Asthma, Atopic Dermatitis Associated With Poor Sleep Outcomes in Urban Children

Children with asthma and atopic dermatitis (AD) who live in urban areas may be at a higher risk for poor sleep outcomes, according to study results published in the Annals of Allergy, Asthma and Immunology.

Researchers used data from the Nocturnal Asthma and Performance in School study (NAPS), which included children between the ages 7 and 9 years with persistent asthma (n=206) and asthma with AD (n=35) who resided in urban areas. An additional 130 healthy control individuals were also included in the study. Each child with asthma had a current asthma controller medication prescription or caregiver-reported recurrent daytime or nighttime symptoms, activity limitation, rescue medication use, or ≥2 oral steroid bursts in the previous 12 months.

Asthma outcomes, including 4-week asthma-related lung function assessed from twice-daily measurements of forced expiratory volume in 1 second (FEV₁), were assessed. Additionally, the investigators objectively measured sleep outcomes during the same 4-week period, including the percentage of time spent asleep/total time in bed for the night (ie, sleep efficiency), the mean number of awakenings of ≥3 minutes, and the total time between evening sleep onset and morning waking (ie, sleep duration).

The overall sample was ethnically diverse and included children who were Latino (45%), African American (34%), and non-Latino White (21%). Compared with healthy control individuals, children with asthma and concurrent AD had significantly lower sleep efficiency (b=-2.07; SE=.68; P =.002) and a greater number of awakenings (b=1.14; SE=.45; P =.01). Latino children with asthma and AD also had a significantly shorter sleep duration compared with African American and non-Latino White children with asthma and AD (F=8.31; P =.001).

African American children with asthma alone had significantly lower sleep efficiency than Latino and non-Latino White children (F=3.21; P =.04). Both Latino and African American children with asthma alone had significantly shorter sleep duration compared with non-Latino White children (F=7.73; P =.01). No differences were observed between children with asthma alone vs asthma plus AD in regard to FEV₁-assessed lung function (P =.65) or whether asthma was poorly controlled or well controlled (P =.48).

A significantly greater number of awakenings was associated with a lower mean FEV₁ in children with asthma plus AD (b=-1.36; SE=.67; P =.03). Also, a more optimal sleep efficiency was associated with better asthma control in children with asthma alone (b=.21; SE=0.8; P =.03).

A limitation of the study included the small sample size.

Based on their findings, the researchers suggested that “[i]nterventions that consider specific challenges that may negatively impact sleep outcomes in urban children with asthma and AD are needed, particularly in those of Latino and [African American] descent.”

Reference

Aquino M, Kopel SJ, Dunsiger S, Koinis-Mitchell D. Sleep and asthma outcomes in urban children: does atopic dermatitis increase risk? [published online June 22, 2020]. Ann Allergy Asthma Immunol. doi:10.1016/j.anai.2020.06.029