Sleep duration, sleep hygiene, and insomnia in adolescents with asthma

Abstract

Background: There is a need to understand more about modifiable health behaviors that may be related to asthma control. Sleep is one such health behavior that has received little attention in pediatric asthma research.

Objective: To examine sleep duration, sleep hygiene, and insomnia in adolescents with and without asthma.

Methods: Adolescents (n = 298; 51% boys; age range, 12-17 years; 48% with asthma) from the general community completed an online survey that included the International Study of Asthma and Allergies in Childhood questionnaire, the Children's Report of Sleep Patterns, and the Insomnia Severity Index.

Results: Sleep duration did not differ between the asthma severity groups, yet more adolescents with severe asthma reported insufficient weekday sleep (44%) versus adolescents without asthma (31%). Significant asthma group differences were found for sleep hygiene, with adolescents with severe asthma reporting poorer sleep hygiene. Almost twice as many adolescents with severe asthma reported clinically significant insomnia than adolescents with mild or no asthma. Sleep hygiene variables were correlated with insomnia, although these associations did not differ between adolescents with and without severe asthma. Finally, both insomnia severity and asthma severity were significant predictors of daytime sleepiness; however, asthma severity accounted for only 2% of the variance compared with 28% of the variance accounted for by insomnia severity.

Conclusions: Many adolescents with severe asthma regularly obtain insufficient sleep, have poor sleep hygiene, and experience clinically significant insomnia. It is important to ask adolescents with asthma about sleep duration, sleep hygiene, and insomnia because there are effective interventions that can improve sleep for these youths.

Keywords: Adolescents; Asthma; Sleep; Sleep deprivation; Sleep disorders.

Conflict of interest statement

Conflicts of Interest: Drs. Meltzer and Ullrich have no conflicts of interest. Dr. Szefler has consultant arrangements with Merck, Genentech, Boehringer Ingelheim, and GlaxoSmithKline; has received grants from GlaxoSmithKline; has received payment for lectures from Merck; has received payment for manuscript preparation from Genentech; and has submitted a patent for the National Heart, Lung, and Blood Institute CARE network. However, none of these disclosures pertain to the material presented.

Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Flow diagram of participant recruitment. ISAAC definitions(34): aAsthma Ever: Positive response to question “Have you ever had asthma?” bCurrent Wheeze: Positive response to “Have you ever had wheezing or whistling in the chest at any time in the past?” and “Have you had wheezing or whistling in the chest in the past 12 months?” cSevere Asthma: Positive response to Current Wheeze and in the past 12 months had (1) >4 attacks of wheeze or (2) >1 night per week sleep disturbance from wheeze or (3) wheeze affecting speech

Figure 2

Percent of adolescents with and without asthma meeting CDC criteria for insufficient (

Figure 3

Frequency of adolescents with and without asthma reporting no insomnia (ISI score 0 to 7), subthreshold clinical insomnia (ISI score 8 to 14), or moderate/severe clinical insomnia (ISI score ≥ 15).