Sleep disorders in children with asthma

Abstract

Asthma and sleep disorders are both common in childhood, and often co‐exist in the same child. Moreover, studies have shown that in many children the rate of one is influenced by the other. Sleep disorders can be classified into six different groups—insomnia, hypersomnia, parasomnia, movement disorders, circadian disorders, and sleep‐related breathing disorders. Children with asthma often present with complaints of insomnia with poor sleep quality, difficulty falling asleep and sleep disruptions. These complains are often associated with asthma control. They may also complain of daytime sleepiness and have higher rates of parasomnias, such as night terrors and nocturnal enuresis when compared with their healthy peers. Whether movement and circadian disorders are also more prevalent in children with asthma is less clear. Finally, there is a complex bidirectional interaction between sleep‐related breathing disorders and asthma: poor sleep and sleep disorders may worsen asthma, and asthma, particularly when it is poorly controlled, may impair sleep. In the current review we examine the association of each of the sleep disorders with asthma and review the common pathophysiological pathways. We hope to convince the reader that appropriate management of asthma must include inquiries into the patient's sleep, and vice versa.

Paediatric asthma and non‐allergic comorbidities: A review of current risk and proposed mechanisms

“…“Sleep disorders” is an umbrella term that includes several aspects of sleep including sleep quality/satisfaction/duration, daytime sleepiness, circadian rhythm and sleep disordered breathing (SDB). The prevalence of sleep disorders depends on which aspect is studied, but on the whole, sleep disorders are generally described as common in childhood 105,106 . Exploring the relationship between asthma and sleep disorders has been of interest for decades, in particular the role of asthma severity and asthma control as sleep can be disturbed by nocturnal asthma symptoms 106 …”

“…Furthermore, studies have found an inverse relationship between PSQ score and Asthma Control Test (ACT) score ( p < .001), 121–123 suggesting an association between SDB and poor asthma control. It has been proposed that the bidirectional association between asthma and SBD is due to inflammation in the “united airway,” for example, those with uncontrolled asthma have been found to have higher levels of tonsil TNF‐α compared to children with well‐controlled asthma 105,124 …”

Heterogeneous Condition of Asthmatic Children Patients: A Narrative Review

“…Among all sleep disorders it represents the most frequent in the asthmatic adolescent [62,63] and, despite these findings, is underestimated, poorly characterized, little faced. Insomnia can be secondary to asthma and its therapies [64], be present independently [65], or both with the creation of a vicious circle that is self-sustaining with serious consequences on health and more (Figure 1).…”

“…Among all sleep disorders it represents the most frequent in the asthmatic adolescent [62,63] and, despite these findings, is underestimated, poorly characterized, little faced. Insomnia can be secondary to asthma and its therapies [64], be present independently [65], or both with the creation of a vicious circle that is self-sustaining with serious consequences on health and more (Figure 1). Poorly controlled asthma, weight gain, depression, mental capacity reduction, tendency to illicit drug use, poor scholastic performance, and problems in social and familiar spheres, are just a few of the many consequences [66].…”

“…A stimulating effect is demonstrated for bronchodilators and antileukotriene, which, in addition to promoting sleepwalking and somniloquy (parasomnia NREM), also promote insomnia disorder [60,61]. Improving sleep quality and quantity is highly recommended to achieve asthma control in adolescents [62][63][64][65]. Cognitive Behavioral Therapy (CBT-I) for insomnia is highly recommended due to the positive outcomes observed in sleepless adolescents [68].…”