Researchers examined data on 339 children (mean age 7.9 years) with persistent asthma whose parents or caregivers completed quarterly surveys for 12 months on asthma symptoms, snoring, health care use, and other outcomes such as missed school for children and disrupted plans or sleep for caregivers. Habitual snoring, defined as at least six nights a week, was reported for 24.8% of the children at the initial assessment.
Habitual snorers had significantly more "maximum symptom days" than non-snorers (3.8 vs 2.7 days, odds ratio 1.58), which researchers defined the number of days in the previous two-week period that the children had wheezing, chest tightness, or cough or experienced disrupted sleep or play due to these symptoms.
These results aren't surprising because many risk factors that can increase snoring - pollutants, poor air quality, and tobacco smoke exposure - disproportionately impact inner-city children and can also exacerbate asthma symptoms, said senior study author Dr. Wanda Phipatanakul, a researcher at Harvard Medical School and Boston Children's Hospital.
"Awareness of early detection of these factors can help inform early intervention to reduce the morbidity and long-term complications from asthma," Dr. Phipatanakul said by email.
A majority of children in the study were from low-income households (72.2%), defined as less than $45,000 a year, and a majority of kids were Black (31.5%) or Hispanic (36.3%).
Overall, about half the children in the study had overweight (14%) or obesity (35%), and these conditions were even more prevalent among habitual snorers (17% and 45%, respectively). Habitual snorers were more likely to be obese than non-snorers.
The study also found that habitual snoring, compared to non-snoring, was associated with health care utilization (incidence rate ratio 1.72) and worse asthma control (OR 1.49).
One limitation of the study is that researchers lacked objective measurements of sleep disordered breathing, the authors note in the Journal of Allergy and Clinical Immunology: In Practice. Recall bias in caregiver reports of asthma symptoms or snoring frequency also may have influenced the results.
However, it makes sense that more snoring is linked with worse asthma symptoms, since both of these conditions involve problems with the airway, and links between lung and airway disorders and sleep-related breathing problems are often seen in adults, said Michael Grandner, director of the Sleep and Health Research Program at the University of Arizona in Tucson.
"Sleep-disordered breathing is much more common in the population than many people realize," Grandner, who wasn't involved in the study, said by email. "And rates in children are growing, especially among children who are overweight."
The study results underscore how incredibly common it is to find snoring in children with asthma, said Dr. Kristie Ross, chief of pediatric pulmonology and sleep medicine at UH Rainbow Babies and Children's Hospital and an associate professor at Case Western Reserve University School of Medicine in Cleveland.
"While this study doesn't address whether treating snoring and sleep disordered breathing improves asthma outcomes, other studies have suggested that it might," Dr. Ross, who wasn't involved in the study, said by email. "Sleep is a critical part of health and well-being, and it's important to ask about it, especially in children with chronic illnesses such as asthma."
SOURCE: https://bit.ly/3q7zrur Journal of Allergy and Clinical Immunology: In Practice, online June 5, 2021.
By Lisa Rapaport
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