Asthma-related lung function, sleep quality, and sleep duration in urban children

Abstract

Objectives Examine 1) the extent to which changes in objectively measured asthma-related lung function (FEV1 % predicted) within a sleep period are associated with sleep quality and sleep duration during that sleep period, in a group of urban children with persistent asthma; and 2) associations between morning and evening asthma-related lung function and sleep quality and duration on the adjacent night, and 3) whether these associations differ by ethnic group. Design Cross-sectional, multi-method approach. Children completed a clinic assessment of asthma and allergy status and used home-based objective measurements of asthma-related lung function and sleep. Setting Children and their caregivers participated in a clinic assessment at an asthma and allergy clinic and completed additional assessments at home. Participants Two hundred and sixteen African American, Latino, and non-Latino white urban children, ages 7–9 years, and their primary caregivers. Measurements Participants took part in a clinic assessment of asthma and allergy status, completed interview-based questionnaires including a diary to track asthma symptoms and sleep patterns, and used actigraphy and home-based spirometry daily across a 4-week period to assess sleep and lung function. Results and Conclusions Results from analyses using structural equation modeling revealed an association between worsening FEV1 and poor sleep quality in the full sample, as well as better asthma-related lung function at night and more optimal sleep efficiency that night. Ethnic group differences emerged in the association with morning or nighttime lung function measurements and sleep quality. Urban minority children with asthma may be at heightened risk for poorer quality sleep. Timing of lung function worsening may be important when considering when and how to improve both asthma health outcomes and sleep quality within specific groups.

The epidemiology of sleep and obesity

“…145 Asthma symptoms tend to worsen at night and have been associated with impairments in sleep. 146,147 …”

Asthma and academic performance in urban children

“…In this report, we compare academic performance of a carefully evaluated group of urban children with asthma with that of their urban counterparts without asthma, and we examine ethnic differences in these associations. Based on previous results showing associations between poorer asthma control and poorer sleep quality and shorter sleep duration, 16 as well as increased absences in urban children with asthma, 11,12 we expect those in our study to experience poorer academic performance across indicators compared with their healthy peers. Given the cumulative impact that uncontrolled asthma and urban stressors can have on morbidity and daily functioning, 7 we expect urban minority children with asthma to have the poorest academic outcomes relative to minority children without asthma.…”

“…Data were collected within a larger 5-year study, Project Nocturnal Asthma and Performance in School, that assessed the cooccurrence of asthma, allergic rhinitis, sleep quality, and academic functioning in urban children and healthy controls across 1 academic year. 3,16,22 Participants were recruited from the 4 largest urban school districts in an urban Northeast US city, and from hospital-based ambulatory pediatric clinics. Study eligibility criteria for the asthma participants required that the child was between 7 and 9 years old, the child's legal guardian was willing to participate, and self-identified as Latino (Dominican or Puerto Rican), black/African American, or non-Latino white (NLW); the child attend an urban public school in 1 of the 4 targeted school districts that are identified as being high-risk for asthma prevalence and asthma-related health care utilization; and that the child had physician-diagnosed asthma or caregiver-reported asthma symptoms in the previous 12 months.…”

“…Primary caregivers provided key demographic information (Table 1). 16,25 Caregivers reported on children's risk for sleepdisordered breathing using the Sleep-related Breathing Disorders scale of the Pediatric Sleep Questionnaire. 26…”

“…12 Another way in which asthma can affect academic performance is through its impact on sleep. Nocturnal asthma can affect children's sleep quality and duration, 16 which can interfere with attention in school and impact the quality of school work. Moreover, urban minority children with asthma are exposed to increased environmental triggers 5,20 and are found to have poorer adherence to asthma daily controller medications than their non-Latino white counterparts.…”