Association of Asthma and Allergic Rhinitis With Sleep-Disordered Breathing in Childhood

Abstract

Objective: Asthma and allergic rhinitis (AR) are the most common chronic conditions in childhood and have previously been linked to sleep-related breathing disorder (SRBD). Aim of the study was to examine the association between SRBD risk and asthma control in children with asthma and with or without AR.Methods: The assessment of FeNO and pulmonary function tests were performed in 140 children (65 with asthma, 57 with both asthma, and AR, 18 with only AR). Children with asthma completed the childhood Asthma Control Test (c-ACT), and the Sleep-Related Breathing Disorder scale, extracted from the Pediatric Sleep Questionnaire (PSQ). C-ACT scores ≤ 19 are indicative of poor asthma control whereas SRBD from PSQ scores ≥ 0.33 are suggestive of high risk for SRBD.Results: Mean age ± SD was 7.8 ± 3.1 years. Mean PSQ ± SD and c-ACT ± SD scores were 0.17 ± 0.14 and 24.9 ± 3.2, respectively. High risk for SRBD was identified in 26 children. Children at high risk for SRBD had significantly decreased c-ACT score (P = 0.048), verified by a negative association between c-ACT and PSQ-SRBD scores (r = −0.356, P < 0.001). Additionally a difference in diagnosis distribution between children at high or low risk for SRBD was observed. More specifically, among children at high risk, 88.5% were diagnosed with both atopic conditions, while this percentage among children at low risk was 29.8%. Asthma was mainly diagnosed in the latter group (P < 0.001).Conclusions: Poor asthma control is associated with SRBD. The presence of AR in children with asthma seems to increase the prevalence of SRBD in that particular population, requiring further investigation toward this direction.

Relationship between Poorly Controlled Asthma and Sleep-Related Breathing Disorders in Children with Asthma: A Two-Center Study

“…However, only few studies focusing on the pediatric population have reported on the relationship between asthma control/management and SRBD. Perikleous et al [ 16 ] demonstrated that poor asthma control was associated with SRBD, and asthma control test scores were negatively correlated with pediatric sleep questionnaire (PSQ) scores; however, a limitation of this study was that only 9 children were poorly controlled, which was a small number. In addition, no data are available about the relationship between asthma control and SRDB in China to date.…”

“…The PSQ identifies children with SRBD with a sensitivity of 83% and a specificity of 87%; its applicability and generalizability in assessing childhood SRBD in China has been confirmed [ 24 ]. This multipage questionnaire consists of 22 questions on snoring, sleepiness, and behavioral problems and has been used frequently for sleep-associated respiratory research studies [ 15 , 16 , 24 – 31 ]. The three possible responses to each question are “yes = 1,” “no = 0,” and “do not know = missing.” The number of symptom items endorsed positively (“yes”) is divided by the number of items answered positively or negatively; the denominator therefore excludes items with missing responses, i.e., items answered with “do not know.” Scores >0.33 are considered positive and suggestive of a high risk of having SRBD.…”

“…SRBD are common in childhood; its spectrum ranges from primary snoring to partial or complete airway obstruction, which is termed obstructive sleep apnea syndrome (OSAS) [ 6 ]. SRBD affects 5.1–13.3% of children [ 7 – 16 ], resulting in dysfunction of immune responses, cardiovascular function, and neurocognitive function [ 6 ]. Recently, research has shown that asthma is associated with a high risk of SRBD in children.…”

“…Asthma is also associated with airway inflammation and resistance, which cause decreased airway flow rates during sleep, thereby affecting the quality of sleep [ 17 , 18 ]. Furthermore, common comorbidity of asthma such as obesity, gastroesophageal reflux, and allergic rhinitis (AR) may also lead to SRDB due to narrowing of the upper airway by local fat infiltration [ 15 ], altered parasympathetic tone to trigger bronchoconstriction [ 13 ], and nasal congestion [ 16 ]. These mechanisms provide evidence that the prevalence of asthma is associated with a high risk of SRBD in children.…”

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“…5 The coexistence of AR in children with asthma further increases the burden of sleep-related breathing disorders. 6 A study of adults with allergic occupational rhinitis demonstrated impaired QoL and work productivity. 7 In a study of 101 adolescents and 41 children with moderate and severe persistent AR, medical treatment failure was associated with worse QoL outcomes.…”