The importance of considering sleep in adolescents with asthma
Published Online: April 14, 2014
Despite significant medical advances in asthma management, asthma prevalence continues to rise in youth, highlighting the need to examine modifiable health behaviors that may influence functional asthma outcomes, including sleep duration (the amount of sleep), sleep hygiene (behaviors that promote healthy sleep), and insomnia (difficulties initiating and maintaining sleep due to conditioned arousal). Deficient sleep has been linked to increased inflammation, disease development, and poorer health outcomes. In general, adolescents are known to be chronically sleep deprived due to the intersection of academic, extracurricular, and social demands with early school start times. Thus it is important to understand more about the sleep of adolescents with asthma, who may be more negatively impacted by deficient sleep than their healthy peers.
In a study recently published in The Journal of Allergy and Clinical Immunology: In Practice, Meltzer and colleagues surveyed nearly 300 adolescents with and without asthma. These adolescents completed questions about sleep duration, sleep hygiene (including caffeine use, electronics use at sleep onset, and sleep location), and insomnia symptoms. Study results highlighted some striking differences between adolescents with and without asthma. First, more adolescents with severe asthma reported deficient sleep (<7 hours per night) compared to adolescents without asthma. Second, adolescents with asthma reported poorer sleep hygiene and more severe insomnia. Notably, almost 40% of adolescents with severe asthma reported clinically significant insomnia (compared to only 23% of adolescents without asthma). Finally, adolescents with severe asthma reported more daytime sleepiness than adolescents without asthma. However, the results suggest that the reported daytime sleepiness was due to insomnia severity rather than asthma severity.
The results of this study highlight how common sleep issues—including deficient sleep—are among adolescents with asthma, underscoring the need to learn more about the direct impact of sleep duration on functional asthma outcomes in adolescents. In particular, it is well known that deficient sleep is related to changes in immune functioning and disease development. Thus it is possible that if adolescents with asthma were to extend their sleep duration (as well as improve their sleep hygiene), improved asthma functioning may follow. This study also highlighted the fact that a significant number of adolescents with asthma experience clinical insomnia. With short-term behavioral treatments available to address insomnia in these youth, it is critical for clinicians to screen adolescents with asthma for sleep problems, including difficulties initiating and maintaining sleep.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.