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Polysomnographic characteristics of adolescents with asthma and low risk for sleep-disordered breathing

  • Basheer KhassawnehEmail author
  • Sheila C. Tsai
  • Lisa J. Meltzer
Pediatrics • Original Article
  • 22 Downloads

Abstract

Purpose

The aim of this study was to describe the polysomnographic characteristics of adolescents with asthma who are at low risk for sleep-disordered breathing (SDB) based on the Pediatric Sleep Questionnaire (PSQ).

Methods

Overnight polysomnography was performed on 85 adolescents with asthma and a score < 0.33 on the PSQ. The Asthma Control Questionnaire was used to define “well-controlled” versus “inadequately controlled” asthma.

Results

Mean age of participants was 14.5 ± 1.6 years (range, 11 to 17 years), 63.5% were girls, 57.6% were Caucasians, and the mean body mass index percentile was 65.1 ± 26.5. Asthma was well-controlled in 51.7% of the adolescents and inadequately controlled in 15.3%. Mean sleep efficiency (SE) was 88.0 ± 11.1%, and 24.7% had SE < 85%. Mean wakefulness after sleep onset (WASO) was 40.9 ± 44.0 min, and the mean arousal index was 10.8 ± 5.6 per hour. The mean apnea/hypopnea index (AHI) was 2.3 ± 4.2, and 29.4% of participants had SDB (defined by an AHI ≥ 2). Compared with normative values, adolescents with asthma had more nocturnal awakenings and WASO, and less REM sleep. SDB risk was higher in boys [odds ratio = 4.6 (confidence interval 1.4–14.7), p = 0.01]. Asthma control did not impact sleep and respiratory parameters, with no differences found between youth with well-controlled and inadequately controlled asthma.

Conclusions

Adolescents with asthma are at increased risk of sleep-disordered breathing and suffer from disturbances in sleep continuity with more arousals and sleep fragmentation. Study results highlight the importance of proper screening for sleep-disordered breathing in adolescents with asthma.

Keywords

Asthma Sleep Polysomnography Children Adolescence Sleep-disordered breathing 

Notes

Acknowledgments

B. Khassawneh was on sabbatical leave from the Faculty of Medicine at Jordan University of Science and Technology, Irbid, Jordan. The authors thank the adolescents who participated in this study, the SIESTA team for their assistance with recruitment, as well as Lori Spindler, Emy Basham, and the National Jewish Health Sleep Lab for all of their assistance with data collection.

Funding

This study was funded by the NIH/NHLBI (R01 HL119441).

Compliance with ethical standards

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the National Jewish Health Institutional Review Board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

References

  1. 1.
    WHO (2017) Asthma fact sheet. In: World Health Organization http://www.who.int/news-room/fact-sheets/detail/asthma. Accessed August 09 2018Google Scholar
  2. 2.
    Akinbami LJ, Simon AE, Schoendorf KC (2016) Trends in allergy prevalence among children aged 0-17 years by asthma status, United States, 2001-2013. J Asthma 53(4):356–362.  https://doi.org/10.3109/02770903.2015.1126848 CrossRefGoogle Scholar
  3. 3.
    Centers for Disease C, Prevention (2011) Vital signs: asthma prevalence, disease characteristics, and self-management education: United States, 2001--2009. MMWR Morb Mortal Wkly Rep 60(17):547–552Google Scholar
  4. 4.
    Association AL (2012) Trends in asthma morbidity and mortalityGoogle Scholar
  5. 5.
    Moonie SA, Sterling DA, Figgs L, Castro M (2006) Asthma status and severity affects missed school days. J Sch Health 76(1):18–24.  https://doi.org/10.1111/j.1746-1561.2006.00062.x CrossRefGoogle Scholar
  6. 6.
    Sutherland ER (2005) Nocturnal asthma. J Allergy Clin Immunol 116(6):1179–1186; quiz 1187.  https://doi.org/10.1016/j.jaci.2005.09.028 CrossRefGoogle Scholar
  7. 7.
    Meltzer LJ, Ullrich M, Szefler SJ (2014) Sleep duration, sleep hygiene, and insomnia in adolescents with asthma. J Allergy Clin Immunol Pract 2(5):562–569.  https://doi.org/10.1016/j.jaip.2014.02.005 CrossRefGoogle Scholar
  8. 8.
    Fagnano M, Bayer AL, Isensee CA, Hernandez T, Halterman JS (2011) Nocturnal asthma symptoms and poor sleep quality among urban school children with asthma. Acad Pediatr 11(6):493–499.  https://doi.org/10.1016/j.acap.2011.05.006 CrossRefGoogle Scholar
  9. 9.
    Strunk RC, Sternberg AL, Bacharier LB, Szefler SJ (2002) Nocturnal awakening caused by asthma in children with mild-to-moderate asthma in the childhood asthma management program. J Allergy Clin Immunol 110(3):395–403.  https://doi.org/10.1067/mai.2002.127433 CrossRefGoogle Scholar
  10. 10.
    Diette GB, Markson L, Skinner EA, Nguyen TT, Algatt-Bergstrom P, Wu AW (2000) Nocturnal asthma in children affects school attendance, school performance, and parents' work attendance. Arch Pediatr Adolesc Med 154(9):923–928CrossRefGoogle Scholar
  11. 11.
    Stores G, Ellis AJ, Wiggs L, Crawford C, Thomson A (1998) Sleep and psychological disturbance in nocturnal asthma. Arch Dis Child 78(5):413–419.  https://doi.org/10.1136/adc.78.5.413 CrossRefGoogle Scholar
  12. 12.
    Jensen ME, Gibson PG, Collins CE, Hilton JM, Latham-Smith F, Wood LG (2013) Increased sleep latency and reduced sleep duration in children with asthma. Sleep Breath 17(1):281–287.  https://doi.org/10.1007/s11325-012-0687-1 CrossRefGoogle Scholar
  13. 13.
    Teng YK, Chiang LC, Lue KH, Chang SW, Wang L, Lee SP, Ting H, Lee SD (2014) Poor sleep quality measured by polysomnography in non-obese asthmatic children with or without moderate to severe obstructive sleep apnea. Sleep Med 15(9):1062–1067.  https://doi.org/10.1016/j.sleep.2014.04.017 CrossRefGoogle Scholar
  14. 14.
    Meltzer LJ, Jump S, Flewelling KD, Sundstrom D, White M, Strand MJ (2018) 0851 sleep duration and asthma outcomes in adolescents. Sleep 41(suppl_1):A315–A316.  https://doi.org/10.1093/sleep/zsy061.850 CrossRefGoogle Scholar
  15. 15.
    Chervin RD, Hedger K, Dillon JE, Pituch KJ (2000) Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems. Sleep Med 1(1):21–32CrossRefGoogle Scholar
  16. 16.
    Iber C A-IS, Chesson AL, Jr, Quan SF for the American Academy of Sleep Medicine. (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. 1st edn. American Academy of Sleep Medicine, Westchester, ILGoogle Scholar
  17. 17.
    Aurora RN, Zak RS, Karippot A, Lamm CI, Morgenthaler TI, Auerbach SH, Bista SR, Casey KR, Chowdhuri S, Kristo DA, Ramar K (2011) American Academy of Sleep M. Practice parameters for the respiratory indications for polysomnography in children Sleep 34(3):379–388Google Scholar
  18. 18.
    Juniper EF, Bousquet J, Abetz L, Bateman ED, Committee G (2006) Identifying ‘well-controlled’ and ‘not well-controlled’ asthma using the asthma control questionnaire. Respir Med 100(4):616–621.  https://doi.org/10.1016/j.rmed.2005.08.012 CrossRefGoogle Scholar
  19. 19.
    Juniper EF, O'Byrne PM, Ferrie PJ, King DR, Roberts JN (2000) Measuring asthma control. Clinic questionnaire or daily diary? Am J Respir Crit Care Med 162(4 Pt 1):1330–1334.  https://doi.org/10.1164/ajrccm.162.4.9912138 CrossRefGoogle Scholar
  20. 20.
    Cloutier MM, Schatz M, Castro M, Clark N, Kelly HW, Mangione-Smith R, Sheller J, Sorkness C, Stoloff S, Gergen P (2012) Asthma outcomes: composite scores of asthma control. J Allergy Clin Immunol 129(3 Suppl):S24–S33.  https://doi.org/10.1016/j.jaci.2011.12.980 CrossRefGoogle Scholar
  21. 21.
    Chervin RD, Weatherly RA, Garetz SL, Ruzicka DL, Giordani BJ, Hodges EK, Dillon JE, Guire KE (2007) Pediatric sleep questionnaire: prediction of sleep apnea and outcomes. Arch Otolaryngol Head Neck Surg 133(3):216–222.  https://doi.org/10.1001/archotol.133.3.216 CrossRefGoogle Scholar
  22. 22.
    Meltzer LJ, Biggs S, Reynolds A, Avis KT, Crabtree VM, Bevans KB (2012) The children's report of sleep patterns—sleepiness scale: a self-report measure for school-aged children. Sleep Med 13(4):385–389.  https://doi.org/10.1016/j.sleep.2011.12.004 CrossRefGoogle Scholar
  23. 23.
    Scholle S, Beyer U, Bernhard M, Eichholz S, Erler T, Graness P, Goldmann-Schnalke B, Heisch K, Kirchhoff F, Klementz K, Koch G, Kramer A, Schmidtlein C, Schneider B, Walther B, Wiater A, Scholle HC (2011) Normative values of polysomnographic parameters in childhood and adolescence: quantitative sleep parameters. Sleep Med 12(6):542–549.  https://doi.org/10.1016/j.sleep.2010.11.011 CrossRefGoogle Scholar
  24. 24.
    Scholle S, Wiater A, Scholle HC (2011) Normative values of polysomnographic parameters in childhood and adolescence: cardiorespiratory parameters. Sleep Med 12(10):988–996.  https://doi.org/10.1016/j.sleep.2011.05.006 CrossRefGoogle Scholar
  25. 25.
    Scholle S, Wiater A, Scholle HC (2012) Normative values of polysomnographic parameters in childhood and adolescence: arousal events. Sleep Med 13(3):243–251.  https://doi.org/10.1016/j.sleep.2011.07.022 CrossRefGoogle Scholar
  26. 26.
    Sogut A, Yilmaz O, Dinc G, Yuksel H (2009) Prevalence of habitual snoring and symptoms of sleep-disordered breathing in adolescents. Int J Pediatr Otorhinolaryngol 73(12):1769–1773.  https://doi.org/10.1016/j.ijporl.2009.09.026 CrossRefGoogle Scholar
  27. 27.
    Meltzer LJ, Avis KT, Biggs S, Reynolds AC, Crabtree VM, Bevans KB (2013) The children’s report of sleep patterns (CRSP): a self-report measure of sleep for school-aged children. J Clin Sleep Med 9(3):235–245.  https://doi.org/10.5664/jcsm.2486 Google Scholar
  28. 28.
    Ramagopal M, Scharf SM, Roberts DW, Blaisdell CJ (2008) Obstructive sleep apnea and history of asthma in snoring children. Sleep Breath 12(4):381–392.  https://doi.org/10.1007/s11325-008-0174-x CrossRefGoogle Scholar
  29. 29.
    Nishida M, Pearsall J, Buckner RL, Walker MP (2009) REM sleep, prefrontal theta, and the consolidation of human emotional memory. Cereb Cortex 19(5):1158–1166.  https://doi.org/10.1093/cercor/bhn155 CrossRefGoogle Scholar
  30. 30.
    Gujar N, McDonald SA, Nishida M, Walker MP (2011) A role for REM sleep in recalibrating the sensitivity of the human brain to specific emotions. Cereb Cortex 21(1):115–123.  https://doi.org/10.1093/cercor/bhq064 CrossRefGoogle Scholar
  31. 31.
    Sanchez T, Castro-Rodriguez JA, Brockmann PE (2016) Sleep-disordered breathing in children with asthma: a systematic review on the impact of treatment. J Asthma Allergy 9:83–91.  https://doi.org/10.2147/JAA.S85624 Google Scholar
  32. 32.
    Goldstein NA, Aronin C, Kantrowitz B, Hershcopf R, Fishkin S, Lee H, Weaver DE, Yip C, Liaw C, Saadia TA, Abramowitz J, Weedon J (2015) The prevalence of sleep-disordered breathing in children with asthma and its behavioral effects. Pediatr Pulmonol 50(11):1128–1136.  https://doi.org/10.1002/ppul.23120 CrossRefGoogle Scholar
  33. 33.
    Li Z, Huang IC, Thompson L, Tuli S, Huang SW, DeWalt D, Revicki D, Shenkman E (2013) The relationships between asthma control, daytime sleepiness, and quality of life among children with asthma: a path analysis. Sleep Med 14(7):641–647.  https://doi.org/10.1016/j.sleep.2013.04.002 CrossRefGoogle Scholar
  34. 34.
    Hanson MD, Chen E (2008) The temporal relationships between sleep, cortisol, and lung functioning in youth with asthma. J Pediatr Psychol 33(3):312–316.  https://doi.org/10.1093/jpepsy/jsm120 CrossRefGoogle Scholar
  35. 35.
    Beebe DW (2011) Cognitive, behavioral, and functional consequences of inadequate sleep in children and adolescents. Pediatr Clin N Am 58(3):649–665.  https://doi.org/10.1016/j.pcl.2011.03.002 CrossRefGoogle Scholar
  36. 36.
    Katz ES, Greene MG, Carson KA, Galster P, Loughlin GM, Carroll J, Marcus CL (2002) Night-to-night variability of polysomnography in children with suspected obstructive sleep apnea. J Pediatr 140(5):589–594.  https://doi.org/10.1067/mpd.2002.123290 CrossRefGoogle Scholar
  37. 37.
    Lee JJ, Tseng C (2001) Uniform power method for sample size calculation in historical control studies with binary response. Control Clin Trials 22(4):390–400CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Internal Medicine, Faculty of MedicineJordan University of Science and TechnologyIrbidJordan
  2. 2.Department of MedicineNational Jewish HealthDenverUSA
  3. 3.Department of PediatricsNational Jewish HealthDenverUSA

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