Obstructive sleep apnea in poorly controlled asthmatic children: Effect of adenotonsillectomy

Abstract

Background Asthma and obstructive sleep apnea (OSA) in children share multiple epidemiological risk factors and the prevalence of snoring is higher in asthmatic children, suggesting that the latter may be at increased risk for OSA. Since both asthma and OSA are inflammatory disorders, we hypothesized that polysomnographically-demonstrated OSA would be more frequent among poorly controlled asthmatics (PCA), and that treatment of OSA, if present, would ameliorate the frequency of acute asthmatic exacerbations (AAE). Methods Children with PCA were referred for an overnight sleep study, and adenotonsillectomy (T&A) was performed if OSA was present. Frequency of asthma symptoms and exacerbations were compared. Results 92 PCA children, ages 3-10 years, with a mean frequency of AAE of 3.4±0.4/year were prospectively referred for a sleep study. OSA (i.e., AHI>5/hrTST) was present in 58 patients (63.0%; OR: 40.9, 12.9-144.1, p<0.000001 compared to the prevalence of OSA in a non-asthmatic population). Information at 1-year follow-up was available for 35 PCA children after tonsillectomy and adenoidectomy (T&A). The annual frequency of AAE, rescue inhaled use, and asthma symptoms in this sub-group decreased compared to no changes in the group without OSA. Conclusions The prevalence of OSA is markedly increased among PCA children and treatment of OSA appears to be associated with substantial improvements in the severity of the underlying asthmatic condition.

Asthma outcomes improve with continuous positive airway pressure for obstructive sleep apnea

“…The first studies, carried out in the 1980s, consisted in series of 9‐10 patients followed sometimes for only 2 weeks 14, 15. More recently, other groups have confirmed the positive effects of treating OSAS (in adults using CPAP and in children undergoing adenoidectomy and tonsillectomy) in the clinical course of asthma 10, 17, 18, 19. In contrast, the effects of CPAP therapy on pulmonary function of asthmatic patients with OSAS are less common and limited to small improvements in blood gases 16 or small increases (around 10%) in the peak expiratory flow rate 14.…”

“…OSAS is an important risk factor for uncontrolled asthma and for frequent exacerbations 7, 8, 9, 10, 11. In a prospective study of 22 patients with difficult‐to‐control asthma, a night polysomnography showed that all but one patient had OSAS (95.5% prevalence) 7.…”

“…Also, it has been shown that the prevalence of OSAS increased progressively according to severity of asthma (from 58% in moderate asthma to 88% in severe asthma) 9. In children with poorly controlled asthma and frequent asthmatic exacerbations, the prevalence of OSAS was markedly increased (63%) 10. Current asthma clinical practice guidelines already include OSAS as a possible comorbidity affecting asthma management, and recommend to investigate the presence of OSAS in the cases of severe or uncontrolled asthma 12, 13.…”

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

“…In a class III report, SDB was a predictor of asthma severity, and in two retrospective cohort studies, adenotonsillectomy was accompanied by improved asthma outcomes (class II and IV) [116][117][118].…”

Insights into Selected Aspects of Pediatric Sleep Medicine

“…In adults, an increased prevalence of OSA was reported in patients with poorly controlled asthma (11,12) and vice versa (13). Furthermore, a small, prospective, uncontrolled study showed that treatment of OSA in children with poorly controlled asthma markedly ameliorated their symptoms (14), and the aforementioned CHAT study would also indicate similar outcomes (4). Indeed, Marcus and colleagues (4) reported that 18 asthmatic events took place among 203 children in the delayed treatment group compared with 3 asthmatic events among 194 children in the early AT group (P , 0.002).…”