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By Cole Petrochko, Staff Writer, MedPage Today Reviewed by F. Perry Wilson, MD, MSCE; Instructor of Medicine, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse PlannerThis study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.Note that this small pilot study with a before-after design demonstrated that providing teens with asthma with the opportunity for "healthy sleep" improved nocturnal symptoms and subjective measures of executive function.BALTIMORE -- A pilot sleep extension program for teens with asthma was associated with improved daytime lung function and fewer nighttime symptoms, researchers reported here.
Teens with asthma who got more sleep during an experimental sleep extension program had significantly fewer nocturnal asthma symptoms (P=0.001) and less variability in objective daily lung function (P=0.05), according to Lisa Meltzer, MD, of the National Jewish Health Center in Denver, Colo., and colleagues.
Longer sleep among teens with asthma was also associated with moderate effects on executive functioning, Meltzer said during an oral presentation at the Associated Professional Sleep Societies meeting.
The authors noted that sleep disturbance in young patients with asthma can be significant even among those with well-controlled asthma. Management of symptoms, such as increasing sleep duration, may improve asthma control, they hypothesized.
The researchers tested their hypothesis through a 12-teen, 2-week pilot sleep extension study that measured the impact of healthy sleep duration on asthma symptoms and executive function. The patients were mostly white (58%), mostly male (75%), and had a mean age of 13.3.
A preliminary study sampling sleep duration in teens showed that teens, regardless of asthma status, did not get enough sleep, which was not a surprise, Meltzer noted. Sleep time fell well below the recommended 9.3 hours on weekdays with an average roughly around 7.5 hours of sleep a night.
Participants completed a baseline sleep stabilization week, followed by 5 nights of 10 hours of sleep, deemed a healthy sleep opportunity week.
The teens kept a sleep diary and had sleep data collected through actigraph. The authors also collected data on lung function through morning electronic peak expiratory flow, as well as an asthma symptom diary. Parents of the participants also completed a Brief Rating Inventory of Executive Functioning measure.
The baseline adjustment week showed improved outcomes for fewer daytime asthma symptoms (P=0.04) and objective daily lung function (P=0.04) among participants who reported better sleep quality.
Compared with the baseline stabilization period, the experimental sleep period was associated with significantly earlier reported bedtimes (20:40 versus 22:10, P<0.001), improved actigraphic sleep onset time (21:36 versus 22:37, P<0.001), and total sleep time (475 minutes versus 429 minutes, P<0.001). There was no significant difference between periods for reported wake time, which was 6:30 a.m. in each group.
During the sleep extension period, longer actigraphic sleep duration was tied to fewer nocturnal symptoms and less variability in objective daily lung function, they wrote.
Based on parental report of executive function, teens showed a moderate effect for working memory (d=0.54), planning and organization (d=0.42), and monitoring (d=0.53) during the extended sleep week.
"The sleep extension protocol was feasible in adolescents with asthma," said Meltzer, adding that, because most adolescents were sleep derived, "increased sleep duration may contribute to decreased inflammation and improved asthma expression."
She also said that the disruption in sleep and subsequent fault in executive function could impair adherence to asthma treatment, which may explain poorer outcomes for function and symptoms in patients who get fewer hours and lower quality of sleep.
She said that ongoing research on the topic will include a larger sample, a counterbalanced design of participants receiving healthy (10 hours) and deficient (6.5 hours) sleep, and weekly outcome measures for lung function, airway inflammation, and inflammatory cytokines.
Session moderator Ann Halbower, MD, of the Children's Hospital Colorado in Aurora and who was not involved in the study, noted she was excited to see data from the larger patient population, as well as outcomes on inflammation and inflammatory cytokines.
"As long as we can rule out sleep apnea in those kids so that we're only looking at inflammation and asthma, it should be very interesting to correlate inflammatory markers in those kids with sleep disruption," Halbower told MedPage Today.
The study was supported by an NIH grant.
The authors declared no conflicts of interest.
Primary source: Associated Professional Sleep Societies
Source reference:
Meltzer LJ, et al "Experimentally manipulated sleep extension in adolescents with asthma: feasibility and preliminary findings" SLEEP 2013; Abstract 0993.
Cole Petrochko
Staff Writer
Cole Petrochko started his journalism career at MedPage Today in 2009, after graduating from New York University with B.A.s in Journalism and Psychology. When not writing for MedPage Today, he blogs about nerd culture, designs websites, and buys and sells collectible card game cards. He is based out of MedPage Today's Little Falls, N.J. Headquarters.
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