Sleep Apnea in Asthmatic Children and Teenagers
Condition: Asthma, Bronchial; Bronchial Asthma; Apnea, Sleep; Sleep Apnea, Mixed Central and Obstructive; Sleep Hypopnea (Diagnosis); Obstructive Sleep Apnea; Obstructive Sleep Apnea Syndrome
MeSH terms: Asthma; Apnea; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
Study type: Interventional

Summary: 
      Asthma and sleep apnea are both respiratory diseases and one can worsen the other. Those who
      suffer from asthma have a higher risk of sleep apnea and sleep apnea can make the asthma more
      difficult to control.

      As girls usually have a more severe asthma than boys, the investigators believe that girls
      have a higher risk of sleep apnea.

      To test if asthmatic girls have more sleep apnea than boys, the investigators are going to
      ask them questions regarding asthma and sleep symptoms (such as snore) and the investigators
      are going test the lung function and how many times they stop breathing during the sleep. The
      sleep test is going to be performed in children's home.

      In children, having sleep apnea can make the asthmatic stay in the hospital 30% more when
      they have an asthma attack. We also are going to look if sleep apnea increases the number of
      hospitalizations and asthma attacks in the past 12 months.
    

Detailed description: 
      Obstructive sleep apnea (OSA) and asthma are both inflammatory airway diseases. A systematic
      review regarding sleep-disordered breathing (SDB) in asthmatic children analyzed 17 studies
      but only two of them had objective OSA measurement. In total, 45,115 children were included,
      53% boys, mean age 8.6 ± 2.5 years. SDB was present in 23.8% of asthmatic children and in
      16.7% of non-asthmatic (p < 0.001, OR 1.9, 95%CI 1.7-2.2).

      An American study found that OSA in asthmatic children increases hospital length of stay (OR
      2.3; 95% CI = 1.8 - 2.9). Brazilian database of the year 2015 showed that, among children
      5-19 years, asthma was the 5th cause of hospitalization: a total of 2.4% of the
      hospitalization in this age group, after birth and its complication (31%), limb fractures
      (5.7%), pneumonia (3.8%), and appendicitis (3.2%).

      The relationship among asthma severity (mild, moderate, and severe) and OSA has been
      described previously, but not in every study. Poor asthma control has also been linked to a
      higher OSA risk in adults and children.

      OSA and asthma share many risk factors: rhinitis, increased collapsibility of the upper
      airway, local and systemic inflammation, gastroesophageal reflux, and obesity.

      A higher risk of SDB in asthmatic girls has recently been described (OR 2.55 for girls and
      0.70 for boys). Among non-asthmatic children OSA is usually equal among boys and girls until
      adolescence. A possible explanation is asthma severity in children: younger boys are more
      severe but after puberty, girls are.

      Since OSA and asthma are linked diseases and that little is known about them in the pediatric
      field, specially differences related to sex, the investigators hypothesize that: 1) asthmatic
      girls have a higher OSA risk; 2) OSA will be higher in asthmatic children compared to the
      pediatric literature; 3) asthma severity, asthma control, and rhinitis will be related to a
      higher OSA risk. The investigators also aim to analyze factors associated with a higher risk
      of hospitalizations and asthma attacks.
    

Intervention name(s): Questionnaire; Lung Function Test; Home Sleep Study
Intervention type(s): Other; Other; Other
Intervention description(s): Children and parents are going to inform data regarding socioeconomical status, asthma and rhinitis diagnosis, asthma and rhinitis control, medications, sleep complaints, and sleep habits; Children are going to blow in a machine that measures how the lung is working; Children are going to sleep at home with a device that tells if they stop breathing during sleep
Other intervention name(s): Spirometry; Polysomnography
Intervention model: Single Group Assignment
Intervention model description: Sleep study and spirometric evaluation of children with asthma
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Asthma; Obstructive Sleep Apnea; Children; Teenagers