Impaired Patient-Reported Outcomes Predict Poor School Functioning and Daytime Sleepiness: The PROMIS Pediatric Asthma Study

Abstract

Objectives Poor asthma control in children is related to impaired patient-reported outcomes (PROs; e.g., fatigue, depressive symptoms, anxiety), but less well studied is the impact of PROs on children’s school performance and sleep outcomes. This study investigated whether the consistency status of PROs over time impacted school functioning and daytime sleepiness in children with asthma. Methods Of the 238 children with asthma enrolled in the Patient-Reported Outcomes Measurement Information System® (PROMIS®) Pediatric Asthma Study, 169 children who provided survey data for all four time points were used in analysis. The child’s PROs, school functioning, and daytime sleepiness were measured four times within a 15-months period. PROs domains included asthma impact, pain interference, fatigue, depressive symptoms, anxiety, and mobility. Each child was classified as having poor/fair vs. good PROs per meaningful cut-points. The consistency status of each domain was classified as consistently poor/fair if poor/fair status was present for at least three time points; otherwise, the status was classified as consistently good. Seemingly unrelated regression was performed to test if consistently poor/fair PROs predict impaired school functioning and daytime sleepiness at the fourth time point. Results Consistently poor/fair in all PROs domains was significantly associated with impaired school functioning and excessive daytime sleepiness (p’s <0.01) after controlling for the influence of the child’s age, sex, and race/ethnicity. Conclusions Children with asthma with consistently poor/fair PROs are at risk of poor school functioning and daytime sleepiness. Developing child-friendly PROs assessment systems to track PROs can inform potential problems in the school setting.

Sleep problems, behavioural problems and respiratory health in children born extremely preterm: a parental questionnaire study

“…We are unaware of other studies that have addressed relationships between respiratory symptoms and sleep in children born EPT, but our finding that several sleep problems were associated with wheezing and asthma is in agreement with similar findings in children born at term 37–39. Although respiratory symptoms in EPT-born children resemble asthma, the pathophysiology of lung disease after preterm birth is different which, for instance, is reflected in that the disease is unresponsive to inhaled corticosteroids 12 40–42.…”

The impact of childhood asthma on academic performance: A matched population‐based cohort study

“…[7] Young people hospitalized with asthma may also experience nocturnal disturbances that may, in turn, have a negative impact on ability to concentrate and learn during school hours. [7,8,39]…”

“…[7] Young people hospitalized with asthma may also experience nocturnal disturbances that may, in turn, have a negative impact on ability to concentrate and learn during school hours. [7,8,39] The association between common chronic health conditions of young people and their adverse impact on academic performance has previously been demonstrated. [40,41] Yet, it appears that studies of the impact of asthma on school performance that also include less severe asthma (eg seasonal or mild) may underestimate the effect of inadequately controlled asthma on performance.…”

Impact of chronic health conditions and injury on school performance and health outcomes in New South Wales, Australia: a retrospective record linkage study protocol

“…This will be a retrospective population-level case-comparison study of injured or chronically ill children (ie, diabetes, epilepsy, asthma or mental health conditions). These four health conditions and injury were selected as injuries are the leading cause of hospitalisation in Australia for children aged 1–18 years,17 and the four chronic health conditions represent the most common health conditions experienced by children in Australia18 that have previously been associated with having a detrimental impact on learning 2–9. This will be a retrospective epidemiological study of children aged ≤18 years at the date of admission for their index hospitalisation in New South Wales (NSW), Australia.…”

“…Any restrictions on the ability of a child to perform to the best of their ability at school may adversely affect their career prospects and long-term quality of life. Traumatic injury or the presence of a chronic health condition, such as diabetes, epilepsy, asthma or mental health conditions, can have an adverse impact on the child’s performance at school 2–9. Interruptions to education can have a cumulative effect, resulting in being less likely to complete school or attend university and potentially limiting future employment opportunities 10.…”