Association of sleep disordered breathing with severity and control of persistent asthma in Indian children

Abstract

Objective

To assess the association of pediatric sleep disordered breathing (SDB) with control and severity of asthma, and to evaluate the comorbidities associated with both.

Methods

Based on the Sleep-Related Breathing Disorder scale, extracted from the Pediatric Sleep Questionnaire (SDBS-PSQ), children (5–15 years) with persistent asthma were classified as; with SDB (SDBS-PSQ≥0.33) and without SDB (SDBS-PSQ<0.33), in a cross-sectional study. Baseline characteristics were compared. Control of asthma into well-controlled, not-well, and poorly controlled was assessed using childhood – asthma control test (c-ACT). Comorbidities like adeno-tonsillar hypertrophy, gastroesophageal reflux disease (GERD), obesity and allergic rhinitis (AR) for presence of SDB in asthma were assessed.

Results

Sixty asthmatics were included. Mild, moderate, and severe persistent asthma was observed in 26.67 %, 40 % and 33.33 % respectively, with 18.33 % asthmatics having SDB. 42.3 % of uncontrolled asthmatics had SDB. Baseline characteristics were similar in both groups. Asthmatics with SDB had higher frequency of severe persistent (63.6 % vs 26.5 %, p = 0.018) and uncontrolled asthma i.e. partly & poorly controlled (100 % vs 30.6 %, p < 0.001) versus asthmatics without SDB. Mean SDBS-PSQ score was higher in uncontrolled asthmatics compared to well-controlled asthmatics (0.255 ± 0.19 vs 0.047 ± 0.06, p < 0.001). Mean c–ACT score was lower with SDB (14.45 ± 3.20 vs 20.04 ± 4.56, p < 0.001), indicating poor control of asthma. A negative relationship was established between c-ACT and SDBS-PSQ (p < 0.001, r² = −0.36). Higher occurrence of AR was found in asthmatics with SDB (72.7 % vs 20.4 %, p = 0.001).

Conclusion

SDB may be associated with poor control and worsening severity of asthma. Concomitant AR was found in asthmatic children with SDB.