Association of asthma and allergic rhinitis with sleep-disordered breathing in childhood

Introduction: Asthma and allergic rhinitis (AR) have been associated with sleep disordered breathing (SDB). Aim of the study was to examine the association between SDB and diagnosis of asthma and/or rhinitis in children. Methods: Consecutive children (n=140) undergoing PFTs and FeNO examination at the Asthma Outpatient Unit, were recruited. Asthma was diagnosed in 65, both asthma and AR in 57, and single AR in 18. Parents completed the Childhood Asthma Control Test (C-ACT) (for the asthmatic children) and the Sleep-Related Breathing Disorder scale, extracted from the Pediatric Sleep Questionnaire (PSQ) with scores ≥ 0.33 suggestive of high risk for SDB. Results: Mean age was 7.8±3.1 years (range: 4-16.7 years). Mean PSQ and C-ACT scores were 0.17±0.14 and 24.9±3.2 respectively. High risk for SDB was identified in 26 children (mean PSQ 0.4±0.08). Comparison between them and children with normal PSQ score did not reveal differences in terms of age (7.8±3.3 vs. 7.9±3.1, p=0.858) or FeNO [median 19.6 (range 5.6-248) vs. 20.3, (6.7-233.6), p=0.613]. A difference in C-ACT score was disclosed (25.1±3.1 vs. 23.7±3.5, p=0.048) and a negative association between ACT and PSQ scores was demonstrated (r=-0.356, p<0.001). A difference in diagnosis distribution between children at high or low risk for SDB was also revealed (p<0.001). Among children at high risk, 23 (88.5%) were diagnosed with both atopic conditions, 2 had only asthma and 1 single AR. The percentage of both conditions among children with low PSQ score was 29.8 %. Asthma was mainly diagnosed in this group. Conclusions: The presence of AR in asthmatic children seems to increase the burden of SDB, requiring further investigation in this direction.