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Asthma and sleep disordered breathing in the pediatric adenotonsillectomy trial for snoring study
Po-Yang Tsou1, Seyni Gueye-Ndiaye2, Krysta Lynn Gorman3
1Division of Pulmonary Medicine, Boston Children's Hospital, Boston, MA, USA.
Insights
In children with mild sleep-disordered breathing (SDB), moderate-to-severe asthma is linked to worse quality of life and increased SDB symptoms. Co-management strategies are recommended for these interconnected conditions.
Area of Science:
- Pediatric pulmonology
- Sleep medicine
- Allergy and immunology
Background:
- Asthma is frequently observed in children with sleep-disordered breathing (SDB).
- The precise relationship between asthma and SDB-related outcomes in children requires further elucidation.
- The Pediatric Adenotonsillectomy for Snoring (PATS) study provides a cohort for investigating these associations.
Purpose of the Study:
- To identify risk factors for asthma in children diagnosed with mild SDB (mSDB).
- To evaluate the association between asthma and the severity of various sleep-related outcomes.
- To compare outcomes between children with mild asthma and those with moderate-to-severe asthma within the mSDB cohort.
Main Methods:
- Cross-sectional analysis of 425 children aged 3-12.9 years with mSDB.
- Assessment of sleep-related outcomes including SDB symptoms (PSQ-SRBD), quality of life (OSA-18), sleepiness, and polysomnographic/actigraphic measures.
- Asthma defined by caregiver report or a Composite Asthma Severity Index (CASI) score ≥ 4, categorized as mild (CASI < 4) or moderate-to-severe (CASI ≥ 4).
Main Results:
- Asthma prevalence was 19.1% (12.0% mild, 7.1% moderate-to-severe).
- Environmental tobacco smoke exposure and atopy markers were associated with asthma.
- Moderate-to-severe asthma correlated with increased SDB symptoms (PSQ-SRBD), reduced quality of life (OSA-18), and a higher arousal index.
Conclusions:
- Moderate-to-severe asthma significantly worsens quality of life and exacerbates SDB symptoms in children with mSDB.
- The shared risk factors and overlapping symptomatology highlight the interconnectedness of asthma and mSDB.
- Coordinated prevention and management strategies are crucial for addressing both conditions concurrently.
Purpose:
Although asthma is common in children with sleep-disordered breathing (SDB), it is unclear whether and to what extent asthma is associated with SDB-related outcomes. Our objectives are to describe risk factors for asthma among children with mild SDB (mSDB) and assess the association between asthma and the severity of sleep-related outcomes.
Methods:
Cross-sectional analyses were conducted for children aged 3-12.9 years with mSDB enrolled in Pediatric Adenotonsillectomy for Snoring Children Study. Sleep-related outcomes included SDB symptoms (Pediatric Sleep Questionnaire-Sleep-Related Breathing Disorder scale (PSQ-SRBD)), SDB-specific quality of life (OSA-18), sleepiness (modified Epworth Sleepiness Score) and polysomnographic and actigraphic measures. Asthma was defined by caregiver-reported diagnosis with current asthma symptoms and medication use, or a Composite Asthma Severity Index (CASI) score ≥ 4. Asthma was further categorized into mild (CASI < 4) and moderate-to-severe (CASI ≥ 4). Regression analyses were conducted to identify asthma risk factors and estimate the associations between mild and moderate-to-severe asthma with sleep-related outcomes.
Results:
The sample included 425 children (20.3%-Black, 17.4%-Hispanic; 51.7%-female). The prevalence of asthma was 19.1% (7.1% moderate-to-severe, 12.0% mild). Environmental tobacco smoke exposure and markers of atopy were associated with asthma in multivariable-adjusted analyses. Moderate-to-severe asthma was associated with increased OSA symptoms measured by PSQ-SRBD (adjusted effect estimate for moderate-to-severe vs. no asthma ( adj; 95%CI): 0.08; 0.01, 0.15)) and decreased quality of life measured by OSA-18 ( adj; 95%CI: 7.5; 1.20, 13.82)), and a small increase in the arousal index ( adj; 95%CI: 0.80; 0.09, 1.51)).
Conclusion:
Moderate-to-severe asthma was associated with worse QoL and greater SDB symptoms among children with mSDB. The co-occurrence of common risk factors for mSDB and asthma and worse symptoms and quality of life in children with both conditions support coordinated strategies for prevention and co-management of both disorders.
Clinical Trial:
Pediatric Adenotonsillectomy for Snoring (PATS), NCT02562040, https://clinicaltrials.gov/study/NCT02562040.
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