The frequency of sleep-disordered breathing in preschool children with asthma and its effects on control of asthma
Main Article Content
Keywords
Asthma, Asthmatic Children, Asthma Control, Sleep Disorders, Asthma Severity
Abstract
Sleep-disordered breathing (SDB) is more common in asthmatic patients than in non-asthmatic persons, and SDB affects negatively to control asthma. A limited number of studies are discovered on the effect of SDB in preschool asthmatic children. In this study, we aimed to investigate the prevalence of SDB and its effect on control and severity of asthma in preschool children. A pediatric sleep questionnaire was completed by parents of asthmatic children. Patients who received a score of 0.33 or higher were diagnosed with SDB. Control and severity of asthma was assessed by a pediatric allergy specialist based on the Global Initiative for Asthma (GINA) criteria. The study included 249 patients, with a mean±SD age of 4.37±1.04 (range: 2–5.9) years; 69% were boys; 56.6% children had uncontrolled asthma and 28.7% had SDB. The SDB score was significantly different between controlled and uncontrolled asthma (0.19 vs 0.28; P < 0.001). The frequency of uncontrolled asthma in patients with and without SDB was 74.3% and 49.4%, respectively (P < 0.010). Based on the severity of asthma, the frequency of SDB among patients with mild, moderate, and severe asthma was 23.4%, 35.2%, and 47.4%, respectively (P = 0.010).
Conclusion: The frequency and score of SDB were higher in patients with uncontrolled asthma. Frequency and score of SDB were significantly affected by the severity of asthma. SDB must be evaluated in preschool children with uncontrolled asthma.
References
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38. Chan CS, Woolcock AJ, Sullivan CE. Nocturnal asthma: Role of snoring and obstructive sleep apnea. Am Rev Respir Dis. 1988;137(6):1502–4. 10.1164/ajrccm/137.6.1502
39. Silvestri M, Bontempelli M, Giacomelli M, Malerba M, Rossi GA, Di Stefano A, et al. High serum levels of tumour necrosis factor-alpha and interleukin-8 in severe asthma: Markers of systemic inflammation? Clin Exp Allergy. 2006;36(11):1373–81. 10.1111/j.1365-2222.2006.02502.x
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41. Lumeng JC, Chervin RD. Epidemiology of pediatric obstructive sleep apnea. Proc Am Thorac Soc. 2008;5(2):242–52.
42. Goldstein NA, Abramowitz T, Weedon J, Koliskor B, Turner S, Taioli E. Racial/ethnic differences in the prevalence of snoring and sleep disordered breathing in young children. J Clin Sleep Med. 2011;7(2):163–71.
43. O'Brien LM, Lucas NH, Felt BT, Hoban TF, Ruzicka DL, Jordan R, et al. Aggressive behavior, bullying, snoring, and sleepiness in schoolchildren. Sleep Med. 2011;12(7):652–8.
2. Ginis T, Akcan FA, Capanoglu M, Toyran M, Ersu F, Kocabas CN, et al. The frequency of sleep-disordered breathing in children with asthma and its effects on asthma control. J Asthma. 2017;54(4):403–10. 10.1080/02770903.2016.1220012
3. Goldstein NA, Aronin C, Kantrowitz B, Hershcopf R, Fishkin S, Lee H, et al. The prevalence of sleep-disordered breathing in children with asthma and its behavioral effects. Pediatr Pulmonol. 2015;50(11):1128–36. 10.1002/ppul.23120
4. Brockmann PE, Bertrand P, Castro-Rodriguez JA. Influence of asthma on sleep disordered breathing in children: a systematic review. Sleep Med Rev. 2014;18(5):393–97. 10.1016/j.smrv.2014.01.005
5. National Asthma Education and Prevention Program. Expert Panel Report 3 (EPR-3): Guidelines for the diagnosis and management of Asthma-Summary Report 2007 [published correction appeared in J Allergy Clin Immunol. 2008 Jun;121(6):1330]. J Allergy Clin Immunol. 2007;120(5 Suppl):S94–138. 10.1016/j.jaci.2007.09.029
6. Kheirandish-Gozal L, Dayyat EA, Eid NS, Morton RL, Gozal D. Obstructive sleep apnea in poorly controlled asthmatic children: Effect of adenotonsillectomy. Pediatr Pulmonol. 2011;46(9):913–8. 10.1002/ppul.21451
7. Prasad B, Nyenhuis SM, Weaver TE. Obstructive sleep apnea and asthma: Associations and treatment implications. Sleep Med Rev. 2014;18(2):165–71. 10.1016/j.smrv.2013.04.004
8. Ciftci TU, Ciftci B, Guven SF, Kokturk O, Turktas H. Effect of nasal continuous positive airway pressure in uncontrolled nocturnal asthmatic patients with obstructive sleep apnea syndrome. Respir Med. 2005;99(5):529–34. 10.1016/j.rmed.2004.10.011
9. Greenfeld M, Sivan Y, Tauman R. The effect of seasonality on sleep-disordered breathing severity in children. Sleep Med. 2013;14(10):991–4. 10.1016/j.sleep.2013.03.026
10. Marshall NS, Almqvist C, Grunstein RR, Marks GB; Childhood asthma prevention study. predictors for snoring in children with rhinitis at age 5. Pediatr Pulmonol. 2007;42(7):584–91. 10.1002/ppul.20606
11. Buyuktiryaki B, Sahiner UM, Yavuz ST, Cavkaytar O, Arik Yilmaz E, Uysal Soyer O, et al. Validation of the Turkish version of “Test for Respiratory and Asthma Control in Kids (TRACK)” questionnaire. J Asthma. 2013;50(10):1096–101. 10.3109/02770903.2013.837481
12. Global Initative For Asthma (GINA) Reports. Global strategy for asthma management and prevention [Internet]. (2022 update). Available from: www.ginasthma.org/gina-reports/
13. Ersu R, Arman AR, Save D, Karadag B, Karakoc F, Berkem M, et al. Prevalence of snoring and symptoms of sleep--disordered breathing in primary school children in Istanbul. Chest. 2004;126(1):19–24. 10.1378/chest.126.1.19
14. Yüksel H, Sogut A, Yilmaz O, Kutluay E. Reliability and validity of the Turkish version of the pediatric sleep questionnaire: A tool for prediction of sleep-related breathing disorder. Tuberk Toraks. 2011;59(3):236–41. 10.5578/tt.2467
15. 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(1):21–32. 10.1016/S1389-9457(99)00009-X
16. Hekking PP, Amelink M, Wener RR, Bouvy ML, Bel EH. Comorbidities in difficult-to-control asthma. J Allergy Clin Immunol Pract. 2018;6(1):108–13. 10.1016/j.jaip.2017.06.008
17. Xiang L, Zhao J, Zheng Y, Liu H, Hong J, Bao Y, et al. Uncontrolled asthma and its risk factors in Chinese children: A cross-sectional observational study. J Asthma. 2016;53(7):699–706. 10.3109/02770903.2016.1144199
18. Edalat A, Abbaszadeh M, Eesvandi M, Heidari A. The relationship of severe early childhood caries and body mass index in a group of 3-to 6-year-old children in Shiraz. J Dent. 2014;15(2):68.
19. Kaya A, Erkocoglu M, Akan A, Vezir E, Azkur D, Ozcan C, et al. TRACK as a complementary tool to GINA and NAEPP guidelines for assessing asthma control in pre-school children. J Asthma. 2014;51(5):530–5. 10.3109/02770903.2014.887729
20. Wong GW, Kwon N, Hong JG, Hsu JY, Gunasekera KD. Pediatric asthma control in Asia: Phase 2 of the Asthma Insights and Reality in Asia-Pacific (AIRIAP 2) survey. Allergy. 2013;68(4):524–30. 10.1111/all.12117
21. Li L, Xu Z, Jin X, Yan C, Jiang F, Tong S, et al. Sleep-disordered breathing and asthma: Evidence from a large multicentric epidemiological study in China. Respir Res. 2015;16(1):56. 10.1186/s12931-015-0215-5
22. Ross KR, Storfer-Isser A, Hart MA, Kibler AM, Rueschman M, Rosen CL, et al. Sleep-disordered breathing is associated with asthma severity in children. J Pediatr. 2012;160(5):736–42. 10.1016/j.jpeds.2011.10.008
23. 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(1):218–25. 10.1542/peds.2008-2525
24. Rivera N, Flores C, Morales M, Padilla O, Causade S, Brockmann SE, et al. Preschoolers with recurrent wheezing have a high prevalence of sleep disordered breathing. J Asthma. 2020;57(6):584–92. 10.1080/02770903.2019.1599385
25. Tsaoussoglou M, Bixler EO, Calhoun S, Chrousos GP, Sauder K, Vgontzas AN. Sleep-disordered breathing in obese children is associated with prevalent excessive daytime sleepiness, inflammation, and metabolic abnormalities. J Clin Endocrinol Metab. 2010;95(1):143–50. 10.1210/jc.2009-0435
26. Nagel G, Koenig W, Rapp K, Wabitsch M, Zoellner I, Weiland SK. Associations of adipokines with asthma, rhinoconjunctivitis, and eczema in German schoolchildren. Pediatr Allergy Immunol. 2009;20(1):81–8. 10.1111/j.1399-3038.2008.00740.x
27. Brockmann PE, Castro-Rodriguez JA, Holmgren NL, Cerda J, Maria Contreras A, Moya A, et al. Urinary leukotriene excretion profile in children with exercise-induced asthma compared with controls: A preliminary study. Allergol Immunopathol (Madr). 2012;40(3):181–6. 10.1016/j.aller.2011.03.012
28. Goldbart AD, Goldman JL, Veling MC, Gozal D. Leukotriene modifier therapy for mild sleep-disordered breathing in children. Am J Respir Crit Care Med. 2005;172(3):364–70. 10.1164/rccm.200408-1064OC
29. Kaditis AG, Kalampouka E, Hatzinikolaou S, et al. Associations of tonsillar hypertrophy and snoring with history of wheezing in childhood. Pediatr Pulmonol. 2010;45(3):275–80. 10.1002/ppul.21174
30. Teodorescu M, Consens FB, Bria WF, Lianou L, Papaefthimiou M, Gartagani-Panagiotopoulouet P, et al. Predictors of habitual snoring and obstructive sleep apnea risk in patients with asthma. Chest. 2009;135(5):1125–32. 10.1378/chest.08-1273
31. Bjerg A, Hedman L, Perzanowski M, Wennergren G, Lundbäck B, Rönmark E. Decreased importance of environmental risk factors for childhood asthma from 1996 to 2006. Clin Exp Allergy. 2015;45(1):146–53. 10.1111/cea.12439
32. Lawson JA, Janssen I, Bruner MW, Hossain A, Pickett W. Asthma incidence and risk factors in a national longitudinal sample of adolescent Canadians: A prospective cohort study. BMC Pulm Med. 2014;14:51. 10.1186/1471-2466-14-51
33. Patelarou E, Tzanakis N, Kelly FJ. Exposure to indoor pollutants and wheeze and asthma development during early childhood. Int J Environ Res Public Health. 2015;12(4):3993–4017. 10.3390/ijerph120403993
34. Sasaki M, Yoshida K, Adachi Y, Furukawa M, Itazawa T, Odajima H, et al. Factors associated with asthma control in children: Findings from a national Web-based survey. Pediatr Allergy Immunol. 2014;25(8):804–9. 10.1111/pai.12316
35. Irwin MR, Wang M, Campomayor CO, Collado-Hidalgo A, Cole S. Sleep deprivation and activation of morning levels of cellular and genomic markers of inflammation. Arch Intern Med. 2006;166(16):1756–62. 10.1001/archinte.166.16.1756
36. Alkhalil M, Schulman ES, Getsy J. Obstructive sleep apnea syndrome and asthma: The role of continuous positive airway pressure treatment. Ann Allergy Asthma Immunol. 2008;101(4):350–7. 10.1016/S1081-1206(10)60309-2
37. Salles C, Terse-Ramos R, Souza-Machado A, Cruz ÁA. Obstructive sleep apnea and asthma. J Bras Pneumol. 2013;39(5):604–12. 10.1590/S1806-37132013000500011
38. Chan CS, Woolcock AJ, Sullivan CE. Nocturnal asthma: Role of snoring and obstructive sleep apnea. Am Rev Respir Dis. 1988;137(6):1502–4. 10.1164/ajrccm/137.6.1502
39. Silvestri M, Bontempelli M, Giacomelli M, Malerba M, Rossi GA, Di Stefano A, et al. High serum levels of tumour necrosis factor-alpha and interleukin-8 in severe asthma: Markers of systemic inflammation? Clin Exp Allergy. 2006;36(11):1373–81. 10.1111/j.1365-2222.2006.02502.x
40. Li AM, Hung E, Tsang T, Yin J, So HK, Wong E, et al. Induced sputum inflammatory measures correlate with disease severity in children with obstructive sleep apnoea. Thorax. 2007;62(1):75–9. 10.1136/thx.2006.060657
41. Lumeng JC, Chervin RD. Epidemiology of pediatric obstructive sleep apnea. Proc Am Thorac Soc. 2008;5(2):242–52.
42. Goldstein NA, Abramowitz T, Weedon J, Koliskor B, Turner S, Taioli E. Racial/ethnic differences in the prevalence of snoring and sleep disordered breathing in young children. J Clin Sleep Med. 2011;7(2):163–71.
43. O'Brien LM, Lucas NH, Felt BT, Hoban TF, Ruzicka DL, Jordan R, et al. Aggressive behavior, bullying, snoring, and sleepiness in schoolchildren. Sleep Med. 2011;12(7):652–8.
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