The Relationship Between Sleep and Asthma

Sleep duration patterns from adolescence to young adulthood and the risk of asthma

PURPOSE

This study examined the association between sleep duration trajectories from adolescence to young adulthood and the risk of asthma into young adulthood.

METHODS

Using data from 10,362 participants in the National Longitudinal Study of Adolescent to Adult Health (Add Health) free of asthma at baseline, we constructed trajectories of sleep duration from adolescence (age 13-18 years) to young adulthood (age 24-32 years) and used them to examine the association between sleep duration patterns and the risk of new-onset asthma using a log-binomial regression model after adjusting for potential confounders.

RESULTS

The results revealed that 14.4% of nonasthmatic participants had persistent short sleep duration, whereas 80.0% had adequate sleep duration from adolescence through young adulthood. Consistently short-sleepers had 1.52 times the risk of new-onset asthma by age 32 years (95% CI 1.11, 2.10) compared with consistently adequate sleepers. The association was stronger in those with a family history of asthma (aRR = 2.43, 95% CI 1.15, 5.13) than in those without such history (aRR = 1.43, 95% CI 1.05, 1.95).

CONCLUSIONS

We conclude that persistent short sleep duration is associated with an increased risk of new-onset asthma in young adults. This association may be more pronounced among those at high risk of asthma because of family history.

Impact of sleep opportunity on asthma outcomes in adolescents

RATIONALE

Insufficient sleep is associated with a number of negative health outcomes; as most adolescents obtain <7 h of sleep per night, it is important to understand how sleep impacts asthma among adolescents.

OBJECTIVES

To examine the impact of sleep opportunity on asthma in adolescents.

METHODS

In this study, 54 adolescents with asthma (12-17 years, 69% female, 65% Caucasian) participated in a randomized, cross-over sleep manipulation trial, including a sleep stabilization week, five nights of a "Short" sleep opportunity (time in bed: 6.5 h/night), and five nights of a "Long" sleep opportunity (time in bed: 9.5 h/night). Wake times were consistent across all three study weeks. Primary outcomes were lung function (daily peak expiratory flow rate, weekly spirometry) and functional asthma outcomes (daily asthma symptoms, Asthma Control Questionnaire, PROMIS Asthma Impact Scale). Markers of inflammation were also explored.

MEASUREMENTS AND MAIN RESULTS

Compared to the Long sleep week, during the Short sleep week, morning FEV1 was lower (p = 0.006), while asthma symptoms and albuterol use was higher (p < 0.05), and asthma showed a trend towards greater negative impact on daily life (p = 0.07). No differences were found for weekly measures of lung function or inflammation.

CONCLUSIONS

An insufficient sleep opportunity negatively impacts objective and subjective daily symptoms of asthma in adolescents, as well as health related quality of life. As most adolescents are significantly sleep deprived, it is important to target sleep health in the treatment of asthma.

Understanding the Relationship Between Asthma and Sleep in the Pediatric Population

The Centers for Disease Control and Prevention reports that 9.5% of children have been diagnosed with asthma. Sleep disturbances affect 20% to 30% of the pediatric population. The prevalence of nocturnal symptoms of asthma is high, and most children regularly experience nighttime symptoms. Sleep is important for growth and development, and untreated sleep disturbances have adverse effects on school performance, mental health, physical health, and functioning. This review will explore the relationship between asthma and sleep disturbances. Clinicians need to assess children with asthma for sleep disturbance.

Missed sleep and asthma morbidity in urban children

BACKGROUND

Children living in urban environments have many risk factors for disrupted sleep, including environmental disturbances, stressors related to ethnic minority status, and higher rates of stress and anxiety. Asthma can further disrupt sleep in children, but little research has examined the effects of missed sleep on asthma morbidity.

OBJECTIVE

To examine the associations among missed sleep, asthma-related quality of life (QoL), and indicators of asthma morbidity in urban children with asthma from Latino, African American, and non-Latino white backgrounds. Given the importance of anxiety as a trigger for asthma symptoms and the link between anxiety and disrupted sleep, the associations among anxiety, asthma morbidity indicators, and missed sleep were also tested.

METHODS

Parents of 147 children ages 6 to 13 years completed measures of asthma morbidity and missed sleep, parental QoL, and child behavior.

RESULTS

Higher reports of missed sleep were related to more frequent school absences, more activity limitations, and lower QoL across the sample. The associations between missed sleep and asthma morbidity were stronger for Latino children compared with non-Latino white and African American children. For children with higher anxiety, the associations between missed sleep and asthma morbidity were stronger than for children with lower anxiety.

CONCLUSION

Results offer preliminary support for missed sleep as a contributor to daily functioning of children with asthma in urban neighborhoods. Missed sleep may be more relevant to Latino families. Furthermore, anxiety may serve as a link between sleep and asthma morbidity because higher anxiety may exacerbate the effects of disrupted sleep on asthma.