Impact of sleep opportunity on asthma outcomes in adolescents

Abstract

Rationale: Insufficient sleep is associated with a number of negative health outcomes; as most adolescents obtain <7 h of sleep per night, it is important to understand how sleep impacts asthma among adolescents.

Objectives: To examine the impact of sleep opportunity on asthma in adolescents.

Methods: In this study, 54 adolescents with asthma (12-17 years, 69% female, 65% Caucasian) participated in a randomized, cross-over sleep manipulation trial, including a sleep stabilization week, five nights of a "Short" sleep opportunity (time in bed: 6.5 h/night), and five nights of a "Long" sleep opportunity (time in bed: 9.5 h/night). Wake times were consistent across all three study weeks. Primary outcomes were lung function (daily peak expiratory flow rate, weekly spirometry) and functional asthma outcomes (daily asthma symptoms, Asthma Control Questionnaire, PROMIS Asthma Impact Scale). Markers of inflammation were also explored.

Measurements and main results: Compared to the Long sleep week, during the Short sleep week, morning FEV1 was lower (p = 0.006), while asthma symptoms and albuterol use was higher (p < 0.05), and asthma showed a trend towards greater negative impact on daily life (p = 0.07). No differences were found for weekly measures of lung function or inflammation.

Conclusions: An insufficient sleep opportunity negatively impacts objective and subjective daily symptoms of asthma in adolescents, as well as health related quality of life. As most adolescents are significantly sleep deprived, it is important to target sleep health in the treatment of asthma.

Keywords: Adolescence; Pediatrics; Quality of life; Sleep extension; Sleep restriction.

Figure 1:

CONSORT flow diagram of participant recruitment, randomization, and analysis.

Figure 2:

(a) Mean morning FEV1 by treatment and day (bars), with 95% confidence intervals (error bars). Estimates were derived from longitudinal models discussed in the text. (b) Mean difference in morning FEV1, Long versus Short, by day, with 95% confidence intervals. Results show that the biggest mean differences occurred on Days 1 and 2.

Figure 3:

(a) Probability of daytime asthma symptoms by treatment and day (bars), with 95% confidence intervals (error bars). Estimates were derived from longitudinal models discussed in the text. (b) Estimated odds ratios for Short versus Long, by day, with 95% confidence intervals. Results show that the biggest mean difference occurred on Day 3.