Original Article
Sleep-Disordered Breathing is Associated with Asthma Severity in Children

https://doi.org/10.1016/j.jpeds.2011.10.008Get rights and content

Objective

To examine the relationships among obesity, sleep-disordered breathing (SDB, defined as intermittent nocturnal hypoxia and habitual snoring), and asthma severity in children. We hypothesized that obesity and SDB are associated with severe asthma at a 1- year follow-up.

Study design

Children aged 4-18 years were recruited sequentially from a specialty asthma clinic and underwent physiological, anthropometric, and biochemical assessment at enrollment. Asthma severity was determined after 1 year of follow-up and guideline-based treatment, using a composite measure of level of controller medication, symptom burden, and health care utilization. Multivariate logistic regression was used to examine adjusted associations of SDB and obesity with asthma severity at 12-month follow-up.

Results

Among 108 subjects (mean age, 9.1 ± 3.4 years; 45.4% African-American; 67.6% male), obesity and SDB were common, affecting 42.6% and 29.6% of subjects, respectively. After adjusting for obesity, race, and sex, children with SDB had a 3.62-fold increased odds of having severe asthma at follow-up (95% CI, 1.26-10.40). Obesity was not associated with asthma severity.

Conclusion

SDB is a modifiable risk factor for severe asthma after 1 year of specialty asthma care. Further studies are needed to determine whether treating SDB improves asthma morbidity.

Section snippets

Methods

This was a prospective observational study performed at Rainbow Babies and Children’s Hospital in Cleveland, Ohio. Children aged 4-18 years initially seen between August 2006 and November 2008 who were diagnosed with asthma by a pediatric pulmonologist were enrolled sequentially. Asthma was diagnosed based on chronic or recurrent symptoms of cough, wheeze, and/or shortness of breath that responded to inhaled bronchodilators and/or inhaled corticosteroids (ICS). Additional eligibility

Results

At the time of our analysis, 201 children had been enrolled out of 477 children eligible for participation. Reasons for refusal were similar to those described in our previous report, with insufficient time being the most commonly cited reason.6 Enrolled children did not differ from those who did not enroll in terms of age, sex, raw BMI, or BMI category (data not shown). Enrolled children had a higher BMI percentile than the 229 nonenrolled children for whom these data were available (77.5 ± 25.4

Discussion

In this prospective observational study, we assessed whether obesity and SDB were associated with asthma severity after 1 year of follow-up in a specialty asthma clinic. After 1 year of follow-up and treatment in a specialty-based asthma clinic, more than 25% of the participants in our study had a high exacerbation rate, had a high symptom burden, or required high doses of ICS to manage their asthma. We found that traditional risk factors for asthma, including male sex and African-American

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    Supported by the Cleveland Foundation (grant L2005-0254) and the National Center for Research Resources (grants KL2RR024990, 1 U54 CA116867, M01 RR00080, and UL1 RR024989). The contents are solely the responsibility of the authors and do not necessarily represent the official view of the National Center for Research Resources or the National Institutes of Health. The authors declare no conflicts of interest.

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