Insufficient sleep opportunity has a negative effect on objective and subjective daily asthma symptoms, along with quality of life, among adolescents, according to the results of an analysis published in the journal Sleep Medicine.
Investigators conducted a randomized crossover sleep manipulation study among adolescents with asthma who were recruited from either National Jewish Health in Denver, Colorado, or community advertisements (eg, Facebook, radio) between May 2015 and July 2017. Recognizing that the majority of adolescents sleep for fewer than 7 hours per night and that insufficient sleep in this population is linked to a number of negative sleep outcomes, the investigators sought to examine the effect of sleep opportunity among adolescents.
A total of 54 adolescents with asthma were enrolled in the study. Overall, 69% of the patients were girls and 65% were white. The study included a sleep stabilization week, 5 nights of a “short” sleep opportunity (ie, time in bed: 6.5 h/night), and 5 nights of a “long” sleep opportunity (ie, time in bed: 9.5 h/night). The wake times were consistent across all 3 study weeks.
The primary study outcomes included lung function (ie, daily peak expiratory flow rate, weekly spirometry) and functional asthma outcomes (ie, daily asthma symptoms, Asthma Control Questionnaire, PROMIS Asthma Impact Scale). Inflammatory markers were also explored.
Study inclusion criteria were age 12.0 to 17.9 years at the time of summer participation in the study; evidence of active asthma in the last year, exemplified by the presence of recurrent daytime or nighttime symptoms, such as cough, wheeze, chest tightness, and shortness of breath, or asthma exacerbations that necessitated an urgent care visit, hospital stay, or systemic corticosteroid use in the past year, or the use of inhaled or oral medications for asthma; or average weekday sleep opportunity between bedtime and wake time of 7.5 to 9 hours.
Compared with the long sleep week, during the short sleep week, morning forced expiratory volume in 1 second (FEV1) was significantly lower than the FEV1 during the long sleep week (P =.006). Further, daily and nightly asthma symptoms (P =.002 and P =.04, respectively) and albuterol use (P <.0001) were both significantly higher in the short sleep week than in the long sleep week. In addition, during the short sleep week, asthma demonstrated a trend toward a greater negative effect on patients’ daily life (P =.07). With regard to weekly measures of lung function and inflammation, no differences were reported between the groups.
The investigators concluded that with the knowledge that most adolescents experience chronic sleep deprivation, it is critically important to target sleep health in the treatment of asthma in this population. Further education of patients and their families regarding the importance of a healthy sleep opportunity is critical.
Meltzer LJ, Beebe DW, Jump S, et al. Impact of sleep opportunity on asthma outcomes in adolescents. Sleep Med. 2019;65:134-141.