Influence of Allergy, Asthma Treatment(AT) and Eviction Diet(ED) on Sleep-Disordered Breathing(SDB) in Pediatric Asthma Associated With Osa, Increased Respiratory Effort(RE) During Sleep and Overweight/Obesity: a Study in 78 Children

Abstract

Pathophysiological mechanisms and allergies in Obstructive Sleep Apnoea-asthma associated are unclear. Apnoea hypopnea Index alone does not seem sufficient to correctly guide for adequate treatment without identification of the specific profile of each patient. Children suffering from allergies and SDB-asthma association are treated with the same recommendations as those suffering from the obstructive type of Obstructive Sleep Apnoea. Obstructive Sleep Apnoea correlates with obesity; however, links between obesity, allergy, and Obstructive Sleep Apnoea remain unexplored. Obesity is considered a risk factor for OSA; however, children with Obstructive Sleep Apnoea increase their Body Mass Index despite being treated adequately for OSA and following adequate weight interventions. Asthma is considered to favor Obstructive Sleep Apnoea; however, it is not explored whether allergies pre-exist and favor Obstructive Sleep Apnoea. Parents often ask questions about the efficacy of adenotonsillectomy/anti-leukotriene treatments/PPC, which are difficult to answer. We aimed to study the Respiratory Polygraphy/Polysomnography profile of children suffering Obstructive Sleep Apnoea-asthma associated and the influence of allergies and Asthma Treatment/Eviction Diet upon Apnoea Hypopnea Index/Respiratory Effort/Body Mass Index to diagnose, treat and prevent pediatric Obstructive Sleep Apnoea-asthma associated and related obesity early and accurately. We effectuated a cross-sectional/case controls diagnostic cohort. We used Receiver Operating Characteristic curves, General Linear Models, regression, and path analysis to evaluate the effect of treatments and allergies on Apnoea Hypopnea Index, Respiratory Effort, Body Mass Index and Polygraphy/Polysomnography parameters such as Respiratory Distress Index, Sleep Fragmentation, Sleep Fragmentation Ventilatory Origin, Oxygen Desaturation Index. We identified that asthma treatment and specific allergen eviction, along with the co-existence of non-IgE-mediated and respiratory allergies, influence the Apnoea Hypopnea Index, Respiratory Effort during sleep and the Body Mass Index. Increased Respiratory effort during sleep inherently correlates with SDB/OSA related to allergies, especially the coexistence of RANIgE, and is the origin of the sleep fragmentation in children suffering from OSA-asthma association, even if AHI remains at low levels. It decreases (as AHI) with AT or ED and, if untreated, contributes to AHI increase, thus favoring the persistence of OSA and its comorbidities (hyperactivity, decrease in school performance, behavior/concentration problems), asthma, and obesity. Consideration of asthma treatment, allergies, and allergen eviction upon interpretation of polygraphy/polysomnography parameters could ameliorate the diagnosis and treatment of Obstructive Sleep Apnoea-asthma associated and possibly avoid, upon their origin, asthma, and obesity.