Asthma and sleep apnea

This article explains a link between asthma and sleep apnea.

Two troublesome adult breathing issues -- asthma and sleep apnea -- may have a connection, a new study suggests.

Adults who struggle with asthma face an increased risk for also developing the nighttime breathing disorder known as obstructive sleep apnea, the new research reveals.

The finding stems from the long-term tracking of about 550 men and women, of whom a little over 15 percent had asthma.

All were participants in the Wisconsin Sleep Cohort Study. At the study's launch in 1988, all the enrollees were between the ages of 30 and 60. Every four years since that time, each completed general health questionnaires, while also completing in an overnight in-laboratory sleep test.

At the very first four-year follow-up, the study authors found that more than a quarter of the asthma patients (27 percent) also had newly developed sleep apnea. This compared with just 16 percent of the non-asthmatic patients.

Over the full study period, the team concluded that asthma patients faced an almost 40 percent greater risk for sleep apnea than asthma-free participants.

What's more, the longer an individual had asthma, the greater their increased risk for developing OSA, investigators found.

However, while the study could point to an association between asthma and sleep apnea, it couldn't prove a cause-and-effect relationship.

The study was led by Dr. Mihaela Teodorescu, of the William S. Middleton Memorial Veteran's Hospital and the University of Wisconsin School of Medicine and Public Health, both in Madison, Wisc. They published the findings in the Jan. 13 issue of Journal of the American Medical Association.

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Sleep apnea surgery in children helps improve asthma control

Removing a child's tonsils and adenoids for sleep apnea can help his or her asthma control.

Researchers from the University of Chicago found that surgical removal of the tonsils and adenoids in children suffering from sleep apnea is associated with decreased asthma severity. The study was published in PLOS Medicine (November 4, 2014).

In the first year after the operation, the children who had their tonsils and adenoids removed had a 30% reduction in acute asthma exacerbations and a 38% decrease in acute status asthmaticus, episodes of severe asthma that do not respond to repeated courses of therapy.

"Several small studies have described a strong association between obstructive sleep apnea and asthma, two common inflammatory conditions that impair breathing in children. But we wanted to test the strength of the connection when studied in a much larger population," said lead study author Rakesh Bhattacharjee, MD, an assistant professor of pediatrics at the University of Chicago and an authority on pediatric sleep medicine, in a statement.

Obstructive sleep apnea is affects an estimated 2% to 3% of all children. The removal of the adenoids and tonsils, known as surgical adenotonsillectomy, is considered standard therapy.

Asthma is the third-most prevalent chronic pediatric disease in the U.S., affecting an estimated 7.1 million according to the Centers for Disease Control and Prevention and is the third-most common cause of hospitalization of U.S. children younger than age 15.

In the study, researchers also noted that pediatric patients who received the surgery had a 36% reduction in asthma-related hospitalizations and a 26% decline in asthma-related emergency room visits. Children who did not have the surgery did not have significant reductions in these categories.

"Our study adds weight to the growing sense that obstructive sleep apnea aggravates asthma and further tips the balance toward early identification of obstructive sleep apnea," Dr. Bhattacharjee said. "This will help physicians advocate for surgical intervention, not just to eradicate sleep-disordered breathing, but also to reduce asthma severity and decrease reliance on medications in asthmatic children."

Data on more than 40,000 children between the ages of 3 and 17, obtained from Truven Health's MarketScan databases were included in the study. More than 13,500 U.S. children with asthma who underwent removal of their adenoids and tonsils as treatment for obstructive sleep apnea were included. Asthma symptoms from the year before surgery to the year afterward were compared. Researchers also matched those results to the results of more than 27,000 children with asthma who still had their tonsils and adenoids.

Overall, adenotonsillectomy brought significant improvement: The frequency of acute status asthmaticus dropped almost 40%, from 562 in the year before surgery to 349 in the year after. In children who did not have surgery, such severe asthma attacks also decreased but by only 7%, from 837 to 778.

Acute asthma exacerbations fell from more than 2,200 before surgery to 1,566 after, a 30% reduction. Exacerbations for children who did not have surgery also fell from 3,403, to 3,336, a 2% drop.

Also decreasing significantly for those children who had the surgery was the incidence of secondary asthma outcomes, such as acute bronchospasm and wheezing, while rates were unchanged for those who did not. Prescription refills followed the same pattern.

The authors' concerns about the MarketScan database included that it only includes those patients with private insurance and a lack of available data why patients underwent adenotonsillectomy.

Despite the limitations, they emphasize the many plausible connections that link obstructive sleep apnea to asthma:

• Both are inflammatory diseases.
• Both share risk factors, such as allergies, obesity, and exposure to tobacco smoke.
• Severe obstructive sleep apnea is often associated with poorly controlled asthma.

A prospective, randomized, controlled clinical trial is still needed to show a direct causal relationship, Dr. Bhattacharjee noted.

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Study: Children with ADHD benefit from treating sleep problems

A study shows that children with ADHD benefit from treating underlying sleep problems.

Addressing sleep problems often improves psychiatric symptoms in children and teens, including those with attention-deficit/hyperactivity disorder and chronic pain.

Sleep-focused treatment improves mood and quality of life in children with attention-deficit/hyperactivity disorder (ADHD), asthma, chronic pain, and cancer, according to speakers at symposium on sleep in children with chronic health conditions at the annual meeting of the American Academy of Sleep Medicine and Sleep Research Society in Minneapolis in June.

Children with ADHD are two to three times more likely to have trouble sleeping than children without the disorder, said Penny Corkum, Ph.D., a professor of psychology and neuroscience at Dalhousie University in Halifax, Nova Scotia. Their sleep problems may undermine daytime performance, said Corkum, who directs research and training at Colchester Regional Hospital’s ADHD Clinic.

In research reported at the meeting, she and colleagues assessed sleep in 30 children newly diagnosed with ADHD and 30 age- and sex-matched typically developing controls. The children’s mean age was about 8.5. At baseline, children with ADHD took 47 minutes to fall asleep in the sleep laboratory, while controls took 24 minutes. Children with ADHD slept about 30 minutes less than controls.

In a four-week medication trial, the researchers gave the 30 children with ADHD either a standard single daily morning dose of methylphenidate or a placebo, in random order for two weeks. While children took longer to fall asleep and slept less when taking the stimulant than when taking the placebo, parents and teachers said their behavior improved.

Children being evaluated for problems with attention, Corkum said, should also be screened for sleep disorders. Consequences of sleep disorders such as obstructive sleep apnea, insomnia, and periodic limb movement disorder/restless leg syndrome may mimic symptoms of ADHD.

Children with and without ADHD, she added, benefit from having a consistent bedtime, learning to fall asleep on their own, sleeping in a dark room, and avoiding television, computers, telephones, and other electronic devices near bedtime.

Children and adolescents with persistent pain commonly report difficulty falling or staying asleep or complain of poor quality sleep, said symposium speaker Tonya Palermo, Ph.D., a professor of anesthesiology and pain medicine at the University of Washington, Seattle.

About 5 percent to 8 percent of children and adolescents in community samples experience moderate to severe disability from persistent pain, most often in the head, abdomen, or limbs, she noted. Common causes include headache disorders, juvenile arthritis, and sickle-cell disease.

Some have depression. Their pain medications may be sedating. These youngsters often say, “I’m always tired,” Palermo noted. Many take frequent and often long naps that may interfere with school or social activities. Concerned parents may allow children to stay in bed late in the morning.

Engaging children and adolescents in self-assessment, Palermo said, may foster improved sleep habits. She asks them to abstain from watching television in their bedroom for a week, for example, to see how that affects their sleep. She also encourages them to use an alarm clock and get up on their own and to maintain a consistent weekday/weekend schedule.

Palermo and colleagues also found that poor sleep diminishes the effectiveness of cognitive-behavioral therapy for chronic pain. She said sleep-specific intervention may need to be delivered before pain-focused behavioral therapy starts.

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Child's asthma and autism predicted my prenatal maternal stress

A study looks into prenatal maternal stress and how it predicts asthma and autism young children.

A new study finds a link between prenatal maternal stress (PNMS) and the development of symptoms of asthma and autism in children.

A team of scientists from The Douglas Mental Health University Institute and from McGill University has been studying women who were pregnant during the January 1998 Quebec ice storm since June of that year and observing effects of their stress on their children's development (Project Ice Storm). The team examined the degree to which the mothers' objective degree of hardship from the storm and their subjective degree of distress explained differences among the women's children in asthma-like symptoms and in autism-like traits.

Results reported in the journal Psychiatry Researchshow that the greater the mothers' objective hardship from the ice storm (such as more days without electricity), and the greater the mothers' distress about the ice storm 5 months later, the more severe their children's autistic-like traits at 6½ years of age.

The team emphasizes that the children in Project Ice Storm are not autistic; the results describe normal variations among children.

These traits include difficulty making friends, being clumsy, speaking in odd ways, etc. The effect of the mothers' ice storm stress was especially strong when the ice storm happened in the first trimester of pregnancy. Interestingly, the children with the most severe symptoms had mothers who had had high levels of hardship from the ice storm but low levels of distress.

"We have found effects of the mothers' objective hardship from the ice storm (such as the number of days without electricity), or their degree of distress from the storm, on every aspect of child development that we have studied, said Suzanne King, PhD, the senior author of the paper. This is surprising, since the children in our study are mostly from upper class families and are generally doing extremely well in school and in life."

In May, the team reported in the journal Biomedical Research International that girls whose mothers had had high levels of distress after the ice storm were more likely to have experienced wheezing, to have been diagnosed with asthma by a doctor, and to have been prescribed asthma medication before the age of 12. There was no effect in boys, and there was no effect of the mothers' objective hardship.

These results demonstrate the power of a stressor in pregnancy to influence both the physical development and the mental health of the unborn child. Project Ice Storm continues to follow the children's development, including brain MRI scans at the age of 16 years starting in September.

"If the stress of the ice storm could have such large effects on these children, helping to explain why some are sicker than others or have more atypical development than others, added Suzanne King, how much greater would the effects be with an even more stressful event in pregnancy or in disadvantaged families with fewer resources? Our research is showing us how vulnerable the unborn child is to his mother's environment and her mood."

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CPAPs can help people with asthma

A study looks into how CPAP machines can help people with asthma
.

More than 25 million Americans suffer from asthma. They use steroids, inhalers, and pills to help control symptoms. But soon there may be a new way: it’s not a drug but a device used for sleep disorders.

Professor Kurt Stoecker spends many late nights grading papers, but some nights his asthma gets the best of him.

"You can't sleep, that kind of thing. It's a tightness in your chest, and then you cough," Stoecker said.

He was diagnosed with asthma at age 16. He's used steroids and inhalers, but now he's trying something new.

As part of a clinical trial, doctors are testing whether treatment with a CPAP machine can improve symptoms in asthma patients by making their airways less reactive.

"At nighttime, their muscles that are around their windpipes are not being allowed to relax. In essence, they're working almost 24 hours a day," Mario Castro, MD, MPH, Professor of Medicine and Pediatrics, Washington University School of Medicine said.

The CPAP pushes gentle air down the windpipe, forcing the muscles to relax. It's typically used for patients with sleep apnea, but doctors say it could be the first drug-free option for asthma.

In the 12-week study, patients used the device for at least four hours a day with no serious side effects.

"The most exciting thing is that it's not a drug. This is a device," Dr. Castro said.

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Study: Asthma medications can raise risk of sleep apnea

I have had questions on this one. This is a very small study n=18. Association does not imply causation. 

Call your pulmonologist to optimize your asthma management.

JR

A study shows that using common asthma medications can raise a person's risk of sleep apnea.

Medicines commonly used to control asthma may increase the risk of a potentially serious sleep problem in some people, a small, early study suggests.

"Inhaled corticosteroids may predispose to sleep apnea in some asthma patients," said study author Dr. Mihaela Teodorescu, an associate professor of medicine at the University of Wisconsin School of Medicine and Public Health, in Madison.

In sleep apnea, breathing periodically stops during sleep, for a few seconds or even minutes at a time, according to the U.S. National Heart, Lung, and Blood Institute. The pauses can occur as often as 30 times or more in a single hour. In the most common type of apnea, the airway becomes blocked or collapses during sleep. If untreated, apnea can increase the risk of high blood pressure, heart attack, stroke and other problems.

However, the new study linking asthma medicines with an increased apnea risk was very small -- including just 18 patients. And the researchers found a link, not cause and effect, and don't yet know what that connection means.

An expert not involved in the study was skeptical of the findings, emphasizing that more work is needed.

Teodorescu agreed, and is continuing to look at the medicines.

In the new study, the 18 men and women evaluated were taking 1,760 micrograms a day of inhaled fluticasone (Flovent). (Another inhaled corticosteroid is budesonide, or Pulmicort.)

The researchers monitored the men and women for changes in the "collapsibility" of their upper airways during sleep and their tongue function. Three patients had the amount of fat in their soft palates measured with MRIs, which found a redistribution of fat to the neck area, which can narrow the airway.

All the patients had changes in their tongue function and upper airway consistent with sleep apnea, said Teodorescu, who is also the director of the James B. Skatrud Pulmonary Sleep Research Laboratory at the Middleton Memorial Veterans Hospital, in Madison, Wisc.

Some patients were more affected than others, Teodorescu said. More vulnerable, she said, were the patients who were mid-30s or older, men and those whose asthma was poorly controlled at the start.

Teodorescu decided to study the effect of the corticosteroids after she said she found growing evidence that sleep apnea is more prevalent among people with more severe asthma. The current study is a pilot study.

The study appears in the February issue of the Journal of Clinical Sleep Medicine.

One expert called for more research into the link.

"We need a larger study," said Dr. Len Horovitz, a pulmonologist and internist at Lenox Hill Hospital in New York City. The steroids studied by the Wisconsin researchers are a mainstay of treatment for moderate asthma, he said, and can work well to control the asthma.

The findings cited by the researchers -- floppiness of the tongue and oral membranes -- would typically also be linked with noticeable speech changes and vocal quality changes, he said. The researchers should consider including evaluations by a speech pathologist and ear-nose-throat specialists, he added.

"Time will tell when we look at a larger study," Horovitz said.

Michele Meixell, a spokesperson for AstraZeneca, said that her company's Pulmicort (budesonide) is safe and effective "when used in accordance with the FDA-approved indications."

Meanwhile, Teodorescu said if asthma patients are getting control of their asthma on prescribed steroids, "they should continue." She suggested the medicine and dose be tailored to each patient's needs.

"If people with asthma are told they snore, they should talk to their physician about the possibility of sleep apnea," she added.

Study: Asthma and migraine linked admission of self-harm

A study claims that there is a link between having asthma and migraine and a person admitting to self-harm.

Certain long-term physical disorders, such as asthma and migraine, may boost the risk of self- harm, indicates a comparative study of hospital admissions after an episode of deliberate injury in England, and published in the Journal of the Royal Society of Medicine.

Over 200,000 people are admitted to hospital every year in England as a result of self-harm, and people who self-harm have a substantially increased risk of suicide.

The new National Suicide Prevention Strategy for England includes several priority groups including people with a history of self-harm, young people, and those living with long-term physical health conditions.

The peak age for self-harm is 15–24 years, and suicide is the third leading cause of death in this age group.

While it’s well known that psychiatric illness greatly increases the risk of self-harm, it’s less clear whether physical disorders have a similar impact.

The researchers therefore looked at risk of hospital admission for self-harm among people with different long-term psychiatric and physical disorders across England, using a linked dataset of Hospital Episode Statistics (HES) for 1999–2011.

The psychiatric illnesses studied included depression, bipolar disorder, alcohol abuse, anxiety disorders, eating disorders, schizophrenia and substance abuse.

Unsurprisingly, the analysis showed that patients with these conditions were at much greater risk. They were more than five times as likely to self-harm as those without these conditions, the findings showed.

But certain physical ailments also seemed to be linked to an increased risk of self-harm. Among the physical illnesses studied, patients with epilepsy were around three times more likely to self-harm, while those with asthma or migraine were almost twice as likely to do so.

Patients with psoriasis and diabetes also had a moderately increased risk of self-harm of around 60%, while those with eczema and inflammatory polyarthropathies were around 40% more likely to do so.

Patients with cancers under the age of 65, congenital heart disease, ulcerative colitis, sickle cell anaemia and Down’s syndrome were less likely to self-harm.

“It is important for physicians, general practitioners and mental health workers to be aware of the physical disorders that are associated with an increased risk of self-harm so that at-risk individuals may be better identified and can be monitored for any psychiatric symptoms and mental distress,” write the authors.

Much greater integration of medical and mental health services is needed, they say.

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Study: Children with ADHD more likely to have asthma or allergies

A study claims that children, specifically boys, with ADHD are more likely to have allergies or asthma.

Boys diagnosed with attention-deficit/hyperactivity disorder are more likely also to have asthma, allergies and skin infections than youngsters without ADHD, a new study finds, suggesting a possible link between these conditions.

Of those in the study, boys newly diagnosed with ADHD were 40 percent more likely to have asthma, 50 percent more likely to have needed a prescription for allergy medicine and 50 percent more likely to have had a bacterial skin infection than other boys.

"Our study provides additional evidence to support the hypothesis that atopic disorders, such as asthma and food allergies increase the risk of developing ADHD," the authors wrote, adding that further research is necessary to determine just how these conditions might be connected.

Their results were published in the August issue of the Annals of Allergy, Asthma & Immunology.

ADHD, a chronic mental health condition involving difficulty paying attention, hyperactivity and impulsivity, affects as many as 9 percent of American children, according to background information in the study conducted by Eelko Hak, of the University of Groningen, and colleagues in the Netherlands and Boston.

The increase in the prevalence of ADHD has been paralleled by an increase in allergic (also called atopic) diseases, such as asthma and allergies, the researchers reported. They also noted that environmental risk factors, such as foods that cause an allergic reaction, may trigger symptoms of both ADHD and allergic asthma.

To get a better idea of whether or not there actually is an association between these conditions, the researchers used data from a large U.K. study. Within that database, the researchers found nearly 900 boys who were first diagnosed with ADHD and prescribed medication for the condition between 1996 and 2006. All of the boys were between 4 and 14 years old when first diagnosed.

The researchers compared the children with ADHD to about 3,500 children without the condition.

After adjusting the data to account for age, and for low birth weight or premature birth, they found significant relationships between the diagnosis of ADHD and a history of asthma, impetigo or a prescription for antihistamines (allergy medicines).

They also found weaker associations between ADHD and cow's milk intolerance, and prescriptions for oral or topical corticosteroids, antibacterial or antifungal drugs.

The authors theorize that the links they found may be food-allergy related. However, this study didn't attempt to prove cause and effect, so the exact reason behind the association remains unknown.

Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Steven and Alexandra Cohen Children's Medical Center of New York, said the connection between ADHD and allergic diseases has been seen in other studies.

"The association seems to be real. The chicken-and-the-egg question remains unanswered. The challenge is in teasing out why they're linked," he said.

For her part, Dr. Jennifer Appleyard, chief of allergy and immunology at St. John Hospital and Medical Center in Detroit, said, "This is an interesting, but very early study. They're definitely not showing cause and effect."

Appleyard pointed out that impetigo and milk intolerance aren't typically considered allergic diseases. Impetigo is a bacterial infection of the skin. And, a milk intolerance isn't the same as an allergy to milk.

"They looked at food allergies, too, and they didn't find an association. They also didn't find an association with atopic dermatitis [eczema], and impetigo is not necessarily correlated with an allergic reaction," she said.

The bottom line, she said, is that parents don't need to have any additional fears from this study. She added that parents of children with asthma or allergies shouldn't start worrying that their children will develop ADHD -- and parents definitely shouldn't make any changes to medications because of this study.

"All of these conditions seem to have increased. Let's pursue this link further, but there's no need for any changes right now," Appleyard said.

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Asthma shown to be a risk factor for obstructive sleep apnea

A study found that asthma significantly increases the likelihood of developing obstructive sleep apnea.

There are several risk factors associated with obstructive sleep apnea that are long-standing and well-known. They include lifestyle and health factors such as obesity or excess body weight, high-blood pressure, and alcohol and tobacco use, as well as genetic and demographic factors such as family history of the disease, being older, and being male. Now, thanks to new research, we may have a new OSA risk factor to add to this list: asthma.

Researchers at the University of Wisconsin investigated the influence of asthma in the development of obstructive sleep apnea. They found a significantly elevated risk for OSA among people with asthma. Those people who'd developed asthma as children were at particularly elevated risk. Researchers observed 773 adult men and women over a period of eight years. All were participants in the Wisconsin Sleep Cohort study, and were between ages 30-60 at the time the study began. Of the 773 participants, 201 had asthma at the beginning of the study period, and 61 of them had developed asthma during childhood. None of the participants had obstructive sleep apnea. Every four years, the subjects participated in laboratory sleep evaluations, clinical health assessments, and health questionnaires. After adjusting for other risk factors for sleep apnea, including age, gender, body-mass index, smoking, and nasal congestion, researchers found that the presence of asthma significantly increased the risk for sleep apnea:

• People with asthma were 1.70 times more likely to develop sleep apnea over the eight-year study period than those without asthma.


• Among those in the study who had developed asthma during childhood, the risk was even higher. These people had 2.34 times the risk of developing obstructive sleep apnea, compared to those without asthma.


• Researchers found that the longer asthma had been present, the higher the risk for sleep apnea. Every five-year period a person had asthma was associated with a 10 percent increase to their risk of developing obstructive sleep apnea.


• Among the participants, 45 developed asthma during the study observation period. Researchers found that these people were 48 percent more likely to develop sleep apnea than those without asthma. The size of this group was too small for researchers to demonstrate a statistical significance to these results. In their discussion of the study's results, researchers pointed to this particular finding as an important one for follow-up investigation.

This latest study is not the first to demonstrate a link between asthma and sleep apnea. Previous research has shown connections between the two conditions:

• In a study of more than 4,500 adults ages 20-69, asthma was found associated with symptoms common to sleep apnea, including snoring, apneas, and daytime sleepiness.


• Researchers at Israel's Technion-Israel Institute of Technology investigated whether difficult-to-control asthma might influence the onset of sleep apnea. They found that patients with unstable, hard-to-control asthma were at significantly higher risk for obstructive sleep apnea.


• Researchers at the University of Wisconsin also looked at the risk of sleep apnea among patients with poorly controlled asthma, and found these patients were at higher risk for obstructive sleep apnea after adjusting for other sleep apnea risk factors, including obesity.

These and other previous studies have identified an association between the two disorders, asthma and sleep apnea. The latest study comes an important step closer to establishing a causal link between the two conditions, by examining specifically the direction of the relationship between the two. The presence of asthma in people later identified as being more likely to develop sleep apnea suggests that asthma may actually contribute to the onset of sleep apnea.

Asthma is a lung disease that causes difficulty breathing, shortness of breath, coughing, and wheezing. Some people can experience these symptoms at night, and they can interfere with sleep. Establishing asthma as a risk factor for OSA is an important public health development. More than 25 million Americans suffer from asthma, including seven million children. If these adults and children are at higher risk for obstructive sleep apnea because of their asthma, they are also at risk for the complications that come with sleep apnea. Obstructive sleep apnea is associated with increased risk for a number of health problems, including heart disease, diabetes, and some cancers. Children can experience apnea and sleep-disordered breathing as well, and children have their own set of health risks associated with the condition, including problems with emotional, social, and cognitive development.

Finding new ways to identify and prevent obstructive sleep apnea is critical to the sleep and overall health of millions of Americans who suffer from this serious sleep disorder. The research into the role of asthma is an important step in this direction.

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People with asthma at higher risk for developing sleep apnea

Researchers find a link between asthma and the eventual development of sleep apnea.

Asthma may be a contributing factor to obstructive sleep apnea, according to researchers at the University of Wisconsin.


Using data from the Wisconsin Sleep Cohort Study, which was funded by the National Institutes of Health, researchers studied 773 participants who joined the study in 1988 when they were between the ages of 30 and 60. None of them had obstructive sleep apnea (OSA) when they joined the study. They found that during the eight year follow-up period, those who had asthma were 1.70 times more likely to develop OSA. The risk was even higher in patients who had asthma as children — they were 2.34 times more likely, according to a press release. 

They also found that for every five years a person had asthma, the likelihood of developing OSA increased by 10 percent.

"This is the first longitudinal study to suggest a causal relationship between asthma and sleep apnea diagnosed in laboratory-based sleep studies," Dr. Mihaela Teodorescu, assistant professor of medicine and lead author said. "Cross-sectional studies have shown that OSA is more common among those with asthma, but those studies weren't designed to address the direction of the relationship."

Obstructive sleep apnea occurs when a person's airway becomes blocked during sleep, forcing them to wake up in order to start breathing properly again. Lacking restful sleep, a person with OSA is typically drowsy throughout the day, which results in a higher risk for car crashes, work-related accidents, and a variety of health problems, according to the National Institutes of Health.

During the course of the study, researchers also made adjustments for variables that contribute to sleep apnea such as age, sex, changes in body mass index, smoking, number of alcoholic drinks per week, and nasal congestion.

They also accounted for the 45 participants who developed asthma during the eight years. They found that these people had a 48 percent higher chance of sleep apnea, however, they pointed out that the size of this group was too small to be statistically significant.

"Forty-eight percent represents a large difference," Paul Peppard, assistant professor of population health sciences and a principal investigator for the cohort study, said. "This is one result that calls for a follow-up study. If confirmed by a larger study with more asthma cases, the finding would have important clinical relevance."

Although he considers it to be a "strong observational study," Peppard stressed that the study falls short of establishing causality between asthma and sleep apnea. He suggested that clinicians consider asthma history in addition to "more traditional factors associated with OSA such as obesity, when deciding whether to evaluate patients for OSA with a sleep study."

A week ago, Peppard released a study based on the same data suggesting the obesity epidemic played a part in the rise of sleep apnea cases. He found that cases of sleep apnea had risen from 14 to 55 percent from 1988 to 1994, and estimated that 80 to 90 percent of the increase was due to the growth of obesity in the country.

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Asthma may cause poor sleep and academic performance

Research shows that uncontrolled asthma symptoms can result in poor sleep quality and poor performance in school for children.

The negative effects of poorly controlled asthma symptoms on sleep quality and academic performance in urban schoolchildren has been confirmed in a new study.

"While it has been recognized that missed sleep and school absences are important indicators of asthma morbidity in children, our study is the first to explore the associations between asthma, sleep quality, and academic performance in real time, prospectively, using both objective and subjective measures," said principal investigator Daphne Koinis-Mitchell, PhD, Associate Professor of Psychiatry & Human Behavior (Research) and Associate Professor of Pediatrics (Research) at Brown University's Alpert Medical School in Providence, Rhode Island. "In our sample of urban schoolchildren (aged 7 to 9), we found that compromised lung function corresponded with both poor sleep efficiency and impaired academic performance."

The results of the study will be presented at the American Thoracic Society's 2013 International Conference.

The study included data on 170 parent-child dyads from urban and African-American, Latino, and non-Latino white backgrounds who reside in Greater Providence, RI. These data are part of a larger 5-year study of asthma and allergic rhinitis symptoms, sleep quality and academic performance (which will include 450 urban children with persistent asthma and healthy controls) funded by The Eunice Kennedy Shriver National Institute of Child Health and Human Development. Project NAPS (Nocturnal Asthma and Performance in School) is administered through Rhode Island Hospital at The Bradley Hasbro Research Center.

Asthma symptoms were assessed over three 30-day monitoring periods across the school year by spirometry, which measures the amount and speed of exhaled air, and with diaries maintained by children and their caregivers. Sleep quality was assessed with actigraphy, which measures motor activity that can be used to estimate sleep parameters. Asthma control was assessed with the Asthma Control Test (ACT), a brief questionnaire used to measure asthma control in children. Academic functioning was assessed by teacher report during the same monitoring periods.

Compared with children with well-controlled asthma, those with poorly controlled asthma had lower quality school work and were more careless with their school work, according to teacher reports. Higher self-reported and objectively measured asthma symptom levels were associated with lower quality school work. Poorer sleep quality was also associated with careless school work. Increased sleep onset latency (the amount of time children take to fall asleep) was associated with more difficulty in remaining awake in class.

"Our findings demonstrate the detrimental effects that poorly controlled asthma may have on two crucial behaviors that can enhance overall health and development for elementary school children; sleep and school performance," said Dr. Koinis-Mitchell. "Urban and ethnic minority children are at an increased risk for high levels of asthma morbidity and frequent health care utilization due to asthma. Given the high level of asthma burden in these groups, and the effects that urban poverty can have on the home environments and the neighborhoods of urban families, it is important to identify modifiable targets for intervention."

"Family-level interventions aimed at asthma control and improving sleep quality may help to improve academic performance in this vulnerable population," Dr. Konis-Mitchell continued. "In addition, school-level interventions can involve identifying children with asthma who miss school often, appear sleepy and inattentive during class, or who have difficulty with school work. Working collaboratively with the school system as well as the child and family may ultimately enhance the child's asthma control."

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Texting children with asthma improves health outcomes

Providing information to children with asthma through text messages resulted improved health outcomes.

Simply sending children with asthma a text message each day asking about their symptoms and providing knowledge about their condition can lead to improved health outcomes.

In a study by the Georgia Institute of Technology, pediatric patients who were asked questions about their symptoms and provided information about asthma via SMS text messages showed improved pulmonary function and a better understanding of their condition within four months, compared to other groups.

"It appears that text messages acted as an implicit reminder for patients to take their medicine and by the end of the study, the kids were more in tune with their illness," said study leader Rosa Arriaga, senior research scientist in the College of Computing's School of Interactive Computing at Georgia Tech.

T.J. Yun, former Georgia Tech Ph.D. student, and Arriaga will present their research, "A Text Message a Day Keeps the Pulmonologist Away", today at the ACM SIGCHI Conference on Human Factors in Computing Systems 2013 in Paris.The research won a best paper award in the Replichi category, which highlights best practices in study methodology.

It is also a replication study of an SMS health intervention for pediatric asthma patients originally published in early 2012 in the Proceedings of the 2^nd ACM SIGHIT International Health Informatics Symposium.

The results of the research hold promise for the future of mHealth studies, a trend based on the idea that mobile devices can be used to improve health and wellness.

Asthma is the most prevalent chronic respiratory disorder in the U.S., affecting about 17.3 million individuals, including more than 5 million children. Medication is the main way patients manage symptoms, but research shows less than 30 percent of teens use their inhalers regularly.

Texting, on the other hand, is something teens do regularly and enjoy. Nearly 75 percent of American teens have mobile devices. Georgia Tech researchers were interested in seeing if this ubiquitous, easy-to-use technology could help young patients manage their asthma.

In both studies, the researchers randomly assigned 30 asthmatic children from a private pediatric pulmonology clinic in Atlanta into three groups -- a control group that did not receive any SMS messages; a group that received text messages on alternate days and a group that received texts every day. The children were between 10 and 17 years old, owned a mobile phone and could read at least at a fifth grade level.

Over four months, the intervention groups received and responded to SMS messages 87 percent of the time, and the average response time was within 22 minutes. After the study, the research team analyzed patients who had follow-up visits with their physician and found that sending at least one text message a day, whether it was a question about symptoms or about asthma in general, improved clinical outcomes.

"The results indicate that both awareness and knowledge are crucial to individuals engaging in proactive behavior to improve their condition," Arriaga said.

In another mHealth study that highlighted the role that online social networks can have on wellness, Arriaga, Georgia Tech Regents Professor of Interactive Computing Gregory Abowd and graduate student Hwajung Hong investigated whether social networking could help individuals with autism improve their social connectedness.

One of the challenges individuals with autism face is not having a large enough network of people who can provide advice about everyday situations, such as home upkeep, financial planning or relationships. They tend to over-rely on a primary caregiver, which limits their independence and may burden the caregiver.

The study involved three individuals with Asperger's Syndrome, a diagnosis that reflects average or above average language skills, but impaired social skills and patterns of behaviors and interests. Individuals with Asperger's Syndrome can have difficulty using traditional social networking sites such as Facebook because it requires a degree of social nuance. They also may be vulnerable to users trying to take advantage of them.

To address this issue, Georgia Tech researchers set up a specialized social network for participants using the commercial cross-platform service, GroupMe. Each participant was linked with a small, pre-determined number of family and friends that he or she could reach out to about everyday life issues and questions.

Over four weeks, GroupME motivated each participant to communicate with this trusted circle of members and reduce reliance on his or her primary caregiver. The circle actively engaged and shared the responsibility for responding to the participant's queries. Primary caregivers gave positive reviews of the specialized social network, saying that they were happy with the diversity of feedback that the system provided and that the load felt lighter thanks to the help of the circle members. Results indicate that positive online interactions lead to real-life interactions between the individuals and their circle members.

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10 Health Conditions That Disrupt Your Sleep

This article outlines ten common health conditions that may negatively impact your sleep.

Having problems going to sleep or staying asleep? A health condition could be to blame. Research suggests that sleep disturbances such as insomnia are rooted in certain medical conditions.

“We’re finding that both the quantity and quality of sleep a person gets can be linked to a number of health issues and diseases,” says James Wellman, MD, medical director of the Sleep Disorders Center of Georgia in Augusta. Sleep problems may be caused by physical, emotional, or hormonal conditions — everything from asthma to depression to menopause. Here are the most common culprits.

Depression: Sleep problems and depression are common bedfellows. Some research shows that 90 per cent of people with depression experience troubled sleep. “In low-grade depression, insomnia is often the most prominent symptom,” says Dr. Wellman. Waking up too early in the morning is a hallmark of serious depression. Other depression-related sleep problems include difficulty falling asleep and sleeping excessively. Anxiety (persistent worrying and uneasiness) can also leave you wide awake due to the inability to relax. Appropriate medications can help ease depression and anxiety, as well as the resulting sleep problems.

Menopause: As a woman’s periods start to end, insomnia may begin. According to the National Sleep Foundation, 61 per cent of menopausal women have sleep problems. One possible reason: Progesterone levels drop off during menopause. “Progesterone is a sleep-promoting hormone,” says Wellman. Changing levels of estrogen during menopause can also cause sleep disruptions by bringing on hot flashes, sudden waves of intense body heat, and sweating.

Diabetes: Diabetics often find restful sleep elusive due to blood sugar fluctuations, night sweats, and the need to urinate frequently during the night. Insomnia can also increase the risk of developing diabetes. In a recent study involving 1,741 adults, people who slept less than six hours were more likely to develop type 2 diabetes than those who got more sleep.

Musculoskeletal Disorders: The intense pain of arthritis can make drifting off to dreamland difficult. Plus, arthritis patients who must shift positions during the night often find it hard to fall asleep again. A pain reliever before bed can help ease sleep-stealing arthritis pain. Fibromyalgia, a condition characterized by painful ligaments and tendons, has also been linked with sleep disturbances, as well as next-day fatigue.

Cardiovascular Disease: Two common cardiovascular conditions, coronary artery disease and congestive heart failure, have been linked to sleep problems. In coronary artery disease, fluctuations in circadian rhythms can cause chest pain, an irregular heartbeat, or even a heart attack while sleeping. Congestive heart failure prevents the heart from pumping enough blood to reach all parts of the body. As a result, extra fluid accumulates around the lungs while you are lying down, causing you to wake up during the night. Using pillows to elevate the upper body can help.

Asthma: People with asthma often have sleep disturbances because of breathing difficulties, wheezing, and coughing, says Wellman. Asthma symptoms are usually worse at night due to night time changes in functioning that constrict the airway, increasing the risk of asthma attacks during the night. Some of the medications used to treat asthma can also cause insomnia and fragmented sleep.

Heartburn Or GERD: In heartburn or gastroesophageal reflux disease (GERD), acidic juices in the stomach flow back into the esophagus, causing irritation and painful burning sensations. This can make it difficult to fall asleep and stay asleep. Lying down often worsens the condition. Avoiding big meals, coffee, and alcohol in the evening may help relieve heartburn and bring on a restful night’s sleep.

Eating Disorders: “Anorexia has been found to interrupt normal sleep patterns, possibly due to malnutrition and excessive weight loss,” says Wellman. Research suggests that anorexics get more non-REM sleep and less REM sleep than people of normal weight, resulting in next-day tiredness. Bulimia is often characterized by eating binges and purges during the night, interfering with a good night’s sleep.

Kidney Disease: Kidney disease prevents the kidneys from filtering wastes from the blood, which can lead to insomnia or restless legs syndrome. Dialysis or even a kidney transplant doesn’t always result in normal sleep, says Wellman. Researchers aren’t sure why.

Thyroid Disease: An overactive thyroid gland (hyperthyroidism) can cause sleep-busting night sweats, while an underactive thyroid gland (hypothyroidism) brings on excessive daytime sleepiness. Both of these thyroid conditions can be diagnosed with a simple blood test and easily treated with medications.

When sleep problems are due to a medical problem or physical condition, treating the condition will often resolve the insomnia and ease sleep disturbances, says Wellman. See your doctor for an evaluation, and you may find that your insomnia does a disappearing act. If not, the next step is to make an appointment with a sleep specialist.

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Reasons Why Children Snore

This article discusses many reasons that could cause children to snore.

With school days upon us, a good night's sleep should be on the top of each child's list of supplies. But for some children, getting the rest they need means more than an early bedtime. At Clarity Allergy Center in Chicago, allergy, asthma, and immunology expert, Dr. Brian Rotskoff, is helping parents recognize the signs of childhood obstructive sleep apnea by carefully monitoring childhood snoring and childhood nasal allergies.

Many children snore from time to time, particularly if they have a cold or asthma. But as Dr. Rotskoff, a highly specialized pediatric nasal congestion and sleep apnea expert explains, "if your child is a restless sleeper who chronically snores and mouth breaths and shows signs of daytime difficulties, obstructive sleep apnea could be the cause." He also points out that the symptoms ofsleep apnea in kids can be subtler than those of adult sleep apnea.

Beyond restless nights, Dr. Rotskoff encourages parents who suspect their child may have obstructive sleep apnea to watch for these warning signs that can begin as early as 2-6 years of age.

Nighttime Sleep Apnea Symptoms

• Persistent snoring and mouth breathing
• Gasping or labored breathing
• Frequent bedwetting beyond normal age range
• Night sweats
• Unusual sleeping positions

Daytime Sleep Apnea Symptoms

• Allergies, asthma, or frequent ear infections
• Poor school performance or trouble focusing on tasks
• Behavioral or social problems
• Bad mood or constant agitation
• Depression or anxiety

Childhood Nasal Allergies and Asthma

It's highly common for children with sleep apnea to have other breathing issues. "Some children are just persistent snorers and don't necessarily have sleep apnea," acknowledges Dr. Rotskoff, "but compounding issues, such as enlarged tonsils and adenoids, can elevate to sleep apnea."

Dr. Rotskoff is one of few allergy and asthma experts to give childhood sleep apnea the attention it deserves. Even if your child is getting 10-12 hours of sleep each night, sleep apnea can cause enough disruption to affect mood, school performance, and overall behavior. "Studies show that middle school and high school kids with moderate to severe sleep apnea achieve lower grades and have greater trouble focusing or paying attention in class," he says.

If you think your child suffers from sleep apnea, Dr. Rotskoff suggests a thorough exploration of all symptoms and physical factors that could contribute to breathing problems. Beyond monitoring your child's tonsil and adenoid size, Dr. Rotskoff will evaluate their soft palate and uvula, tongue, jaw positioning, and nasal passages and airways. He works closely with parents to determine the most conservative and effective treatment.

"Addressing your child's sleep issues early will not only improve academic and social performance, it will also position them for healthy adult sleep habits," concludes Dr. Rotskoff.

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