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Tuesday, 25 June 2013

Sleep May Ease Asthma in Teens (CME/CE)

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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.

Asthma Tied to Sleep Apnea (CME/CE)

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By Ed Susman, Contributing Writer, MedPage Today Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse PlannerNote that this 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.A new study suggests a link between patients with asthma and development of obstructive sleep apnea.Note that for each 5-year increment in duration of asthma, the likelihood of developing obstructive sleep apnea increased by 12%.

PHILADELPHIA -- Patients with asthma were also more likely to develop obstructive sleep apnea, researchers reported here.

Participants in the Wisconsin Sleep Cohort who self-identified as having asthma at the start of the research in 1988 had a 41% incident obstructive sleep apnea rate, compared with an obstructive sleep apnea incident rate of 29% among participants who did not report asthma at the beginning of the study (P<0.001), said Mihaela Teodorescu, MD, of the University of Wisconsin in Madison.

Of the 205 individuals who reported a history of asthma, 84 developed obstructive sleep apnea during the 8-year interval sleep studies, she reported at the annual meeting of the American Thoracic Society.

Of the 1,278 individuals who entered the study without a self-report of asthma, 369 had developed incident obstructive sleep apnea after 8 years.

"There has been a body of evidence published suggesting that there is a relationship between obstructive sleep apnea and asthma," Teodorescu told MedPage Today. "Each disorder makes the other worse, so understanding what starts this vicious cycle is very important. We asked the question of whether asthma promotes the development of obstructive sleep apnea."

"In this cohort we found that having asthma at baseline predicted an increased incidence of obstructive sleep apnea 8 years later," she said. "Overall, having any asthma at baseline predicted about a 72% higher likelihood of developing obstructive sleep apnea 8 years later."

"Interestingly, when stratifying by the age of diagnosis, childhood onset of asthma was a higher predictor for development of obstructive sleep apnea, with an odds ratio of about 2.1," she said in a press briefing following her poster presentation.

"For each 5 years increment in duration of asthma, the likelihood of developing obstructive sleep apnea increased by 12%," she said.

Susheel Patil, MD, of Johns Hopkins University, who moderated the press briefing, said, "Over the years obstructive sleep apnea has been found not to just be associated with excessive daytime sleepiness but has been associated with other diseases such as cardiovascular outcomes, diabetes and metabolic syndromes."

"I think that the relationship between asthma and obstructive sleep apnea may, indeed, be bidirectional as exhibited in this new study," he told MedPage Today.

Teodorescu explained that in the prospective Wisconsin Sleep Cohort participants are studied every 4 years with laboratory polysomnography, validated questionnaires, and structured interviews.

"We selected people in the cohort who were free of obstructive sleep apnea at baseline," she said. "We stratified them based on their asthma diagnosis which was self-reported and they also self-reported the duration of asthma. We didn't see any differences in obstructive sleep apnea severity when we looked at stratification of asthmatics versus no asthma, but the sample sizes became quite small when we tried to separate these groups."

"Overall we conclude that these prospective data suggest that asthma, particularly of childhood onset may contribute to the development of obstructive sleep apnea later on in life. Childhood asthma onset seems to be more of a risk factor for this disease," she said.

The research into teasing out how the diseases impact each other will require further study, she said. "How intrinsic disease characteristics or associated features starting early in life affect upper airway patency during sleep remains unknown," she said.

Teodorescu and Patil said they had no relevant commercial disclosures.

Primary source: American Thoracic Society
Source reference:
Teodorescu M, et al "Asthma predicts 8 year incidence of obstructive sleep apnea in the wisconsin sleep cohort" Am J Respir Crit Care Med 2013; 187: A6015.