Association between asthma and sleep hours in Brazilian adolescents: ERICA

Association of sleep disorders with asthma: a meta-analysis

BACKGROUND

Animal experiments and clinical trials have revealed a potential relationship between sleep disorders and asthma. However, the associations between these factors remain unclear.

MATERIAL AND METHODS

We searched PubMed, Embase, Web of Science and Cochrane Library databases for eligible studies published before 30 December 2022. Studies investigating the association between sleep disorders (insomnia, poor sleep quality and insufficient sleep time) and asthma were selected. Sleep disorders were assessed using questionnaires, interviews, or medical records. Asthma was diagnosed based on medical history and drug use. The Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality checklist were employed for quality assessment. We used OR with 95% CI as the effect measures and forest plots to display the results. Heterogeneity was evaluated using I2 statistics and subgroup analyses were performed for bias analysis. Publication bias was evaluated using the funnel plots and Egger's test.

RESULTS

Twenty-three studies were included in the primary analysis, which suggested a positive association between sleep disorders and asthma (OR: 1.38, 95% CI 1.10 to 1.74). Subgroup analyses were conducted according to the study design, age, family history of asthma and type of sleep disorders. We did not find any association between sleep disorders and asthma in children aged ˂12 years (OR: 1.13, 95% CI 0.97 to 1.32). The association was insignificant in studies where the family history of asthma was adjusted for (OR: 1.16, 95% CI 0.94 to 1.42). Funnel plot and Egger's test indicated a significant publication bias.

CONCLUSION

Sleep disorders are associated with an increased prevalence and incidence of asthma. However, the quality of the evidence was low because of potential biases.

PROSPERO REGISTRATION NUMBER

CRD42023391989.

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.

Sleep and asthma management in youth with poorly-controlled asthma and their caregivers: a qualitative approach

OBJECTIVE

Youth with poorly-controlled asthma are at increased risk for sleep disturbances caused by nocturnal symptoms like coughing. Asthma-related sleep disturbances can have downstream consequences for youth with asthma and their families. This study aims to describe (1) sleep disturbances in adolescents with poorly-controlled asthma and their caregivers and (2) the relationship between sleep and asthma management.

METHODS

Adolescents with poorly-controlled asthma and their caregivers completed the Family Asthma Management System Scale (FAMSS), a semi-structured interview that assesses youth asthma management within the family context. Interviews were audio-recorded and transcribed. Two authors coded each transcript for sleep-related data in NVivo using descriptive content analysis.

RESULTS

Thirty-three adolescents ages 12-15 years old (M = 13.2, SD = 1.2) with poorly-controlled asthma and their caregivers participated in this study. Four main themes emerged: sleep difficulties, sleep environment, sleep and self-management, and fatigue and self-management. 42% of youth and caregivers reported worse nocturnal asthma symptoms (e.g. coughing) that caused frequent nighttime awakening. Approximately 27% of caregivers expressed distress over their child's nocturnal asthma and described their management strategies (e.g. co-sleeping, nighttime symptom monitoring). Adolescents described sleepiness as a barrier to asthma self-management tasks (e.g. medication adherence, response to exacerbation).

CONCLUSION

Interview responses demonstrated the considerable interrelationship of sleep and asthma management in adolescents with poorly-controlled asthma. Asthma providers should consider discussing sleep difficulties with their adolescent patients and their families. Addressing these difficulties may help adolescents improve their asthma self-management and help caregivers better cope with their child's disease.