Abstract
Introduction: Asthma and allergic rhinitis (AR) have been associated with sleep disordered breathing (SDB). Aim of the study was to examine the association between SDB and diagnosis of asthma and/or rhinitis in children. Methods: Consecutive children (n=140) undergoing PFTs and FeNO examination at the Asthma Outpatient Unit, were recruited. Asthma was diagnosed in 65, both asthma and AR in 57, and single AR in 18. Parents completed the Childhood Asthma Control Test (C-ACT) (for the asthmatic children) and the Sleep-Related Breathing Disorder scale, extracted from the Pediatric Sleep Questionnaire (PSQ) with scores ≥ 0.33 suggestive of high risk for SDB. Results: Mean age was 7.8±3.1 years (range: 4-16.7 years). Mean PSQ and C-ACT scores were 0.17±0.14 and 24.9±3.2 respectively. High risk for SDB was identified in 26 children (mean PSQ 0.4±0.08). Comparison between them and children with normal PSQ score did not reveal differences in terms of age (7.8±3.3 vs. 7.9±3.1, p=0.858) or FeNO [median 19.6 (range 5.6-248) vs. 20.3, (6.7-233.6), p=0.613]. A difference in C-ACT score was disclosed (25.1±3.1 vs. 23.7±3.5, p=0.048) and a negative association between ACT and PSQ scores was demonstrated (r=-0.356, p<0.001). A difference in diagnosis distribution between children at high or low risk for SDB was also revealed (p<0.001). Among children at high risk, 23 (88.5%) were diagnosed with both atopic conditions, 2 had only asthma and 1 single AR. The percentage of both conditions among children with low PSQ score was 29.8 %. Asthma was mainly diagnosed in this group. Conclusions: The presence of AR in asthmatic children seems to increase the burden of SDB, requiring further investigation in this direction.
Highlights
Asthma is the most common chronic disease among children and has a significant financial impact in the Western world, especially in European countries [1], asserting that asthma control is of cardinal importance for public health
A recent study showed that sleep-related breathing disorder (SRBD) is a robust risk factor for not-well-controlled asthma; through multivariate logistic regression analysis, the researchers have shown that the coexistence of SRBD and tonsillar hypertrophy were independent risk factors for not-wellcontrolled asthma after adjusting for other established factors to asthma control [9]
In the present study we have demonstrated that poor asthma control is associated with high risk for SRBD in children
Summary
Asthma is the most common chronic disease among children and has a significant financial impact in the Western world, especially in European countries [1], asserting that asthma control is of cardinal importance for public health. Management of symptoms and comorbidities are of fundamental importance for disease control [2]. Children with asthma and AR, exhibit poorer asthma control, reduced quality of life, increased risk for emergency visits, or hospitalizations, and higher health care burden [5, 6]. The link among asthma and sleep-related breathing disorder (SRBD) is bidirectional due to common risk contributors that, induce airway inflammation [7, 8]. SRBD in children with asthma may lead to difficult-to-control asthma. A recent study showed that SRBD is a robust risk factor for not-well-controlled asthma; through multivariate logistic regression analysis, the researchers have shown that the coexistence of SRBD and tonsillar hypertrophy were independent risk factors for not-wellcontrolled asthma after adjusting for other established factors to asthma control [9]
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