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Guidelines for Management of Sleep-Related Breathing Disorders and Asthma

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Allergy and Sleep

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Abstract

Asthma and sleep disordered breathing are highly prevalent conditions associated with tremendous morbidity in the pediatric population. Clinicians may be familiar with managing these conditions in isolation, and guidelines have been drafted to assist in this effort. The task of managing the two conditions together poses a unique challenge, however, where control of one entity is predicated on the control of the other. This comorbidity balancing act is a veritable challenge that is not fully addressed in either asthma or sleep disordered breathing guidelines. This chapter highlights current guidelines with an eye to emerging evidence that may allow clinicians to optimize the treatment of asthma and sleep disordered breathing in unison. A variety of topics are discussed including the impact of aeroallergens and environmental factors in asthma and sleep disordered breathing and the role of inhaled corticosteroids, leukotriene receptor antagonists, and continuous positive airway pressure (CPAP) in the management of obstructive sleep apnea (OSA) in children with asthma.

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References

  1. Masoli M, Fabian D, Holt S, Beasley R. Global burden of asthma. Chest J. 2004;59:469–78. https://doi.org/10.1111/j.1398-9995.2004.00526.x.

    Article  Google Scholar 

  2. NHLBI and Prevention Program Expert Panel Report 3: Guidelines for the diagnosis and management of asthma full report 2007. Children. 2007;120:S94–138. https://doi.org/10.1016/j.jaci.2007.09.029.

  3. Dougherty RH, Fahy JV. Acute exacerbations of asthma: epidemiology, biology and the exacerbation-prone phenotype. Clin Exp Allergy. 2009;39:193–202. https://doi.org/10.1111/j.1365-2222.2008.03157.x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Bergeron C, Al-Ramli W, Hamid Q. Remodeling in asthma. Proc Am Thorac Soc. 2009;6:301–5. https://doi.org/10.1513/pats.200808-089RM.

    Article  PubMed  Google Scholar 

  5. Robinson D, Humbert M, Buhl R, Cruz AA, Inoue H, Korom S, Hanania NA, Nair P. Revisiting Type 2-high and Type 2-low airway inflammation in asthma: current knowledge and therapeutic implications. Clin Exp Allergy. 2017;47:161–75. https://doi.org/10.1111/cea.12880.

    Article  CAS  PubMed  Google Scholar 

  6. Martin RJ, Cicutto LC, Ballard RD. Factors related to the nocturnal worsening of asthma. Am Rev Respir Dis. 1990;141:33–8. https://doi.org/10.1164/ajrccm/141.1.33.

    Article  CAS  PubMed  Google Scholar 

  7. Strunk RC, Sternberg AL, Bacharier LB, Szefler SJ. Nocturnal awakening caused by asthma in children with mild-to-moderate asthma in the childhood asthma management program. J Allergy Clin Immunol. 2002;110:395–403. https://doi.org/10.1067/mai.2002.127433.

    Article  PubMed  Google Scholar 

  8. Chugh IM, Khanna P, Shah A. Nocturnal symptoms and sleep disturbances in clinically stable asthmatic children. Asian Pac J Allergy Immunol. 2006;24:135–42.

    PubMed  Google Scholar 

  9. Robertson CF, Rubinfeld AR, Bowes G. Deaths from asthma in Victoria: a 12-month survey. Med J Aust. 1990;152:511–7.

    CAS  PubMed  Google Scholar 

  10. Brouwer AFJ, Roorda RJ, Brand PLP. Home spirometry and asthma severity in children. Eur Respir J. 2006;28:1131–7. https://doi.org/10.1183/09031936.06.00118205.

    Article  CAS  PubMed  Google Scholar 

  11. Hublet A, De Bacquer D, Vereecken C, Maes L. Value of a shortened questionnaire in the description of asthma in 10-12-year-old pupils. Pediatr Allergy Immunol. 2004;15:247–52. https://doi.org/10.1111/j.1399-3038.2004.00144.x.

    Article  PubMed  Google Scholar 

  12. Ginsberg D. An unidentified monster in the bed – assessing nocturnal asthma in children. Mcgill J Med. 2009;12:31–8.

    PubMed  PubMed Central  Google Scholar 

  13. Porsbjerg C, Von Linstow ML, Ulrik CS, Nepper-Christensen S, Backer V. Risk factors for onset of asthma: a 12-year prospective follow-up study. Chest. 2006;129:309–16. https://doi.org/10.1378/chest.129.2.309.

    Article  PubMed  Google Scholar 

  14. Fishbein AB, Lee TA, Cai M, Oh SS, Eng C, Hu D, Huntsman S, Farber HJ, Serebrisky D, Silverberg J, Williams LK, Seibold MA, Sen S, Borrell LN, Avila P, Rodriguez-Cintron W, Rodriguez-Santana JR, Burchard EG, Kumar R. Sensitization to mouse and cockroach allergens and asthma morbidity in urban minority youth: Genes-environments and Admixture in Latino American (GALA-II) and Study of African-Americans, Asthma, Genes, and Environments (SAGE-II). Ann Allergy Asthma Immunol. 2016;117:43–49.e1. https://doi.org/10.1016/j.anai.2016.05.004.

    Article  PubMed  Google Scholar 

  15. Esteban CA, Everhart RS, Kopel SJ, Klein RB, Koinis-Mitchell D. Allergic sensitization and objective measures of sleep in urban school-aged children with asthma. Ann Allergy Asthma Immunol. 2017;119:238–45. https://doi.org/10.1016/j.anai.2017.06.018.

    Article  PubMed  PubMed Central  Google Scholar 

  16. McColley S a, Carroll JL, Curtis S, Loughlin GM, Sampson H a. High prevalence of allergic sensitization in children with habitual snoring and obstructive sleep apnea. Chest. 1997;111:170–3. https://doi.org/10.1378/chest.111.1.170.

    Article  CAS  PubMed  Google Scholar 

  17. Hanson MD, Chen E. Brief report: the temporal relationships between sleep, cortisol, and lung functioning in youth with asthma. J Pediatr Psychol. 2008;33:312–6. https://doi.org/10.1093/jpepsy/jsm120.

    Article  PubMed  Google Scholar 

  18. Meltzer LJ, Ullrich M, Szefler SJ. Sleep duration, sleep hygiene, and insomnia in adolescents with asthma. J Allergy Clin Immunol Pract. 2014;2:562–9. https://doi.org/10.1016/j.jaip.2014.02.005.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Dewald-Kaufmann JF, Oort FJ, Meijer AM. The effects of sleep extension and sleep hygiene advice on sleep and depressive symptoms in adolescents: a randomized controlled trial. J Child Psychol Psychiatry Allied Discip. 2014;55:273–83. https://doi.org/10.1111/jcpp.12157.

    Article  CAS  Google Scholar 

  20. Hong H, Khan SR, Perez IA. Healthy sleep in children. Am J Respir Crit Care Med. 2017;195:P11–2. https://doi.org/10.1164/rccm.1951P1#readcube-epdf.

    Article  PubMed  Google Scholar 

  21. Brockmann PE, Bertrand P, Castro-Rodriguez JA. Influence of asthma on sleep disordered breathing in children: a systematic review. Sleep Med Rev. 2014;18:393–7. https://doi.org/10.1016/j.smrv.2014.01.005.

    Article  PubMed  Google Scholar 

  22. Castro-Rodriguez JA, Brockmann PE, Marcus CL. Relation between asthma and sleep disordered breathing in children: is the association causal? Paediatr Respir Rev. 2017;22:72. https://doi.org/10.1016/j.prrv.2016.08.010.

    Article  PubMed  Google Scholar 

  23. Bateman ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGerald JM, Gibson P, Ohta K, O’Byrne P, Pedersen SE, Pizzichini E, Sullivan SD, Wenzel SE, Zar HJ. Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J. 2018;51:0751387. https://doi.org/10.1183/13993003.51387-2007.

    Article  Google Scholar 

  24. Meltzer LJ, Johnson C, Crosette J, Ramos M, Mindell J a. Prevalence of diagnosed sleep disorders in pediatric primary care practices. Pediatrics. 2010;125:e1410–8. https://doi.org/10.1542/peds.2009-2725.

    Article  PubMed  Google Scholar 

  25. Li AM, Au CT, So HK, Lau J, Ng PC, Wing YK. Prevalence and risk factors of habitual snoring in primary school children. Chest. 2010;138:519–27. https://doi.org/10.1378/chest.09-1926.

    Article  PubMed  Google Scholar 

  26. Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, Schechter MS, Sheldon SH, Spruyt K, Ward SD, Lehmann C, Shiffman RN, American Academy of Pediatrics. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012a;130:576–84. https://doi.org/10.1542/peds.2012-1671.

    Article  PubMed  Google Scholar 

  27. Rosen CL, Storfer-Isser A, Taylor HG, Kirchner HL, Emancipator JL, Redline S. Increased behavioral morbidity in school-aged children with sleep-disordered breathing. Pediatrics. 2004;114:1640–8. https://doi.org/10.1542/peds.2004-0103.

    Article  PubMed  Google Scholar 

  28. Chervin RD, Ruzicka DL, Archbold KH, Dillon JE. Snoring predicts hyperactivity four years later. Sleep. 2005;28:885–90. https://doi.org/10.1093/sleep/28.7.885.

    Article  PubMed  Google Scholar 

  29. Chervin RD, Ruzicka DL, Giordani BJ, Weatherly RA, Dillon JE, Hodges EK, Marcus CL, Guire KE. Sleep-disordered breathing, behavior, and cognition in children before and after adenotonsillectomy. Pediatrics. 2006;117:e769–78. https://doi.org/10.1542/peds.2005-1837.

    Article  PubMed  Google Scholar 

  30. Teodorescu M, Consens FB, Bria WF, Coffey MJ, McMorris MS, Weatherwax KJ, Palmisano J, Senger CM, Ye Y, Kalbfleisch JD, Chervin RD. Predictors of habitual snoring and obstructive sleep apnea risk in patients with asthma. Chest. 2009;135:1125–32. https://doi.org/10.1378/chest.08-1273.

    Article  PubMed  Google Scholar 

  31. Chervin RD, Hedger K, Dillon JE, Pituch KJ. Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems. Sleep Med. 2000;1:21–32. https://doi.org/10.1016/S1389-9457(99)00009-X.

    Article  CAS  PubMed  Google Scholar 

  32. Chervin RD, Weatherly RA, Garetz SL, Ruzicka DL, Giordani BJ, Hodges EK, Dillon JE, Guire KE. Pediatric sleep questionnaire: prediction of sleep apnea and outcomes. Arch Otolaryngol Head Neck Surg. 2007;133:216–22. https://doi.org/10.1001/archotol.133.3.216.

    Article  PubMed  Google Scholar 

  33. Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, Schechter MS, Ward SD, Sheldon SH, Shiffman RN, Lehmann C, Spruyt K. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012b;130:e714–55. https://doi.org/10.1542/peds.2012-1672.

    Article  PubMed  Google Scholar 

  34. Ehsan Z, Kercsmar CM, Collins J, Simakajornboon N. Validation of the pediatric sleep questionnaire in children with asthma. Pediatr Pulmonol. 2017;52:382–9. https://doi.org/10.1002/ppul.23568.

    Article  PubMed  Google Scholar 

  35. Li AM, Au CT, Sung RYT, Ho C, Ng PC, Fok TF, Wing YK. Ambulatory blood pressure in children with obstructive sleep apnoea: a community based study. Thorax. 2008;63:803–9. https://doi.org/10.1136/thx.2007.091132.

    Article  CAS  PubMed  Google Scholar 

  36. Kirk VG, Bohn SG, Flemons WW, Remmers JE. Comparison of home oximetry monitoring with laboratory polysomnography in children. Chest. 2003;124:1702–8. https://doi.org/10.1378/chest.124.5.1702.

    Article  PubMed  Google Scholar 

  37. Aurora RN, Zak RS, Karippot A, Lamm CI, Morgenthaler TI, Auerbach SH, Bista SR, Casey KR, Chowdhuri S, Kristo DA, Ramar K. Practice parameters for the respiratory indications for polysomnography in children. Sleep. 2011;34:379–88. https://doi.org/10.1093/sleep/34.3.379.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Maris M, Verhulst S, Wojciechowski M, Van de Heyning P, Boudewyns A. Prevalence of obstructive sleep apnea in children with down syndrome. Sleep. 2016;39:699–704. https://doi.org/10.5665/sleep.5554.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Bull MJ, Committee on Genetics the C on, Schieve L, Boulet S, Boyle C, Rasmussen S, Schendel D, Roizen N, Patterson D, Murphy J, et al. Health supervision for children with Down syndrome. Pediatrics. 2011;128:393–406. https://doi.org/10.1542/peds.2011-1605.

    Article  PubMed  Google Scholar 

  40. Weijerman ME, Brand PL, Van Furth MA, Broers CJ, Gemke RJ. Recurrent wheeze in children with Down syndrome: is it asthma? Acta Paediatr. 2011;100:e194. https://doi.org/10.1111/j.1651-2227.2011.02367.

    Article  PubMed  Google Scholar 

  41. Roland PS, Rosenfeld RM, Brooks LJ, Friedman NR, Jones J, Kim TW, Kuhar S, Mitchell RB, Seidman MD, Sheldon SH, Jones S, Robertson P. Clinical practice guideline: polysomnography for sleep-disordered breathing prior to tonsillectomy in children. Otolaryngol Head Neck Surg. 2011;145:S1. https://doi.org/10.1177/0194599811409837.

    Article  PubMed  Google Scholar 

  42. Mitchell RB, Kelly J. Outcome of adenotonsillectomy for obstructive sleep apnea in obese and normal-weight children. Otolaryngol Head Neck Surg. 2007;137:43–8. https://doi.org/10.1016/j.otohns.2007.03.028.

    Article  PubMed  Google Scholar 

  43. Bhattacharjee R, Kheirandish-Gozal L, Spruyt K, Mitchell RB, Promchiarak J, Simakajornboon N, Kaditis AG, Splaingard D, Splaingard M, Brooks LJ, Marcus CL, Sin S, Arens R, Verhulst SL, Gozal D. Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children: a multicenter retrospective study. Am J Respir Crit Care Med. 2010;182:676–83. https://doi.org/10.1164/rccm.200912-1930OC.

    Article  PubMed  Google Scholar 

  44. Bhattacharjee R, Choi BH, Gozal D, Mokhlesi B. Association of adenotonsillectomy with asthma outcomes in children: a longitudinal database analysis. PLoS Med. 2014;11:e1001753. https://doi.org/10.1371/journal.pmed.1001753.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Kheirandish-Gozal L, Dayyat EA, Eid NS, Morton RL, Gozal D. Obstructive sleep apnea in poorly controlled asthmatic children: effect of adenotonsillectomy. Pediatr Pulmonol. 2011;46:913–8. https://doi.org/10.1002/ppul.21451.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Kheirandish-Gozal L, Gozal D. Intranasal budesonide treatment for children with mild obstructive sleep apnea syndrome. Pediatrics. 2008;122:e149–55. https://doi.org/10.1542/peds.2007-3398.

    Article  PubMed  Google Scholar 

  47. Goldbart AD, Goldman JL, Li RC, Brittian KR, Tauman R, Gozal D. Differential expression of cysteinyl leukotriene receptors 1 and 2 in tonsils of children with obstructive sleep apnea syndrome or recurrent infection. Chest. 2004;126:13–8. https://doi.org/10.1378/chest.126.1.13.

    Article  CAS  PubMed  Google Scholar 

  48. Goldbart AD, Goldman JL, Veling MC, Gozal D. Leukotriene modifier therapy for mild sleep-disordered breathing in children. Am J Respir Crit Care Med. 2005;172:364–70. https://doi.org/10.1164/rccm.200408-1064OC.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Kheirandish L, Goldbart AD, Gozal D. Intranasal steroids and oral leukotriene modifier therapy in residual sleep-disordered breathing after tonsillectomy and adenoidectomy in children. Pediatrics. 2006;117:e61–6. https://doi.org/10.1542/peds.2005-0795.

    Article  PubMed  Google Scholar 

  50. Goldbart AD, Greenberg-Dotan S, Tal A. Montelukast for children with obstructive sleep apnea: a double-blind, placebo-controlled study. Pediatrics. 2012;130:e575–80. https://doi.org/10.1542/peds.2012-0310.

    Article  PubMed  Google Scholar 

  51. Kheirandish-Gozal L, Bandla HP, Gozal D. Montelukast for children with obstructive sleep apnea: results of a double-blind randomized placebo-controlled trial. Ann Am Thorac Soc. 2016;13:AnnalsATS.201606–432OC. https://doi.org/10.1513/AnnalsATS.201606-432OC.

  52. Ciftci TU, Ciftci B, Firat Guven S, Kokturk O, Turktas H. Effect of nasal continuous positive airway pressure in uncontrolled nocturnal asthmatic patients with obstructive sleep apnea syndrome. Respir Med. 2005;99:529–34. https://doi.org/10.1016/j.rmed.2004.10.011.

    Article  PubMed  Google Scholar 

  53. Serrano-Pariente J, Plaza V, Soriano JB, Mayos M, López-Viña A, Picado C, Vigil L, CPASMA Trial Group. Asthma outcomes improve with continuous positive airway pressure for obstructive sleep apnea. Allergy. 2017;72:802–12. https://doi.org/10.1111/all.13070.

    Article  CAS  PubMed  Google Scholar 

  54. Martin RJ, Pak J. Nasal CPAP in nonapneic nocturnal asthma. Chest. 1991;100:1024–7.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Pulmonology and Sleep Medicine, Children’s Hospital Los Angeles, Los Angeles, CA, USA

    Daniel Cerrone, Emily Gillett & Sally Ward

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  1. Daniel Cerrone
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  2. Emily Gillett
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  3. Sally Ward
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Correspondence to Sally Ward .

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Editors and Affiliations

  1. Northwestern University, Feinberg School of Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA

    Anna Fishbein

  2. Northwestern University, Feinberg School of Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA

    Stephen H. Sheldon

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Cerrone, D., Gillett, E., Ward, S. (2019). Guidelines for Management of Sleep-Related Breathing Disorders and Asthma. In: Fishbein, A., Sheldon, S. (eds) Allergy and Sleep. Springer, Cham. https://doi.org/10.1007/978-3-030-14738-9_16

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  • DOI: https://doi.org/10.1007/978-3-030-14738-9_16

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