Clinical markers of asthma and IgE assessed in parents before conception predict asthma and hayfever in the offspring

BACKGROUND

Mice models suggest epigenetic inheritance induced by parental allergic disease activity. However, we know little of how parental disease activity before conception influences offspring's asthma and allergy in humans.

OBJECTIVE

We aimed to assess the associations of parental asthma severity, bronchial hyperresponsiveness (BHR), and total and specific IgEs, measured before conception vs. after birth, with offspring asthma and hayfever.

METHODS

The study included 4293 participants (mean age 34, 47% men) from the European Community Respiratory Health Survey (ECRHS) with information on asthma symptom severity, BHR, total and specific IgEs from 1991 to 1993, and data on 9100 offspring born 1972-2012. Adjusted relative risk ratios (aRRR) for associations of parental clinical outcome with offspring allergic disease were estimated with multinomial logistic regressions.

RESULTS

Offspring asthma with hayfever was more strongly associated with parental BHR and specific IgE measured before conception than after birth [BHR: aRRR = 2.96 (95% CI: 1.92, 4.57) and 1.40 (1.03, 1.91), respectively; specific IgEs: 3.08 (2.13, 4.45) and 1.83 (1.45, 2.31), respectively]. This was confirmed in a sensitivity analysis of a subgroup of offspring aged 11-22 years with information on parental disease activity both before and after birth.

CONCLUSION & CLINICAL RELEVANCE

Parental BHR and specific IgE were associated with offspring asthma and hayfever, with the strongest associations observed with clinical assessment before conception as compared to after birth of the child. If the hypothesis is confirmed in other studies, parental disease activity assessed before conception may prove useful for identifying children at risk for developing asthma with hayfever.

[Climateric symptoms and hormone replacement treatment among 50 years old Icelandic women.]

OBJECTIVE

The objective of the research was to estimate the prevalence and treatment of climacteric symptoms among 50 years old women, including which doctors are prescribing the hormone replacement treatment (HRT) and what information is given about the risk and benefit of HRT.

MATERIAL AND METHODS

All (n=956) 50 years old women living in Reykjavík and neighbouring towns were included. A detailed questionnaire was posted to the women with two follow-up reminders. A non-response survey was conducted by phone among those not responding.

RESULTS

The response rate was 72.2% (n=690). Sleep disturbances were the most common climacteric complaint occurring every day, mainly difficulty in maintaining sleep (14.8%). Hot flushes occuring every day (3.6%) and every night (2.2%) were more common than palpitations occuring every day (0.5%) and every night (0.2%). One fourth of the women had been to a doctor because of anxiety and 17% because of depression. Women who had been oophorectomised, were suffering from insomnia, hypertension, had high body mass index (BMI) or were not on HRT were more likely to suffer from hot flushes and palpitations. More than every other woman was on HRT (54%). Combination of oestrogen and progesterone were most commonly used. Hot flushes were less common in women on HRT and one third reported better sleep after starting HRT. Women on HRT more frequently visited doctors, were more often suffering from anxiety, chronic tiredness, fibromyalgia and pain. They more often were heavy smokers and had chronic bronchitis. Most often the HRT was started by gynaecologists (67%) but continued by family doctors (56%). About one fifth claimed that they had not received information about the risk and benefit of HRT.

CONCLUSIONS

More than every other 50 years old woman is on HRT. These women differ in various ways from women not receiving HRT, which underlines the importance of accurate diagnosis and treatment of climacteric symptoms. Better patient information is needed.

Snoring, apneic episodes, and nocturnal hypoxemia among children 6 months to 6 years old. An epidemiologic study of lower limit of prevalence

STUDY OBJECTIVE

To identify a lower limit of the prevalence of sleep-related breathing disturbances among preschool children.

DESIGN

A cross-sectional epidemiologic study in two stages, first by questionnaires and second by whole-night investigation of children symptomatic of the sleep apnea syndrome.

SETTING

Gardabaer, a small town, 10 km south of Reykjavìk, Iceland.

PARTICIPANTS

All children in Gardabaer, 6 months to 6 years old (n = 555).

MEASUREMENTS

Symptom score estimated by questionnaire and respiratory events based on overnight oximetry, thermistors, and a static charge sensitive bed.

RESULTS

The response rate was 81.8%. Snoring was reported as often or very often among 14 (3.2%) and occasionally by 73 (16.7%). Apneic episodes were reported often or very often among seven (1.6%). Altogether 18 children were highly suspected of the sleep apnea syndrome because of habitual snoring or apneic episodes. The girls (n = 9) were older than the boys (mean age: 46 +/- 21 months vs 20 +/- 12 months, p < 0.001). Eventually 11 children came for a whole-night investigation and 8 of them showed more than three respiratory events per hour of sleep, associated with > or = 4% oxygen desaturation. The lower limit of the sleep apnea syndrome prevalence among these children was thus 2.9% (SE, 0.5%).

CONCLUSIONS

Among children, symptoms such as snoring and apneic episodes are reported relatively seldom, but a high proportion of the children with these symptoms have hypoxic respiratory events.

Upper airway infections in preschool children--frequency and risk factors

OBJECTIVE

To estimate the frequency of upper respiratory tract infections (URTI) over a three month period and possible risk factors in the social surroundings, daily routines and health history.

DESIGN

A retrospective epidemiological survey by means of questionnaires.

SETTING

Gardabaer, a small town, ten km south of Reykjavík, Iceland.

PARTICIPANTS

All children in Gardabaer, six months to six years old (n = 555).

MAIN OUTCOME MEASURE

Number of URTI and possible risk factors.

RESULTS

The response rate was 81.8%. The most common infections were common cold (n = 345), acute otitis media (n = 82), sore throat (n = 75), and bronchitis (n = 13). The mean frequency of URTI during the previous three months was 2.2 in boys and 1.7 in girls (p < 0.01). Log-linear regression analysis showed that the predicted number of URTI was 1.9 higher if the child was attending day care, and that the number of URTI increased by 1.015 with each month until the age of 24 months, but decreased after that by 0.985.

CONCLUSIONS

The major factors which affect the frequency of URTI are: age, sex, family history of frequent URTI, asthma, allergy, and the form of day care. Measures to reduce URTI could involve prospective intervention studies on the form of day care.

Sleep habits and sleep disturbances among the elderly--an epidemiological survey

OBJECTIVES

To analyse simultaneously sleep habits and sleep disturbances in an elderly population and numerous factors possibly affecting sleep at the same time.

DESIGN

A cross-sectional epidemiological survey by means of questionnaires.

SETTING

The capital city of Iceland, Reykjavík and surrounding suburbs.

PARTICIPANTS

A randomly selected, but stratified sample with 100 men and 100 women in each 5-year age group of the ages 65-84 years--800 individuals altogether.

MAIN OUTCOME MEASURE

Sleep habits and sleep disturbances.

RESULTS

The mean duration of sleep was 7.25 h (SD 74 min). Mean sleep onset time was 00.13 hours and was not related to age and gender but was delayed at weekends. Daytime napping was reported by 50% of the men and 31% of the women (P < 0.001). Difficulty maintaining sleep (DMS) was the most commonly reported insomnia complaint (men 37% and women 30%). Sleep charts revealed that men woke up an average of 1.2 times per night but women 0.8 times per night (P < 0.01). Difficulty initiating sleep was reported by 9.6% and early morning awakening (EMA) by 16.7%. Pain was a strong factor contributing to EMA. There was also an increase in EMA complaints among the elderly with obstructive pulmonary diseases and systemic hypertension. The prevelance of insomnia was only partly related to age and gender. Multiple regression analyses, however, showed different interrelationships between insomnia and other symptoms and findings for men versus women.

CONCLUSION

DMS is the most commonly reported insomnia complaint among the elderly (men 37% and women 30%). The prevalence of insomnia did not increase with age in our study group.

Snoring, hypertension, and the sleep apnea syndrome. An epidemiologic survey of middle-aged women

The lower limit of the prevalence of sleep apnea syndrome (SAS) was estimated among women 40 to 59 years old by a two-stage procedure. In the first stage 2,016 questionnaires were mailed. The response rate was 75.6 percent. Daytime sleepiness was reported by 8.2 percent, habitual snoring by 11.2 percent, and intermittent snoring by 21.7 percent. There were altogether 128 women described with systemic hypertension and these women were more than twice as often habitual snorers. Logistic multiple regression analyses showed almost a threefold increase in the predicted prevalence of hypertension among intermittent and habitual snorers compared with nonsnorers in the age group 40 to 49 years old and a 60 percent increase in the 50- to 59-year-old age group. In the second stage, a group of 97 women highly suspected of SAS were selected because of their habitual snoring and daytime sleepiness. Eventually, 35 of these came for night studies and 14 were found to have SAS. Among the 35 women, 12 were hypertensive and nine of these had SAS. We estimated the lower limit of the prevalence of SAS to be 2.5 percent for women 40 to 59 years old. It is concluded that SAS is a relatively common occurrence among women, especially postmenopausal ones, and it is strongly related to hypertension.