a sleep study. OSA (i.e., AHI > 5/hrTST) was present in 58 patients (63.0%; OR: 40.9, 12.9-144.1, P < 0.000001 compared to the prevalence of OSA in a non-asthmatic population). Information at 1-year follow-up was available for 35 PCA children after T&A. The annual frequency of AAE, rescue inhaled use, and asthma symptoms in this sub-group decreased compared to no changes in the group without OSA.
Conclusions:
The prevalence of OSA is markedly increased among PCA children and treatment of OSA appears to be associated with substantial improvements in the severity of the underlying asthmatic condition.
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