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Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Associations between sleep, obesity, and asthma in urban minority children
Laura A Conrad1, Kiran Nandalike2, Seema Rani3
1Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York.
Insights
Obesity and lung function independently impact sleep quality and breathing in children with asthma. Asthma medications may improve sleep and breathing, with effects differing by weight status.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Obesity Research
Background:
- Asthma, obesity, and sleep-disordered breathing are interconnected in children.
- Limited understanding exists regarding the distinct roles of body-mass index and pulmonary function in pediatric asthma patients undergoing polysomnography.
Purpose of the Study:
- To investigate the associations between spirometry measures, body-mass index (BMI), and polysomnography (PSG) parameters in children with asthma.
- To differentiate these associations based on weight status (obese vs. healthy-weight).
Main Methods:
- Retrospective chart review of 448 children (7–18 years) with asthma who underwent PSG.
- Analysis adjusted for asthma severity and antiallergic medications.
- Spirometry variables, BMI, and PSG parameters were examined.
Main Results:
- Obese children exhibited poorer sleep architecture and more severe gas exchange abnormalities.
- BMI independently correlated with sleep efficiency and sleep stages, and with oxygen saturation in obese children.
- Pulmonary function (e.g., forced vital capacity, forced expiratory volume) showed independent associations with sleep depth and oxygen levels, varying by weight status.
Conclusions:
- Body-mass index, pulmonary function, and asthma medications exert independent and varied effects on sleep and gas exchange in children with asthma.
- Asthma medications demonstrated benefits for gas exchange in obese children and sleep architecture in healthy-weight children.
Study Objectives:
Although obesity, asthma, and sleep-disordered breathing are interrelated, there is limited understanding of the independent contributions of body-mass index and pulmonary function on polysomnography in children with asthma.
Methods:
We conducted a retrospective chart review on 448 7- to 18-year-old children with asthma who had undergone polysomnography testing between 1/2007-12/2011 to elucidate the association between spirometry variables, body-mass index, and polysomnography parameters, adjusting for asthma and antiallergic medications.
Results:
Obese children had poorer sleep architecture and more severe gas exchange abnormalities compared to healthy weight children. Multivariate analysis revealed an independent association of body-mass index with sleep efficiency, with more light and less deep sleep in both obese and healthy-weight children, and with baseline oxygen saturation and oxygen nadir in obese children. In obese children, forced vital capacity was independently associated with less deep sleep (time in N3 sleep) as well as with oxygen nadir, while among healthy-weight children, forced expiratory volume directly correlated but forced vital capacity inversely correlated with deep sleep. In obese children, inhaled corticosteroid was associated with baseline oxygen saturation, and montelukast was associated with lower end-tidal carbon dioxide. In healthy-weight children, inhaled corticosteroid was associated with arousal awakening index, and montelukast was associated with light sleep. Antiallergic medications were not independently associated with polysomnography parameters.
Conclusions:
Pulmonary function, body-mass index, and asthma medications have independent and differing influences on sleep architecture and gas exchange polysomnography parameters in obese and healthy-weight children with asthma. Asthma medications are associated with improved gas exchange in obese children and improved sleep architecture in healthy-weight children with asthma.
Citation:
Conrad LA, Nandalike K, Rani S, Rastogi D. Associations between sleep, obesity, and asthma in urban minority children. J Clin Sleep Med. 2022;18(10):2377-2385.
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