ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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Asthma and Obstructive Sleep Apnea in Adolescents
Session Title
TP69 - TP069 PEDIATRIC ASTHMA AND ALLERGY
Abstract
A3244 - Asthma and Obstructive Sleep Apnea in Adolescents
Author Block: S. Jayaram1, J. C. Carter2, D. J. Birnkrant3, M. Ayache4; 1Pediatrics, Metrohealth Medical Center, Cleveland, OH, United States, 2Sleep Medicine, Metrohealth Medical Center, Cleveland, OH, United States, 3Pediatric Pulmonology, Metro Health Med Center, Cleveland, OH, United States, 4Pulmonology, Metrohealth Medical Center, Cleveland, OH, United States.
Background:In children, there is a positive association between asthma and obstructive sleep apnea (OSA). However, in adolescents, the relationship been OSA and asthma is not well established.
Objective:To investigate whether adolescents with persistent asthma are more likely to have moderate to severe obstructive sleep apnea compared to adolescents with mild intermittent or exercise-induced asthma.
Methods:This is a cross-sectional observational study of adolescent patients (age 11-17 years) with asthma referred for in-lab polysomnograms for sleep-disordered breathing symptoms (snoring, witnessed apneas, excessive daytime sleepiness, insomnia) in a 3-year period (2017-2019). Demographic factors, asthma severity, inhaled steroid prescription, co-morbidities, and polysomnographic data were extracted from the electronic healthcare records. T-test was used to compare the mean apnea-hypopnea indices (AHI) in adolescents with persistent asthma compared to those with mild intermittent or exercise-induced asthma. Multiple logistic regression was applied to calculate the odds of moderate to severe OSA (AHI ≥ 15) in persistent asthmatics compared to those with milder forms of asthma while adjusting for gender, race, body mass index (BMI), and adenotonsillar hypertrophy.
Results:Two-hundred-thirty one adolescents with asthma (54.5% male, 30.7% white) underwent in-lab polysomnograms. Mean age and BMI (+/- SD) were 13.6(±0.14) years and 30.0(±9.8) kg/m2 respectively. Subjects were diagnosed with persistent (27.3%), exercise-induced (43.3%), mild intermittent (23.4%), or unspecified (6.1%) asthma. The mean AHI was 12.1 events/hour (SE 1.9, 95%CI:8.4-15.9) in adolescents with persistent asthma compared to 13.9 events/hour (SE 1.5, 95%CI:10.9- 16.9) in adolescents with milder forms of asthma (AHI difference=1.8, p=0.49, non-significant). The AHI was also not significantly different among adolescents prescribed inhaled steroids compared with those not prescribed steroids (mean AHI difference=0.36, 95%CI:-4.77-5.49; p=0.89). In a multiple logistic regression model that included BMI, sex, race, and adenotonsillar hypertrophy, moderate to severe OSA was not associated with persistent asthma (odds ratio=0.61, 95% CI:0.26-1.39, p-value = 0.308). In this model, moderate to severe OSA was significantly associated with BMI (OR=1.07;p=0.001), male gender (OR=2.41;p=0.02) and adenotonsillar hypertrophy (OR=3.11;p=0.006).
Conclusion:In our study population consisting of predominantly non-white, obese adolescents with asthma and symptoms of sleep-disordered breathing, persistent asthma, and prescribed inhaled steroids were not associated with an increased likelihood of moderate to severe OSA. Instead, moderate to severe OSA was associated with higher BMI, male gender, and adenotonsillar hypertrophy. These findings are different from the positive association between asthma and OSA reported in younger children.
Author Block: S. Jayaram1, J. C. Carter2, D. J. Birnkrant3, M. Ayache4; 1Pediatrics, Metrohealth Medical Center, Cleveland, OH, United States, 2Sleep Medicine, Metrohealth Medical Center, Cleveland, OH, United States, 3Pediatric Pulmonology, Metro Health Med Center, Cleveland, OH, United States, 4Pulmonology, Metrohealth Medical Center, Cleveland, OH, United States.
Background:In children, there is a positive association between asthma and obstructive sleep apnea (OSA). However, in adolescents, the relationship been OSA and asthma is not well established.
Objective:To investigate whether adolescents with persistent asthma are more likely to have moderate to severe obstructive sleep apnea compared to adolescents with mild intermittent or exercise-induced asthma.
Methods:This is a cross-sectional observational study of adolescent patients (age 11-17 years) with asthma referred for in-lab polysomnograms for sleep-disordered breathing symptoms (snoring, witnessed apneas, excessive daytime sleepiness, insomnia) in a 3-year period (2017-2019). Demographic factors, asthma severity, inhaled steroid prescription, co-morbidities, and polysomnographic data were extracted from the electronic healthcare records. T-test was used to compare the mean apnea-hypopnea indices (AHI) in adolescents with persistent asthma compared to those with mild intermittent or exercise-induced asthma. Multiple logistic regression was applied to calculate the odds of moderate to severe OSA (AHI ≥ 15) in persistent asthmatics compared to those with milder forms of asthma while adjusting for gender, race, body mass index (BMI), and adenotonsillar hypertrophy.
Results:Two-hundred-thirty one adolescents with asthma (54.5% male, 30.7% white) underwent in-lab polysomnograms. Mean age and BMI (+/- SD) were 13.6(±0.14) years and 30.0(±9.8) kg/m2 respectively. Subjects were diagnosed with persistent (27.3%), exercise-induced (43.3%), mild intermittent (23.4%), or unspecified (6.1%) asthma. The mean AHI was 12.1 events/hour (SE 1.9, 95%CI:8.4-15.9) in adolescents with persistent asthma compared to 13.9 events/hour (SE 1.5, 95%CI:10.9- 16.9) in adolescents with milder forms of asthma (AHI difference=1.8, p=0.49, non-significant). The AHI was also not significantly different among adolescents prescribed inhaled steroids compared with those not prescribed steroids (mean AHI difference=0.36, 95%CI:-4.77-5.49; p=0.89). In a multiple logistic regression model that included BMI, sex, race, and adenotonsillar hypertrophy, moderate to severe OSA was not associated with persistent asthma (odds ratio=0.61, 95% CI:0.26-1.39, p-value = 0.308). In this model, moderate to severe OSA was significantly associated with BMI (OR=1.07;p=0.001), male gender (OR=2.41;p=0.02) and adenotonsillar hypertrophy (OR=3.11;p=0.006).
Conclusion:In our study population consisting of predominantly non-white, obese adolescents with asthma and symptoms of sleep-disordered breathing, persistent asthma, and prescribed inhaled steroids were not associated with an increased likelihood of moderate to severe OSA. Instead, moderate to severe OSA was associated with higher BMI, male gender, and adenotonsillar hypertrophy. These findings are different from the positive association between asthma and OSA reported in younger children.
