Asthma symptoms impair sleep quality and school performance in children

(Press-News.org) ATS 2013, PHILADELPHIA ─ 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."

### * Please note that numbers in this release may differ slightly from those in the abstract. Many of these investigations are ongoing; the release represents the most up-to-date data available at press time.

Abstract 42716 Asthma, Sleep, And School Functioning In Urban Children
Type: Scientific Abstract
Category: 02.03 - Disparities in Lung Disease and Treatment (BSHSR)
Authors: D. Koinis Mitchell; Brown Medical School/Rhode Island Hospital - Providence, RI/US; and the Project NAPS Study Group

Abstract Body Rationale: Urban children are at an increased risk for asthma morbidity. Poor quality sleep is an indicator that asthma is in poor control. Asthma and poor sleep can affect children's academic performance. No studies have examined asthma, sleep quality, and academic functioning in urban children with asthma using objective and subjective methods. This study investigates associations among asthma symptoms (FEV1 and symptom reports), asthma control, sleep efficiency (through actigraphy) and academic functioning in a sample of urban children. Methods: Data are from a larger study of asthma and allergic rhinitis symptoms, sleep quality and academic performance in urban children (aged 7-9).To date, data are collected from 170 parent-child dyads from African-American, Latino, and non-Latino white backgrounds. Asthma symptoms were assessed by FEV1 percent predicted via the AM2 (electronic hand-held spirometer) over three, 30 day monitoring periods across the academic year. Children and caregivers also recorded days when asthma symptoms were present via a standard diary. Sleep quality was assessed through actigraphy for 3, 30 day periods across the academic year. Asthma diagnosis and persistent asthma status were confirmed through clinician assessment using standardized procedures (NHLBI, 2007). Asthma control was assessed using the ACT. Teachers reported on children's academic functioning during the same time periods when asthma and sleep data were collected. Results: Results to date show that children with poorly controlled asthma had lower quality school work by teacher report (MN=2.2) relative to their counterparts with well controlled asthma (MN=2.8; F(1,73)=4.9, p=.03). Similarly, on average, children with poor asthma control were reported to be more careless with their school-work (MN=3.1) relative to children with good asthma control (MN=2.5; F(1,73)=4.5, p=.04). Higher levels of asthma symptoms (by diary report) were related to lower quality of school work (r= - .24, p=.03) by teacher report. Careless and hasty schoolwork was negatively associated with objectively measured asthma symptoms (FEV1), (r= -.25, p=.05). Careless school work was associated with poorer sleep quality (r= -.25, p=.03). Teacher report of children's struggle to stay awake in class was negatively associated with sleep onset latency (r=-.29, p=.01), suggesting that children who are more alert in class have less difficulty falling asleep. Conclusions: Results to date indicate that children's asthma symptoms correspond with sleep efficiency indicators using objective and subjective methods, and children's academic performance by teacher report. Results can inform family and school-based interventions designed to improve asthma control, sleep quality and academic performance in urban children.