Sleep Questionnaire Can Identify Severe OSA Among Children With Asthma

A new report suggests the Pediatric Sleep Questionnaire can be used to identify children who may be at risk for severe obstructive sleep apnea (OSA).

The study, published in Pediatric Asthma, deals with links between asthma and sleep quality in children. More than 6 million children in America have been diagnosed with asthma, yet corresponding author Dinesh K. Pillai, MD, of Children’s National Hospital, in Washington DC, and colleagues, said perceptions of asthma symptoms can be influenced by comorbid conditions, such as sleep-disordered breathing.

“Sleep-disordered breathing is a prominent comorbid condition in pediatric asthma that ranges in severity from partial obstruction and snoring to multiple episodes of complete upper airway obstruction leading to obstructive sleep apnea (OSA),” the authors noted.

Nationwide, the prevalence of pediatric sleep-disordered sleeping is estimated to be in the range of 1% to 5%. However, rates are believed to be much higher in some minority populations and among children with asthma.

The National Asthma Education and Prevention Program currently recommends that physicians assess patients with poorly controlled asthma for sleep-disordered breathing. One tool for doing so is the Pediatric Sleep Questionnaire, a tool that has been validated for identifying OSA in children. However, Pillai and colleagues said the questionnaire has not yet been evaluated to see how it is associated with guideline-specific asthma impairment.

“Assessment of asthma control in pediatric patients is oftentimes contingent on anecdotal reporting; thus, it is necessary to investigate the efficacy of Pediatric Sleep Questionnaire as a more objective measure of sleep-disordered breathing affecting parameters of asthma control,” the investigators explained.

Pillai and colleagues conducted a retrospective review of the medical records of 205 inner-city children who sought care at their children’s hospital’s severe asthma clinic.

The children had a median age of 6.4 years and 37.2% were female. Most (72%) of the children were African American. The analysis showed no significant correlation between Pediatric Sleep Questionnaire scores and race, ethnicity, gender, age, or moderate/persistent asthma.

However, using a score of ≥0.33 as the cutoff between “normal” and “abnormal,” the investigators found abnormal scores were associated with diagnoses of allergic rhinitis, eczema, and gastroesophageal reflux.

Although the children were, on average in the 71st percentile in terms of body mass index (BMI), and 38.6% of children met the criteria for being clinically obese, the investigators did not find a correlation between BMI and an abnormal score on the questionnaire.

Serum and pulmonary function tests did not reveal associations with Pediatric Sleep Questionnaire scores, but patients with rhinitis, eczema, and gastroesophageal reflux were more likely to have an abnormal score on the questionnaire.

When comparing scores with asthma control, the authors found an abnormal Pediatric Sleep Questionnaire score was associated with poor asthma control across all of National Asthma Education and Prevention Program’s impairment criteria.

Forty-seven patients in the cohort had also undergone polysomnography. Those results showed patients with abnormal Pediatric Sleep Questionnaire scores tended to have higher average apnea-hypopnea index scores, a measure of OSA severity. Children with normal scores tended to have mild OSA, if at all.

Taken together, Pillai and colleagues said the data suggest that patients with uncontrolled asthma are at a significant risk of sleep-disordered breathing, and therefore warrant screening with a tool uch as the Pediatric Sleep Questionnaire. The questionnaire is a low-risk tool with a high potential benefit, they noted. Furthermore, other research has indicated that children with asthma are at a higher risk of requiring continuous positive airway pressure therapy as adults.

“Therefore, early detection of underlying sleep-disordered breathing symptoms concurrent with poorly controlled asthma may be critical in preventing the development of severe OSA later in life,” they said.

Pillai and colleagues said a better understanding of a particular patient’s case, including the presence of and links between asthma and OSA, can lead to better treatment.

“The connection between the two entities is still unclear but thought to be secondary to bidirectional mechanical and molecular inflammatory pathways,” they wrote. “Controlling for one can help reduce the severity of the other when the more contributory underlying issue is identified and addressed effectively.”