title: The relationships between asthma control, daytime sleepiness, and quality of life among children with asthma: a path analysis.
abstract: OBJECTIVE
  We aimed to examine the relationships between asthma control, daytime sleepiness, and asthma-specific health-related quality of life (HRQOL) among children with asthma. Path analyses were conducted to test if daytime sleepiness can mediate the effect of asthma control status on asthma-specific HRQOL.
  
  
  METHODS
  160 dyads (pairs) of asthmatic children and their parents were collected for analyses. The Asthma Control and Communication Instrument (ACCI) was used to categorize adequate and poor asthma control status. The Cleveland Adolescent Sleepiness Questionnaire (CASQ) was used to measure children's daytime sleepiness, including sleep in school, awake in school, sleep in evening, and sleep during transport. The Patient-Reported Outcomes Measurement Information System (PROMIS) Asthma Impact Scale was used to measure asthma-specific HRQOL.
  
  
  RESULTS
  Poorly controlled asthma was associated with daytime sleepiness and impaired asthma-specific HRQOL. Asthma control status was directly associated with asthma-specific HRQOL (P<.05), whereas sleep in school and sleep in evening domains of daytime sleepiness significantly mediated the relationship between poor asthma control and impaired HRQOL (P<.01).
  
  
  CONCLUSIONS
  Asthma control status was associated with pediatric asthma-specific HRQOL, and the association was significantly mediated by daytime sleepiness. Healthcare providers need to address pediatric sleep needs related to poor asthma control to reduce the negative impact on HRQOL.
authors.affiliation: Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL 32610, USA.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Li
authors.forename: I-Chan
authors.initials: IC
authors.lastname: Huang
authors.forename: Lindsay
authors.initials: L
authors.lastname: Thompson
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Tuli
authors.forename: Shih-Wen
authors.initials: SW
authors.lastname: Huang
authors.forename: Darren
authors.initials: D
authors.lastname: DeWalt
authors.forename: Dennis
authors.initials: D
authors.lastname: Revicki
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Shenkman
mesh_terms: D000293:Adolescent; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology*; D002648:Child; D006970:Disorders of Excessive Somnolence / Q000503:physiopathology*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010290:Parents; D011788:Quality of Life
chemical_list: D018927:Anti-Asthmatic Agents
keywords: Asthma control; Children; Health-related quality of life; Patient-reported outcomes; Sleepiness; Structural equation modeling