title: Obstructive sleep apnea in poorly controlled asthmatic children: effect of adenotonsillectomy.
abstract: BACKGROUND
  Asthma and obstructive sleep apnea (OSA) in children share multiple epidemiological risk factors and the prevalence of snoring is higher in asthmatic children, suggesting that the latter may be at increased risk for OSA. Since both asthma and OSA are inflammatory disorders, we hypothesized that polysomnographically demonstrated OSA would be more frequent among poorly controlled asthmatics (PCA), and that treatment of OSA, if present, would ameliorate the frequency of acute asthmatic exacerbations (AAE).
  
  
  METHODS
  Children with PCA were referred for an overnight sleep study, and adenotonsillectomy (tonsillectomy and adenoidectomy, T&A) was performed if OSA was present. Frequency of asthma symptoms and exacerbations were compared.
  
  
  RESULTS
  Ninety-two PCA children, ages 3-10 years, with a mean frequency of AAE of 3.4 ± 0.4/year were prospectively referred for a sleep study. OSA (i.e., AHI > 5/hrTST) was present in 58 patients (63.0%; OR: 40.9, 12.9-144.1, P < 0.000001 compared to the prevalence of OSA in a non-asthmatic population). Information at 1-year follow-up was available for 35 PCA children after T&A. The annual frequency of AAE, rescue inhaled use, and asthma symptoms in this sub-group decreased compared to no changes in the group without OSA.
  
  
  CONCLUSIONS
  The prevalence of OSA is markedly increased among PCA children and treatment of OSA appears to be associated with substantial improvements in the severity of the underlying asthmatic condition.
authors.affiliation: Sections of Pediatric Pulmonology and Pediatric Sleep Medicine, Department of Pediatrics, University of Chicago, Chicago, Illinois 60637-1470, USA. lgozal@peds.bsd.uchicago.edu
authors.forename: Leila
authors.initials: L
authors.lastname: Kheirandish-Gozal
authors.forename: Ehab A
authors.initials: EA
authors.lastname: Dayyat
authors.forename: Nemr S
authors.initials: NS
authors.lastname: Eid
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Morton
authors.forename: David
authors.initials: D
authors.lastname: Gozal
mesh_terms: D000233:Adenoidectomy; D001249:Asthma / Q000453:epidemiology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000453:epidemiology; D015995:Prevalence; D011788:Quality of Life; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology / Q000601:surgery*; D012913:Snoring / Q000453:epidemiology / Q000601:surgery; D014068:Tonsillectomy; D016896:Treatment Outcome