Perceptual accuracy of upper airway compromise in children: Clinical relevance and future directions for research

Racial and ethnic disparities in sleep outcomes among urban children with and without asthma

BACKGROUND

Suboptimal sleep has been documented in at-risk groups such as urban minority children, particularly those with asthma. It is therefore critical to examine differences in sleep outcomes across specific racial and ethnic groups and to identify factors that contribute to such variations in sleep outcomes to inform tailored interventions to improve sleep health.

OBJECTIVES

The objectives were to examine racial/ethnic differences in sleep outcomes among urban children with and without asthma and to evaluate the extent to which asthma status and aspects of sleep hygiene and the sleep environment contribute to racial/ethnic differences in sleep outcomes in this sample.

METHODS

Two hundred and sixteen African American, Latino, or non-Latino white (NLW) urban children, ages 7-9 years, with (n = 216) and without asthma (n = 130) and their primary caregivers were included. Objective sleep duration and efficiency were assessed via actigraphy. Asthma status was assessed by a study clinician. Caregiver-reported sleep hygiene and exposure to noise were assessed using a questionnaire.

RESULTS

Minority children in the sample had, on average, shorter sleep duration compared to NLW children during the monitoring period (mean difference Latino vs NLW = -22.10, SE = 5.02; mean difference AA vs NLW = -18.69, SE = 5.28) Additionally, several racial/ethnic group differences in sleep outcomes emerged and were dependent on whether or not children had asthma. Specifically, Latinos had lower mean number of awakenings compared to NLWs but only among control participants with no asthma. Furthermore, specific aspects of sleep hygiene and exposure to nighttime noise in the home and neighborhood contributed to racial/ethnic differences in sleep outcomes.

CONCLUSION

Considering urban stressors and asthma status when treating pediatric populations is important, as factors related to urban stress and asthma management may influence sleep hygiene practices and sleep outcomes.

Asthma, allergic rhinitis, and sleep problems in urban children

OBJECTIVES

In this study, we examine the association of asthma (asthma symptoms, asthma control, lung function) and sleep problems in a group of urban children. The role of allergic rhinitis (AR), a comorbid condition of asthma, on children's sleep problems is also examined. Finally, we investigate whether sleep hygiene moderates the association between asthma and sleep problems, and whether there are differences in these associations based on ethnic background.

METHODS

Non-Latino White, Latino, and African American urban children with asthma (n = 195) ages 7-9 (47% female) and their primary caregivers participated in a baseline visit involving interview-based questionnaires on demographics, asthma and rhinitis control, and caregiver report of children's sleep problems and sleep hygiene. Children and their caregivers participated in a clinical evaluation of asthma and AR, followed by a month monitoring period of children's asthma using objective and subjective methods.

RESULTS

Total sleep problem scores were higher in children of the sample who were from African American and Latino backgrounds, compared to non-Latino white children. Poor asthma control was predictive of higher levels of sleep problems in the entire sample. Poorer AR control also was related to more sleep problems, over and above children's asthma in the sample. This association was more robust in non-Latino white children. Poor sleep hygiene heightened the association between poor asthma control and sleep problems in the entire sample and in African American children.

CONCLUSIONS

Multidisciplinary interventions integrating the co-management of asthma, AR, and the effects of both illnesses on children's sleep, need to be developed and tailored to children and their families' ethnic background.

Patient-reported outcomes and quality-of-life questionnaires in the assessment of rhinoconjunctivitis in childhood

PURPOSE OF REVIEW

Rhinoconjunctivitis, and especially allergic rhinoconjunctivitis (ARC) are increasing in prevalence, progressively affecting the well being of more and more adults and children. Clinical trials using allergen immunotherapy (AIT), the sole causal treatment of allergies, are being conducted, but discussions on optimal patient-related outcomes (PROs) are still ongoing.

RECENT FINDINGS

Almost all publications discussing PROs relate to adults. The authors comment on the importance of broader PROs when assessing the results of AIT trials, as focusing on only nasal symptom improvement and medication reduction does not capture the full benefit of AIT. Such intervention also improves comorbid allergic diseases and general well being. In studies on rhinoconjunctivitis in children, using medical treatment or immunotherapy published between November 2012 - February 2014 nasal symptom (and medication) scores were primary outcomes in 18 of 20 trials. Only two trials applied quality-of-life questionnaires.

SUMMARY

Clinical trials conducted in children with ARC should be interpreted with caution, as most currently used PROs give a restricted view, by not considering disease manifestations beyond nasal/ocular symptoms. To correctly estimate the full benefit of AIT in pediatric patients with ARC, broader PROs should be investigated, including disease control and quality of health.

Asthma Control Assessment in Children: Correlation between Asthma Control Test and Peak Expiratory Flow

OBJECTIVES

To assess the correlation between asthma control test and peak expiratory flow measurements in children and the impact of certain factors influencing asthma symptoms perception over their correlation.

METHODS

A prospective study including 54 patients aged 5 to 18 years old, who have been diagnosed with asthma in "Victor Gomoiu" Children's Clinical Hospital between May 2012-November 2013, was initiated. For each patient a personalized asthma monitoring plan was designed. This presumes many evaluations assigned to assess the asthma control status. These evaluations consist in counting of asthma symptoms using ACT (Asthma Control Test) and evaluation of pulmonary function using PEF measurement (peak expiratory flow) and spirometry. In each patient factors known to have an influence on asthma symptoms perception (small age, overweighting and allergic rhinitis) were searched. Finally, the correlation between ACT value and PEF variation and how this correlation is influenced by these factors were assessed.

RESULTS

From all 54 included patients a total of 113 evaluations moments were recorded. The assessment of correlation between ACT score and PEF variation for all evaluations showed a strong correlation overall (p<0.01). The correlation is stronger in the small age group (5 to 6 years: p<0.01) than in the older age group (6 to 11 years: p=0.014, >12 years: p=0.03). ACT does not correlate with PEF variation in the overweight patients subgroup (p=0.226). We found the percent of overweight equal to 8.57% in the small age subgroup (5 to 6 years), 26.78% in the 6 to 11 years old group and 31.81% in the over 12 years old patient group. ACT is correlated with PEF variation in both the allergic rhinitis and non allergic rhinitis subgroups (p<0.01).

CONCLUSIONS

ACT is correlated with PEF variation overall. Their correlation is not influenced by small age and the presence of allergic rhinitis, but is influenced by overweighting.

Allergic rhinitis quality of life in urban children with asthma

BACKGROUND

Urban children with asthma and allergic rhinitis (AR) are at risk for experiencing worse AR-related quality of life (QOL). Although AR may be underdiagnosed and undertreated in urban minority children, research has not considered which illness-related indicators (eg, AR control) may contribute to AR QOL in this population.

OBJECTIVE

To examine associations among AR control, asthma control, allergy symptoms, asthma symptoms, and AR QOL in a sample of 195 urban caregivers and their children with asthma (7-9 years of age) from African American, Latino, and non-Latino white backgrounds. Racial and ethnic differences in AR QOL were also examined.

METHODS

Families resided in 1 of 4 cities selected as recruitment sources because of their high concentrations of ethnic minority and non-Latino white, urban families. Caregivers and children completed a series of interview-based and clinician-based assessments across one academic year and 4-week periods to track daily asthma and nasal symptoms.

RESULTS

Better AR control was associated with higher AR QOL (β = -.32, P < .01) and all QOL subscales. AR control predicted AR QOL over and above asthma control (β = -.28, P < .01). Controlling for AR control, non-Latino white children reported better QOL related to practical problems than both Latino and African American children (P < .05).

CONCLUSION

Findings suggest that strategies to enhance AR control in urban children with asthma may assist in improving AR QOL. Non-Latino white children may experience less impairment of their AR QOL because of practical problems (eg, blow nose) than African American or Latino children with asthma.