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Association of Symptoms of Sleep-Related Breathing Disorders with Asthma Control in Indian Children



To explore the association of symptoms of sleep-related breathing disorders (SRBD) with asthma control in Indian children.


This study was carried out in the pediatric chest clinic of a tertiary care center in western India. Children from 6 to 18 y of age with a physician-diagnosed case of asthma were included in the study. A validated pediatric sleep questionnaire, SRBD scale, was used to screen the symptoms of SRBD. At the same time, Asthma Control Questionnaire (ACQ) was administered to assess asthma control.


A total of 207 (73% boys) children with asthma were enrolled; the median age was 10 (7, 13) y. Asthma symptoms were well controlled (ACQ ≤ 0.75) in 102 (49.3%) and partly or poorly controlled (ACQ > 0.75) in 105 (50.7%) children. Inattention and/or hyperactivity was the most common SRBD symptom observed in 125 (60.4%) children; daytime sleepiness, mouth breathing, snoring, and night-time breathing problems were observed in 92 (44.5%), 91 (44%), 77 (37.2%), and 68 (32.8%) children, respectively. SRBD score showed a near-linear correlation with ACQ score (r = 0.28, p < 0.001). The score was positive in 52 (25.1%) children. A positive SRBD score was statistically more common in partly or poorly controlled asthma (aOR 2.5; 95% CI: 1.2–5.0; p = 0.01). However, the positive score did not show a statistically significant association with gender, being underweight, obesity, allergic rhinitis, compliance to therapy, and inhalation technique.


SRBD symptoms are common in children with asthma. They showed a statistically significant association with partly or poorly controlled asthma. Therefore, it would be interesting to look for SRBD symptoms in children with partly or poorly controlled asthma.

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  1. 1.

    Ferrante G, La Grutta S. The burden of pediatric asthma. Front Pediatr. 2018;6:186.

    Article  Google Scholar 

  2. 2.

    Kaushal R, Bhardwaj P, Goel AD, Shekhar S, Kumar P, Goyal JP. Prevalence of asthma and sleep-related breathing disorder in school-going children. Indian J Community Med. 2020;45:539–42.

    PubMed  PubMed Central  Google Scholar 

  3. 3.

    De Groot EP, Duiverman EJ, Brand PL. Comorbidities of asthma during childhood: possibly important, yet poorly studied. Eur Respir J. 2010;36:671–8.

    Article  Google Scholar 

  4. 4.

    Sánchez T, Castro-Rodríguez JA, Brockmann PE. Sleep-disordered breathing in children with asthma: a systematic review on the impact of treatment. J Asthma Allergy. 2016;9:83–91.

    PubMed  PubMed Central  Google Scholar 

  5. 5.

    Diette GB, Markson L, Skinner EA, Nguyen TT, Algatt-Bergstrom P, Wu AW. Nocturnal asthma in children affects school attendance, school performance, and parents’ work attendance. Arch Pediatr Adolesc Med. 2000;154:923–8.

    CAS  Article  Google Scholar 

  6. 6.

    Fagnano M, Bayer AL, Isensee CA, Hernandez T, Halterman JS. Nocturnal asthma symptoms and poor sleep quality among urban school children with asthma. Acad Pediatr. 2011;11:493–9.

    Article  Google Scholar 

  7. 7.

    Koinis-Mitchell D, Kopel SJ, Boergers J, et al. Asthma, allergic rhinitis, and sleep problems in urban children. J Clin Sleep Med. 2015;11:101–10.

    Article  Google Scholar 

  8. 8.

    Teodorescu M, Barnet JH, Hagen EW, Palta M, Young TB, Peppard PE. Association between asthma and risk of developing obstructive sleep apnea. JAMA - J Am Med Assoc. 2015;313:156–64.

    CAS  Article  Google Scholar 

  9. 9.

    Perikleous E, Steiropoulos P, Nena E, et al. Association of asthma and allergic rhinitis with sleep-disordered breathing in childhood. Front Pediatr. 2018;6:250.

    Article  Google Scholar 

  10. 10.

    Ehsan Z, Kercsmar CM, Collins J, Simakajornboon N. Validation of the pediatric sleep questionnaire in children with asthma. Pediatr Pulmonol. 2017;52:382–9.

    Article  Google Scholar 

  11. 11.

    Kadmon G, Shapiro CM, Chung SA, Gozal D. Validation of a pediatric obstructive sleep apnea screening tool. Int J Pediatr Otorhinolaryngol. 2013;77:1461–4.

    Article  Google Scholar 

  12. 12.

    Chervin RD, Hedger K, Dillon JE, Pituch KJ. Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems. Sleep Med. 2000;1:21–32.

    CAS  Article  Google Scholar 

  13. 13.

    Global Initiative for Asthma. 2020 GINA Report, Global strategy for asthma management and prevention. Available at: Accessed on 27 Sept 2020.

  14. 14.

    Khadilkar VV, Khadilkar AV. Revised Indian academy of pediatrics 2015 growth charts for height, weight, and body mass index for 5-18-year-old Indian children. Indian J Endocrinol Metab. 2015;19:470–6.

    Article  Google Scholar 

  15. 15.

    Juniper EF, Gruffydd-Jones K, Ward S, Svensson K. Asthma control questionnaire in children: validation, measurement properties, interpretation. Eur Respir J. 2010;36:1410–6.

    CAS  Article  Google Scholar 

  16. 16.

    Desager KN, Nelen V, Weyler JJJ, De Backer WA. Sleep disturbance and daytime symptoms in wheezing school-aged children. J Sleep Res. 2005;14:77–82.

    Article  Google Scholar 

  17. 17.

    Fagnano M, Van Wijngaarden E, Connolly HV, Carno MA, Forbes-Jones E, Halterman JS. Sleep-disordered breathing and behaviors of inner-city children with asthma. Pediatrics. 2009;124:218–25.

    Article  Google Scholar 

  18. 18.

    Brockmann PE, Bertrand P, Castro-Rodriguez JA. Influence of asthma on sleep-disordered breathing in children: a systematic review. Sleep Med Rev. 2014;18:393–7.

    Article  Google Scholar 

  19. 19.

    Yuksel H, Sogut A, Yilmaz O, Demet M, Ergin D, Kirmaz C. Evaluation of sleep quality and anxiety-depression parameters in asthmatic children and their mothers. Respir Med. 2007;101:2550–4.

    Article  Google Scholar 

  20. 20.

    Meltzer LJ, Pugliese CE. Sleep in young children with asthma and their parents. J Child Health Care. 2017;21:301–11.

    Article  Google Scholar 

  21. 21.

    Meltzer LJ, Ullrich M, Szefler SJ. Sleep duration, sleep hygiene, and insomnia in adolescents with asthma. J Allergy Clin Immunol Pract. 2014;2:562–9.

    Article  Google Scholar 

  22. 22.

    Koinis Mitchell D, Kopel SJ, Williams B, Cespedes A, Bruzzese JM. The association between asthma and sleep in urban adolescents with undiagnosed asthma. J Sch Health. 2015;85:519–26.

    Article  Google Scholar 

  23. 23.

    Chugh IM, Khanna P, Shah A. Nocturnal symptoms and sleep disturbances in clinically stable asthmatic children. Asian Pac J Allergy Immunol. 2006;24:135–42.

    PubMed  Google Scholar 

  24. 24.

    Li Z, Thompson LA, Gross HE, et al. Longitudinal associations among asthma control, sleep problems, and health-related quality of life in children with asthma: a report from the PROMIS® pediatric asthma study. Sleep Med. 2016;20:41–50.

    Article  Google Scholar 

  25. 25.

    Jones CM, DeWalt DA, Huang IC. Impaired patient-reported outcomes predict poor school functioning and daytime sleepiness: the PROMIS pediatric asthma study. Acad Pediatr. 2017;17:850–4.

    Article  Google Scholar 

  26. 26.

    Ross KR, Storfer-Isser A, Hart MA, et al. Sleep-disordered breathing is associated with asthma severity in children. J Pediatr. 2012;160:736–42.

    Article  Google Scholar 

  27. 27.

    Bhattacharjee R, Kheirandish-Gozal L, Spruyt K, et al. Adenotonsillectomy outcomes in the treatment of obstructive sleep apnea in children: a multicenter retrospective study. Am J Respir Crit Care Med. 2010;182:676–83.

    Article  Google Scholar 

  28. 28.

    Ramagopal M, Mehta A, Roberts DW, et al. Asthma as a predictor of obstructive sleep apnea in urban African-American children. J Asthma. 2009;46:895–9.

    CAS  Article  Google Scholar 

  29. 29.

    Teng YK, Chiang LC, Lue KH, et al. Poor sleep quality measured by polysomnography in non-obese asthmatic children with or without moderate to severe obstructive sleep apnea. Sleep Med. 2014;15:1062–7.

    Article  Google Scholar 

  30. 30.

    Calhoun SL, Vgontzas AN, Fernandez-Mendoza J, et al. Prevalence and risk factors of excessive daytime sleepiness in a community sample of young children: the role of obesity, asthma, anxiety/depression, and sleep. Sleep. 2011;34:503–7.

    Article  Google Scholar 

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The authors thank the University of Michigan Regents for permitting the Hindi version of SRBD scales (License No. 10587-umich) and Professor Juniper EF; McMaster University, Canada, for allowing the Hindi version of the Asthma Control Questionnaire (ACQ). They also thank the children and their parents for participating in this study.

Author information




PK conceptualized and designed the study, developed the protocol, took permission to use questionnaires, collected the data, did literature search, analyzed the data, and prepared an initial draft of the manuscript; JPG and KS analyzed the data, did literature review, and prepared the manuscript. All the authors critically revised and approved the final version of the manuscript. PK will act as the guarantor for this study.

Corresponding author

Correspondence to Prawin Kumar.

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Ethics Committee Approval

The study was approved by the Institute Ethics Committee, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India (AIIMS/IEC/2018/573).

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Kumar, P., Goyal, J.P. & Singh, K. Association of Symptoms of Sleep-Related Breathing Disorders with Asthma Control in Indian Children. Indian J Pediatr (2021).

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  • Asthma control
  • Sleep-related breathing disorder (SRBD)
  • Questionnaire, pediatric sleep questionnaire (PSQ)
  • SRBD scale
  • Asthma control questionnaire (ACQ)