Controller medication use and sleep problems in pediatric asthma: a longitudinal case-crossover analysis
Michelle M Garrison1, Paula Lozano, Dimitri A Christakis
1Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, WA 98145, USA. michelle.garrison@seattlechildrens.org
Objective:
To determine the effect of asthma controller medication use, choice, and adherence on sleep in children with asthma.
Design:
A case-crossover analysis examining within-subject differences in controller use between time points with and without sleep problems, based on survey data from 3 time points (baseline, 6 months, and 1 year) of a randomized trial.
Setting:
Families were recruited from 2 area practice networks; all assessments were completed by parents online.
Participants:
Children with asthma, aged 2 to 10 years, as identified by asthma-related medical encounters and prescription fills.
Main Exposures:
Parent report of asthma controller medication use (yes/no), type (inhaled corticosteroid or leukotriene inhibitor), and adherence (daily use, nonadherent use, or nonuse).
Main Outcome Measures:
Children's sleep problems, as defined by parent report regarding how often the child had difficulty falling asleep or experienced daytime sleepiness.
Results:
The analysis included 482 children; 82.6% and 75.9% completed the 6-month and 1-year follow-up visits, respectively. Sleep problems were common, with 19.4% of parents at baseline reporting frequent problems with the child falling asleep and 12.1% reporting frequent daytime sleepiness. Compared with children who did not use a controller medication, children had a decreased risk of problems falling asleep during periods with daily controller use (odds ratio [OR], 0.34; 95% confidence interval [CI], 0.13-0.92), with a trend toward an effect in those with nonadherent use (0.47; 0.20-1.12). Any controller use, regardless of adherence, was also associated with decreased odds of daytime sleepiness (OR, 0.69; 95% CI, 0.51-0.94). When controller class was examined, leukotriene inhibitors were associated with significantly decreased odds of problems falling asleep (OR, 0.18; 95% CI, 0.04-0.78), with or without concomitant use of inhaled corticosteroids, but the results for use of inhaled corticosteroids alone were not statistically significant (0.69; 0.32-1.53).
Conclusions:
Controller medications appear to be effective in reducing sleep problems in children with asthma, and leukotriene inhibitor medications may be especially effective in this population.
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