Asthma significantly affects quality of sleep. Asthma physiology follows a diurnal pattern with peak flow at its lowest during early morning hours. The type and timing of release of inflammatory mediators also varies during the day and nighttime. Nocturnal symptoms are common in poorly controlled asthma. Hence, these nighttime symptoms play a significant role in the assessment of asthmatic patients as demonstrated in validated asthma control and quality of life questionnaires. Comorbid conditions may include allergic rhinitis, obesity, obstructive sleep apnea, and gastroesophageal reflux, all of which may worsen asthma symptoms, especially during sleep. In addition, exposure to greater loads of allergens in susceptible individuals during sleep is a significant problem and must be addressed to break the cycle of poor asthma control. Thus, asthma education for better symptom control should address these particular issues surrounding sleep.
SondickEJMadansJHGentlemanJF. Summary health statistics for US children: National Health Interview Survey, 2009. Vital Health Stat 10. 2009;(247):1-85.
ManninoDMHomaDMAkinbamiLJMoormanJEGwynnCReddSC. Surveillance for asthma—United States, 1980-1999. MMWR Surveill Summ. 2002;51(1):1-13.
4.
GergenPJWeissKB. Changing patterns of asthma hospitalization among children: 1979-1987. JAMA. 1990;264:1688-1692.
5.
National Heart, Lung, and Blood Institute. Data Fact Sheet: Asthma Statistics. Rockville, MD: US Department of Health and Human, National Heart, Lung, and Blood Institute; 1999. http://www.nhlbi.nih.gov/health/prof/lung/asthma/asthstat.pdf.Accessed February 5, 2011.
6.
AkinbamiLJSchoendorfKC. Trends in childhood asthma: prevalence, health care utilization, and mortality. Pediatrics. 2002;110:315-322.
7.
HaltermanJSAligneCAAuingerPMcBrideJTSzilagyiPG. Inadequate therapy for asthma among children in the United States. Pediatrics. 2000;105:272-276.
8.
WeissKBGergenPJHodgsonTA. An economic evaluation of asthma in the United States. N Engl J Med. 1992;326:862-866.
9.
JuniperEFGuyattGHFeenyDHFerriePJGriffithLETownsendM. Measuring quality of life in children with asthma. Qual Life Res. 1996;5:35-46.
10.
FagnanoMvan WijngaardenEConnollyHVCarnoMAForbes-JonesEHaltermanJS. Sleep-disordered breathing and behaviors of inner-city children with asthma. Pediatrics. 2009;124:218-225.
11.
ChervinRDHedgerKDillonJEPituchKJ. Pediatric Sleep Questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring sleepiness, and behavioral problems. Sleep Med. 2000;1:21-32.
12.
GuilleminaultCStoohsRDuncanS. Snoring (I) Daytime sleepiness in regular heavy snorers. Chest. 1991;99:40-48.
13.
GuilleminaultCStoohsRClerkACetelMMaistrosP. A cause of excessive daytime sleepiness. The upper airway resistance syndrome. Chest. 1993;104:781-787.
14.
DesagerKNNelenVWeylerJJDe BackerWA. Sleep disturbance and daytime symptoms in wheezing school-aged children. J Sleep Res. 2005;14:77-82.
15.
BohadanaABHannhartBTeculescuDB. Nocturnal worsening of asthma and sleep-disordered breathing. Asthma. 2002;39:85-100.
16.
LarssonLGLindbergAFranklinKALundbackB. Symptoms related to obstructive sleep apnea are common in subjects with asthma, chronic bronchitis and rhinitis in a general population. Respir Med. 2001;95:423-429.
GoldsteinMFVezaBADunskyEHDvorinDJBelecanechGAHaralabatosIC. Comparisons of peak diurnal expiratory flow variation, postbronchodilator FEV(1) responses, and methacholine inhalation challenges in the evaluation of suspected asthma. Chest. 2001;119:1001-1010.
19.
PanzerSEDodgeAMKellyEAJarjourNN. Circadian variation of sputum inflammatory cells in mild asthma. J Allergy Clin Immunol. 2003;111:308-312.
20.
EnrightPLMcClellandRLBuistASLebowitzMD. Correlates of peak expiratory flow lability in elderly persons. Chest. 2001;120:1861-1868.
21.
LehtamikiLKankaanrantaHSaarelainenSTurjanmaaVMoilanenE. Increased alveolar nitric oxide concentrations in asthma patients with nocturnal symptoms. Eur Respir J. 2002;20:841-845.
22.
KraftMDjukaovicRWilsonSHolgateSTMartinRJ. Alveolar tissue inflammation in asthma. Am J Resp Crit Care Med. 1996;154:1505-1510.
23.
SutherlandERMartinRJBowlerRPZhangYRexMDKraftM. Physiologic correlates of distal lung inflammation in asthma. J Allergy Clin Immunol. 2004;113:1046-1050.
24.
SmithDLDeshazoRD. Bronchoalveolar lavage in asthma. An update and perspective. Am Rev Respir Dis. 1993;148:523-532.
25.
HowarthP. Small airway inflammation and asthma. Int J Clin Pract Suppl. 1998;96:15-22.
26.
SzeflerSAndoRCicuttoLCSursWHillMRMartinRJ. Plasma histamine, epinephrine, cortisol, and leukocyte beta-adrenergic receptors in nocturnal asthma. Clin Pharmacol Ther. 1991;49:59-68.
27.
KraftMViannaEMartinRJLeungDY. Nocturnal asthma is associated with reduced glucocorticoid receptor binding affinity and decreased steroid responsiveness at night. J Allergy Clin Immunol. 1999;103:66-71.
28.
National Institutes of Health; National Heart, Lung and Blood Institute. Expert Panel Report: Guidelines for the diagnosis and management of asthma (National Asthma Education and Prevention Program). http://www.nhlbi.nih.gov/guidelines/asthma/. Published July2007. Accessed April 20, 2011.
29.
JuniperEFO’ByrnePMGuyattGHFerriePJKingDR. Development and validation of a questionnaire to measure asthma control. Eur Respir J. 1999;14:902-907.
30.
JuniperEFGruffydd-JonesKWardSSvennsonK. Asthma Control Questionnaire in children: validation, measurement properties, interpretation. Eur Respir J. 2010;36:1410-1416.
31.
MurphyKRZeigerRSKosinksiM. Test for respiratory and asthma control in kids (TRACK): a caregiver-completed questionnaire for preschool-aged children. J Aller Clin Immunol. 2009;123:833-839.
RichardsonGEickSJonesR. How is the indoor environment related to asthma? Literature review. J Adv Nurs. 2005;52:328-339.
34.
BousquetJNeukirchFBousquetPJ. Severity and impairment of allergic rhinitis in patients consulting in primary care. J Allergy Clin Immunol. 2006;117:158-162.
35.
LegerDAnnesi-MaesanoICaratF. Allergic rhinitis and its consequences on quality of sleep: an unexplored area. Arch Intern Med. 2006;166:1744-1748.
36.
DeaneSThomsonA. Obesity and the pulmonologist. Arch Dis Child. 2006;91:188-191.
37.
MelenEHimesBEBrehmJM. Analyses of shared genetic factors between asthma and obesity in children. J Allergy Clin Immonol. 2010;126:631-637.
38.
LitonjuaAAGoldDR. Asthma and obesity: common early-life influences in the inception of disease. J Allergy Clin Immunol. 2008;121:1085-1086.
39.
WeissST. Obesity: insight into the origins of asthma. Nat Immunol. 2005;6:537-539.
40.
MatricardiPMGruberCWahnULauS. The asthma-obesity link in childhood: open questions, complex evidence, a few answers only. Clin Exp Allergy. 2007;37:476-484.
41.
OberCHoffjanS. Asthma genetics 2006: the long and winding road to gene discovery. Genes Immun. 2006;7:95-100.
42.
RankinenTZuberiAChagnonYC. The human obesity gene map: the 2005 update. Obesity (Silver Spring). 2006;14:529-644.
43.
Castro-GinerKogevinas MImbodenM. Joint effect of obesity and TNFA variability on asthma: two international cohort studies. Eur Respir J. 2009;33:1003-1009.
44.
MurphyATantisiraKGSoto-QuirosMD. PRKCA: a positional candidate gene for body mass index and asthma. Am J Hum Genet. 2009;85:87-96.
45.
SzczepankiewiczABreborowiczASobkowiakPPopielA. Are genes associated with energy metabolism important in asthma and BMI?J Asthma. 2009;46:53-58.
46.
BiringMSLewisMILiuJTMohsenifarZ. Pulmonary physiologic changes of morbid obesity. Am J Med Sci. 1999;318:293-297.
47.
BedellGNWilsonWRSeebhomPM. Pulmonary function in obese persons. J Clin Invest. 1958;37:1049-1060.
48.
KierCFordeSA. Childhood overweight and obesity and their association with asthma. J Asthma Allergy Educators. 2011;2:119-125.
RudolfMCHochbergZSpeiserP. Perspectives on the development of an international consensus on childhood obesity. Arch Dis Child. 2005;90:994-996.
51.
MaiXMBottcherMFLeijonI. Leptin and asthma in overweight children at 12 years of age. Pediatr Allergy Immunol. 2004;15:523-530.
52.
ShinJHKimJHLeeWYShimJY. The expression of adiponectin receptors and the effects of adiponectin and leptin on airway smooth muscle cells. Yonsei Med J. 2008;49:804-810.
53.
NagelGKoenigWRappKWabitschMZoellnerIWeilandSK. Associations of adipokines with asthma, rhinoconjuctivitis, and eczema in German schoolchildren. Pediatr Allergy Immunol. 2009;20:81-88.
54.
SinDDJonesRLManSFP. Obesity is a risk factor for dyspnea but not for airflow obstruction. Arch Intern Med. 2002;162:1477-1481.
55.
PeroniDGPietrobelliABonerAL. Asthma and obesity in childhood: on the road ahead. Int J Obes (Lond). 2010;344:599-605.
56.
KasasbehAKasasbehEKrishnaswamyG. Potential mechanisms connecting asthma, esophageal reflux, and obesity/sleep apnea complex—a hypothetical review. Sleep Med Rev. 2007;11:47-58.
57.
NamenAMDunganDPFleischerA. Increased physician-reported sleep apnea: the National Ambulatory Medical Care Survey. Chest. 2002;121:1741-1747.
58.
TeodorescuMPolomisDAHallSV. Association of obstructive sleep apnea risk with asthma control in adults. Chest. 2010;138:543-550.
59.
LumengJCChervinRD. Epidemiology of pediatric obstructive sleep apnea. Proc Am Thorac Soc. 2008;5:242-252.
60.
KaditisAGKalampoukaEHatzinikolaouS. Associations of tonsillar hypertrophy and snoring with history of wheezing in childhood. Pediatr Pulmonol. 2010;45:275-280.
61.
SulitLGStorfer-IsserARosenCLKirchnerHLRedlineS. Associations of obesity, sleep-disordered breathing, and wheezing in children. Am J Respir Crit Care Med. 2005;171:659-664.
62.
HatipogluURubinsteinI. Inflammation and obstructive sleep apnea syndrome: how many ways do I look at thee?Chest. 2004;126:1-2.
63.
KlinkMEDodgeRQuanSF. The relation of sleep complaints to respiratory symptoms in a general population. Chest. 1994;105:151-154.
64.
BonekatHWHardinKA. Severe upper airway obstruction during sleep. Clin Rev Allergy Immunol. 2003;25:191-210.
65.
ShamsuzzamanASWinnickiMLanfranchiP. Elevated C-reactive protein in patients with obstructive sleep apnea. Circulation. 2002;105:2462-2464.
66.
Kheirandish-GozalLGozalD. Intranasal budesonide treatment for children with mild obstructive sleep apnea syndrome. Pediatrics. 2008;122:e149-e155.
67.
KheirandishLGoldbartADGozalD. Intranasal steroids and oral leukotriene modifier therapy in residual sleep-disordered breathing after tonsillectomy and adenoidectomy in children. Pediatrics. 2006;117:e61-e66.
68.
SteinMR. Possible mechanisms of influence of esophageal acid on airway hyperresponsiveness. Am J Med. 2003;115(suppl 3A):55S-59S.
69.
KhoshooVMonhotSHaydelRJrSaturnoEEdellDKobernickA. Bronchial hyperreactivity in non-atopic children with asthma and reflux: effect of anti-reflux treatment. Pediatr Pulmonol. 2009;44:1070-1074.
70.
ShakerRCastellDSchoenfeldPSpechlerSJ. Nighttime heartburn is an under-appreciated clinical problem that impacts sleep and daytime function: the results of a Gallup survey conducted on behalf of the American Gastroenterological Society. Am J Gastroenterol. 2003;98:1487-1493.
71.
HardingSM. Gastroesophageal reflux during sleep. Sleep Med Clin. 2007;2:41-50.
72.
KiljanderTOHardingSMFieldSK. Effects of esomeprazole 40 mg twice daily on asthma. A randomized placebo-controlled trial. Am J Respir Crit Care Med. 2006;173:1091-1097.
73.
ChanWWChiouEObsteinKLTignorASWhitlockTL. The efficacy of proton pump inhibitors for the treatment of asthma in adults. Arch Intern Med. 2011;171:620-629.
74.
PaulIM. Data do not support use of OTC decongestants in children. AAP News. 2007;28(1):1.
75.
CustovicAHallamCWoodcockH. Synthetic pillows contain higher levels of cat and dog allergen than feather pillows. Pediatr Allergy Immunol. 2000;11:71-73.
76.
WoodRAJohnsonEFVan NattaMLChenPHEgglestonPA. Placebo-controlled trial of a HEPA air cleaner in the treatment of cat allergy. Am J Respir Crit Care Med. 1998;158:115-120.
77.
van der HeideSvan AalderenWMCKauffmanHFDuboisAEde MonchyJG. Clinical effects of air cleaners in homes of asthmatic children sensitized to pet allergens. J Allergy Clin Immunol. 1999;104:447-451.
78.
BrouilletteRTManoukianJJDucharmeFM. Efficacy of fluticasone nasal spray for pediatric obstructive sleep apnea. J Pediatr. 2001;138:838-844.
