Sleep-Disordered Breathing in Children with Recurrent Wheeze/Asthma: A Single Centre Study

Risk and Protective Factors for Obstructive Sleep Apnea Syndrome Throughout Lifespan: From Pregnancy to Adolescence

BACKGROUND

Obstructive sleep apnea syndrome (OSAS) in children is indeed a significant and often underdiagnosed condition. The risk factors for OSAS vary across different stages of life.

OBJECTIVES

Identifying risk factors early can help in taking preventive measures to reduce the likelihood of developing OSAS, and different life stages may require different interventions.

RESULTS

During pregnancy, maternal factors such as obesity, smoking, and genetic predispositions can increase the risk of OSAS, while breastfeeding serves as a protective factor. For children aged 2 to 12, adenotonsillar hypertrophy is the primary cause of airway narrowing, with other contributing factors including obesity, craniofacial abnormalities, and increased nasal resistance. In adolescence, obesity and craniofacial abnormalities remain the main risk factors.

CONCLUSIONS

By reviewing and understanding these risk factors, healthcare providers can offer more personalized and effective care, ultimately leading to better health outcomes for individuals at all stages of life.

Habitual snoring coexisting with respiratory allergies in children: Prevalence and impact on quality of life extending beyond primary snoring

Background

Children who have respiratory allergies are more likely to experience sleep disturbances. Persistent sleep-disordered breathing directly contributes to poor symptom control for asthma and allergic rhinitis, including deterioration in quality of life. This study aimed to investigate the prevalence, risk factors of habitual snoring, and the correlation between 18-item obstructive sleep apnea (OSA-18) scores and the level of asthma and allergic rhinitis (AR) symptoms control for habitual snorers with respiratory allergies.

Material and methods

A cross-sectional design was conducted on Thai children aged 2 to 15 who were diagnosed with asthma and AR in a respiratory allergy clinic at the Medical Education Center. The Pediatric Sleep Questionnaire was used to determine the prevalence of habitual snoring. Patients with habitual snoring completed the OSA-18 quality of life questionnaire, which was divided into 5 subscales: sleep disturbance, physical symptoms, emotional distress, daytime function, and caregiver concerns. Symptom control for asthma and AR was evaluated according to the Global Initiative for Asthma (GINA) guidelines and the Visual Analog Scales (VAS), respectively. Multivariable logistic regression models and adjusted odds ratios were used to assess associations.

Results

A total of 565 participants were enrolled, and 363 (64.2%) were male. Habitual snoring had the highest prevalence of sleep-disordered breathing in 29.6% of patients with respiratory allergies. Patients with poorly controlled symptoms had a significantly higher risk of habitual snoring than well controlled symptoms for AR (52.0% vs 19.1%, adjusted Odds Ratio: aOR 4.39, 95%CI 2.25-8.58, p < 0.001) and for asthma concomitant with AR (54.9% vs. 18.8%, aOR 5.18, 95%CI 2.52-10.68, p < 0.001). Habitual snorers with poorly controlled asthma negatively affected their quality of life more than those with well controlled asthma (37.7% vs 13.3%, p = 0.005), as did patients with underlying AR (46.2% vs 22.9%, p = 0.002). In comparison to habitual snorers with well controlled symptoms, those with poorly controlled symptoms for respiratory allergies had higher mean the OSA-18 scores across all subscales.

Conclusion

Nearly one-third of children with respiratory allergies develop habitual snoring. Poorly controlled symptoms of asthma and allergic rhinitis raise the possibility of developing habitual snoring. Their quality of life and caregivers were shown to be affected just as negatively as those with obstructive sleep apnea (OSA) syndrome.

Unveiling the Hidden Connection between Allergies and Sleep-Disordered Breathing in Children and Its Impact on Health

Sleep-disordered breathing (SDB) and allergies in children are increasingly relevant health issues that require attention [...].

The relationship between obstructive sleep apnea and asthma severity and vice versa: a systematic review and meta-analysis

BACKGROUND

There is a great association between the prevalence of obstructive sleep apnea (OSA) and asthma. Nonetheless, whether OSA impacts lung function, symptoms, and control in asthma and whether asthma increases the respiratory events in OSA are unknown. This meta-analysis aimed to examine the relationship between obstructive sleep apnea and asthma severity and vice versa.

METHODS

We carried out a systematic search of PubMed, EMBASE, and Scopus from inception to September 2022. Primary outcomes were lung function, parameters of polysomnography, the risk of OSA in more severe or difficult-to-control asthmatic patients, and the risk of asthma in patients with more severe OSA. Heterogeneity was examined with the Q test and I² statistics. We also performed subgroup analysis, Meta-regression, and Egger's test for bias analysis.

RESULTS

34 studies with 27,912 subjects were totally included. The results showed that the comorbidity of OSA aggravated lung function in asthmatic patients with a consequent decreased forced expiratory volume in one second %predicted (%FEV1) and the effect was particularly evident in children. %FEV1 tended to decrease in adult asthma patients complicated with OSA, but did not reach statistical significance. Interestingly, the risk of asthma seemed to be slightly lower in patients with more severe OSA (OR = 0.87, 95%CI 0.763-0.998). Asthma had no significant effect on polysomnography, but increased daytime sleepiness assessed by the Epworth Sleepiness Scale in OSA patients (WMD = 0.60, 95%CI 0.16-1.04). More severe asthma or difficult-to-control asthma was independently associated with OSA (odds ratio (OR) = 4.36, 95%CI 2.49-7.64).

CONCLUSION

OSA was associated with more severe or difficult-to-control asthma with decreased %FEV₁ in children. The effect of OSA on lung function in adult patients should be further confirmed. Asthma increased daytime sleepiness in OSA patients. More studies are warranted to investigate the effect of asthma on OSA severity and the impact of different OSA severity on the prevalence of asthma. It is strongly recommended that people with moderate-to-severe or difficult-to-control asthma screen for OSA and get the appropriate treatment.

Cluster Analysis of Home Polygraphic Recordings in Symptomatic Habitually-Snoring Children: A Precision Medicine Perspective

(1) Background: Sleep-disordered breathing (SDB) is a frequent problem in children. Cluster analyses offer the possibility of identifying homogeneous groups within a large clinical database. The application of cluster analysis to anthropometric and polysomnographic measures in snoring children would enable the detection of distinctive clinically-relevant phenotypes; (2) Methods: We retrospectively collected the results of nocturnal home-based cardiorespiratory polygraphic recordings and anthropometric measurements in 326 habitually-snoring otherwise healthy children. K-medoids clustering was applied to standardized respiratory and anthropometric measures, followed by Silhouette-based statistics. Respiratory Disturbance Index (RDI) and oxygen desaturation index (≤3%) were included in determining the optimal number of clusters; (3) Results: Mean age of subjects was 8.1 ± 4.1 years, and 57% were males. Cluster analyses uncovered an optimal number of three clusters. Cluster 1 comprised 59.5% of the cohort (mean age 8.69 ± 4.14 years) with a mean RDI of 3.71 ± 3.23 events/hour of estimated sleep (e/ehSleep). Cluster 2 included 28.5% of the children (mean age 6.92 ± 3.43 years) with an RDI of 6.38 ± 3.92 e/ehSleep. Cluster 3 included 12% of the cohort (mean age 7.58 ± 4.73 years) with a mean RDI of 25.5 ± 19.4 e/ehSleep. Weight z-score was significantly lower in cluster 3 [-0.14 ± 1.65] than in cluster 2 [0.86 ± 1.78; p = 0.015] and cluster 1 [1.04 ± 1.78; p = 0.002]. Similar findings emerged for BMI z scores. However, the height z-score was not significantly different among the 3 clusters; (4) Conclusions: Cluster analysis of children who are symptomatic habitual snorers and are referred for clinical polygraphic evaluation identified three major clusters that differed in age, RDI, and anthropometric measures. An increased number of children in the cluster with the highest RDI had reduced body weight. We propose that the implementation of these approaches to a multicenter-derived database of home-based polygraphic recordings may enable the delineation of objective unbiased severity categories of pediatric SDB. Our findings could be useful for clinical implementation, formulation of therapeutic decision guidelines, clinical management, prevision of complications, and long-term follow-up.

Paediatric asthma and non-allergic comorbidities: A review of current risk and proposed mechanisms

It is increasingly recognized that children with asthma are at a higher risk of other non-allergic concurrent diseases than the non-asthma population. A plethora of recent research has reported on these comorbidities and progress has been made in understanding the mechanisms for comorbidity. The goal of this review was to assess the most recent evidence (2016-2021) on the extent of common comorbidities (obesity, depression and anxiety, neurodevelopmental disorders, sleep disorders and autoimmune diseases) and the latest mechanistic research, highlighting knowledge gaps requiring further investigation. We found that the majority of recent studies from around the world demonstrate that children with asthma are at an increased risk of having at least one of the studied comorbidities. A range of potential mechanisms were identified including common early life risk factors, common genetic factors, causal relationships, asthma medication and embryologic origins. Studies varied in their selection of population, asthma definition and outcome definitions. Next, steps in future studies should include using objective measures of asthma, such as lung function and immunological data, as well as investigating asthma phenotypes and endotypes. Larger complex genetic analyses are needed, including genome-wide association studies, gene expression-functional as well as pathway analyses or Mendelian randomization techniques; and identification of gene-environment interactions, such as epi-genetic studies or twin analyses, including omics and early life exposure data. Importantly, research should have relevance to clinical and public health translation including clinical practice, asthma management guidelines and intervention studies aimed at reducing comorbidities.

Subjective sleep-related breathing disorders and executive function in children with intermittent or mild persistent asthma

OBJECTIVE

The impact on executive function performance of sleep-related disorders in asthmatic children has been scarcely studied in community settings. The aims of the present study were to assess the prevalence of sleep-related breathing disorders (SRBD) in children with intermittent or mild persistent asthma in primary care settings, and to examine the possible correlations with measures of executive function.

METHODS

We performed a case-control study including 76 children with asthma (intermittent or mild persistent) and 85 healthy controls. The parents of both patients and controls completed the Paediatric Seep Questionnaire (PSQ) and the Behaviour Rating Inventory of Executive Function (BRIEF) questionnaire.

RESULTS

We did not find any statistically significant differences regarding the scales of PSQ. Additionally, there were no statistical differences between asthmatic children and controls regarding the scales of the BRIEF questionnaire. In both asthmatic children and controls the score of the scale of obstructive sleep-related breathing disorder was significantly correlated with the T scores of the two composite scales (BRI and MI) and the Global Executive Composite.

CONCLUSION

In children with intermittent or mild persistent asthma under the care of private general paediatricians there were no statistically significant differences regarding subjective SBD compared to the healthy controls. Also there were no statistical differences between asthmatic children and controls regarding behavioural correlates of executive function during everyday life.