Asthma and sleep disordered breathing in the pediatric adenotonsillectomy trial for snoring study

Abstract

Purpose: Although asthma is common in children with sleep-disordered breathing (SDB), it is unclear whether and to what extent asthma is associated with SDB-related outcomes. Our objectives are to describe risk factors for asthma among children with mild SDB (mSDB) and assess the association between asthma and the severity of sleep-related outcomes.

Methods: Cross-sectional analyses were conducted for children aged 3-12.9 years with mSDB enrolled in Pediatric Adenotonsillectomy for Snoring Children Study. Sleep-related outcomes included SDB symptoms (Pediatric Sleep Questionnaire-Sleep-Related Breathing Disorder scale (PSQ-SRBD)), SDB-specific quality of life (OSA-18), sleepiness (modified Epworth Sleepiness Score) and polysomnographic and actigraphic measures. Asthma was defined by caregiver-reported diagnosis with current asthma symptoms and medication use, or a Composite Asthma Severity Index (CASI) score ≥ 4. Asthma was further categorized into mild (CASI < 4) and moderate-to-severe (CASI ≥ 4). Regression analyses were conducted to identify asthma risk factors and estimate the associations between mild and moderate-to-severe asthma with sleep-related outcomes.

Results: The sample included 425 children (20.3%-Black, 17.4%-Hispanic; 51.7%-female). The prevalence of asthma was 19.1% (7.1% moderate-to-severe, 12.0% mild). Environmental tobacco smoke exposure and markers of atopy were associated with asthma in multivariable-adjusted analyses. Moderate-to-severe asthma was associated with increased OSA symptoms measured by PSQ-SRBD (adjusted effect estimate for moderate-to-severe vs. no asthma ( $\hat{\beta }$ _adj; 95%CI): 0.08; 0.01, 0.15)) and decreased quality of life measured by OSA-18 ( $\hat{\beta }$ _adj; 95%CI: 7.5; 1.20, 13.82)), and a small increase in the arousal index ( $\hat{\beta }$ _adj; 95%CI: 0.80; 0.09, 1.51)).

Conclusion: Moderate-to-severe asthma was associated with worse QoL and greater SDB symptoms among children with mSDB. The co-occurrence of common risk factors for mSDB and asthma and worse symptoms and quality of life in children with both conditions support coordinated strategies for prevention and co-management of both disorders.

Clinical trial: Pediatric Adenotonsillectomy for Snoring (PATS), NCT02562040, https://clinicaltrials.gov/study/NCT02562040.

Keywords: Asthma; Children; PATS; Sleep-related outcomes.