The impact of obstructive sleep apnea on quality of life in children with asthma

  • Lisa Adhia Garina Department Pediatric, Faculty of Medicine Universitas Islam Bandung
  • Faisal Yunus Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Persahabatan Hospital, Jakarta, Indonesia
  • Ina Susianti Timan Department of Clinical Pathology, Faculty of Medicine, Universitas Indonesia, Cipto-Mangunkusumo Hospital, Jakarta, Indonesia
  • Widhy Yudistira Nalapraya Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Islam Bandung, Al Ihsan Hospital, Bandung, Indonesia
  • Bambang Supriyatno Division of Respirology, Department of Pediatrics, Faculty of Medicine, Universitas Indonesia, Cipto-Mangunkusumo Hospital, Indonesia
Keywords: asthma; children; lung function; obstructive sleep apnea; quality of life


Background In children with asthma, obstructive sleep apnea (OSA) is a comorbidity of concern. The presence of OSA has been associated with asthma exacerbations and decreased quality of life. Leukotriene played a role in tonsil hypertrophy which is one of the risk factors for OSA.

Objective To evaluate the influence of OSA on quality of life in children with asthma.

Methods This cross-sectional study in asthmatic children aged 7?15 years was conducted from August 2020 to June 2021 at government elementary and primary high schools in Bandung, West Java, Indonesia. Asthma was diagnosed by peak expiratory flow rate (PEFR) and OSA was diagnosed by polysomnography. Leukotriene was examined by an ELISA method and quality of life assessed by the Pediatric Asthma Quality of Life Questionnaire (PAQLQ).

Results Using the ISAAC questionnaire distributed through teachers to parents, 206 (6.9%) of 2,964 children stated that they had been diagnosed with asthma, 80 of whom were included in our study. Subjects’ mean age was 12 (SD 2) years and most were male. Intermittent asthma and history of allergy was dominant. Thirty-two children had OSA, mostly mild OSA. The mean level of leukotriene was not different between asthmatic children with and without OSA. The percentage of PEFR in asthmatic children with OSA was significantly lower than in those without OSA. The total PAQLQ score in asthmatic children with OSA and all PAQLQ domains were significantly lower  than in those without OSA.

Conclusion Obstructive sleep apnea in children with asthma is significantly associated with decreased peak expiratory flow rate and lower quality of life.


1. Lin CH, Lin WC, Lin CL, Hang LW. Association of childhood asthma and pediatric obstructive sleep apnea: a retrospective cohort study from a nationwide population-based database. J of Sleep Disorders & Therapy. 2017;06:2-5. DOI: 10.4172/2167-0277.1000266.
2. Rogers VE, Bollinger ME, Tulapurkar ME, Zhu S, Hasday JD, Pereira KD, et al. Inflammation and asthma control in children with comorbid obstructive sleep apnea. Pediatr Pulmonol. 2018;53:1200-7. DOI: 10.1002/ppul.24074.
3. Brinke TA, Sterk PJ, Masclee AA, Spinhoven P, Schmidt JT, Zwinderman AH, et al. Risk factors of frequent exacerbations in difficult to treat asthma. The Eur Res J. 2005;26:812-?8. DOI: 10.1183/09031936.05.00037905.
4. Busse. Expert panel report 3 (EPR-3): guidelines for the diagnosis and management of asthma–summary report 2007. J Allergy and Clin Immunol. 2007;120:S94?138. DOI:10.1016/j.jaci.2007.09.029.
5. Kong DL, Qin Z, Hui S, Jin HY, Wang W, Wang ZF. Association of obstructive sleep apnea with asthma:a meta-analysis. Scientific Reports. 2017;7:1-7. DOI: 10.1016/j.cppeds.2015.10.010.
6. Kheirandish-Gozal L. Asthma and obstructive sleep apnea. In Gozal LK, Gozal D, (Ed). Sleep disordered breathing in children. New York: Springer Science NY; 2012. p. 385-9.
7. Kheirandish Gozal L, Dayyat EA, Eid NS, Morton RL, Gozal D. Obstructive sleep apnea in poorly controlled asthmatic children: effect of adenotonsillectomy. Pediatr Pulmonol. 2011;46:913?8. DOI:10.1002/ppul.21451. DOI: 10.1007/978-1-60761-725-9_28.
8. Malakasioti G, Gourgoulianis K, Chrousos G, Kaditis A. Interactions of obstructive sleep-disordered breathing with recurrent wheezing or asthma and their effects on sleep quality. Pediatr Pulmonol. 2011;46:1047-54. DOI: 10.1002/ppul.21497.
9. Kaditis AG, Kalampouka E, Hatzinikolaou S, Lianou L, Papaefthimiou M, Gartagani-Panagiotopoulou P, et al. Associations of tonsillar hypertrophy and snoring with history of wheezing in childhood. Pediatr Pulmonol. 2010;45:275-80. DOI: 10.1002/ppul.21174.
10. Alkhalil M, Schulman E, Getsy J. Obstructive sleep apnea syndrome and asthma: what are the links? J Clin Sleep Med. 2009;5:71?8. PMID: 19317386.
11. Stelter K. Tonsillitis and sore throat in children. Otorhinolaryngol Head and Neck Sur. 2014;1:1-24. DOI: 10.3205/cto000110.
12. Shen Y, Qin Q, Xu Z, Shen K. Serum leukotrienes, circulating neutrophils, and high sensitivity C-reactive protein in Chinese children with sleep-disordered breathing. Int Immunopharmacol. 2014;22:120-5. DOI: 10.1016/j.intimp.2014.05.029.
13. Teodorescu M, Broytman O, Curran-Everett D, Sorkness RL, Crisafi G, Bleecker ER, et al. Obstructive sleep apnea risk, asthma burden, and lower airway inflammation in adults in the severe asthma research program (SARP) II. J Allergy Clin Immunol Pract. 2015;3:566-75. DOI:10.1016/j.jaip.2015.04.002.
14. Bikov A, Losonczy G, Kunos L. Role of lung volume and airway inflammation in obstructive sleep apnea. Respir Investig. 2017;55:326-33. DOI: 10.1016/j.resinv.2017.08.009.
15. Taille C, Rouvel-Tallec A, Stoica M, Danel C, Dehoux M, Marin-Esteban V, et al. Obstructive sleep apnoea modulates airway inflammation and remodelling in severe asthma. PLoS One. 2016;11:1-12. DOI:10.1371/journal. pone.0150042.
16. Wang TY, Lo YL, Lin SM, Huang CD, Chung FT, Lin HC, et al. Obstructive sleep apnoea accelerates FEV1 decline in asthmatic patients. BMC Pulm Med. 2017;17:1-6. DOI: 10.1186/s12890-017-0398-2.
17. Baldassari CM, Mitchell RB, Schubert C, Rudnick EF, Richmond VA. Pediatric obstructive sleep apnea and quality of life: a meta-analysis. Otolaryngol Head Neck Surg. 2008;138:265-73. DOI: 10.1016/j.otohns.2007.11.003.
18. Kim MY, Jo EJ, Kang SY, Chang YS, Yoon IY, Cho SH, et al. Obstructive sleep apnea is associated with reduced quality of life in adult patients with asthma. Ann Allergy Asthma Immunol. 2013;110:253-7. DOI: 10.1016/j.anai.2013.01.005.
19. Madama D, Silva A, Matos MJ. Overlap syndrome-asthma and obstructive sleep apnea. Rev Port Pneumol 2016;22:6-10.DOI: 10.1016/j.rppnen.2015.08.005.
20. Vijil VB, Navarro BdR, Eslava AB, Monge JJLS. Quality of life in pediatric patients with asthma with or without obesity: a pilot study. Allergol et Immunopathol 2004;32:37-42. DOI: 10.1016/s0301-0546(04)79252-6.
21. Adeniyi B, Erhabor GE. The peak flow meter and its use in clinical practice. African J Resp Med. 2011;1:5-8.
22. Godfrey S KP, Nairn JR, Connolly NMC, Davis J, Packham E, et al. Spirometry, lung volumes and airway resistance in normal children aged 5 to 18 years. Brit J Dis Chest 1970;64:1-10. DOI: 10.1016/S0007-0971(70)80045-6.
23. Ikatan Dokter Anak Indonesia. Rahajoe N, Kartasasmita CB, Supriyatno B, Setyanto DB, editors. Pedoman nasional asma anak. Jakarta: Badan Penerbit Ikatan Dokter Anak Indonesia; 2016.
24. Dehlink E, Tan HL. Update on paediatric obstructive sleep apnoea. J Thorac Dis. 2016;8:224-35. DOI: 10.3978/j.issn.2072-1439.2015.12.04.
24. Gipson K, Lu M, Kinane TB. Sleep-Disordered Breathing in Children. Pediatrics in Rev. 2019;40:1-14. DOI: 10.1542/pir.2018-0142.
26.Furtado PR, Maciel ACC, Barbosa RRT, Silva A, Freitas DA, Mendonca K. Association between quality of life, severity of asthma, sleep disorders and exercise capacity in children with asthma: a cross-sectional study. Braz J Phys Ther. 2018;147:1-7. DOI: 10.1016/j.bjpt.2018.08.010.
26. Kang KT, Chou CH, Weng WC, Lee PL, Hsu WC. Associations between adenotonsillar hypertrophy, age, and obesity in children with obstructive sleep apnea. PLoS One. 2013;8:1?8. DOI: 10.1371/journal.pone.0078666.
27. Inoshita A, Kasai T, Matsuoka R, Sata N, Shiroshita N, Kawana F, et al. Age-stratified sex differences in polysomnographic findings and pharyngeal morphology among children with obstructive sleep apnea. J Thorac Dis 2018;10:6702-10. DOI: 10.21037/jtd.2018.11.09.
29.May AM, Mehra R. Obstructive sleep apnea: role of intermittent hypoxia and inflammation. Semin Respir Crit Care Med. 2014;35:531-44. DOI: 10.1055/s-0034-1390023.
30. Brodsky L. Modern assessment of tonsils and adenoids. Ped Clinics of North Am. 1989;36:1551-69. DOI: 10.1016/s0031-3955(16)36806-7.
31. Pepito DL, Mohammed JM, Hardin KA. Obstructive sleep apnea and asthma: more than chance? Cur Pulmonol Reports 2021;10:89-91. 2021;10:84-91. DOI: 10.1007/s13665-021-00271-5.
32. Teodorescu M, Polomis DA, Gangnon RE, Fedie JE, Consens FB, Chervin RD, et al. Asthma control and its relationship with obstructive sleep apnea (OSA) in older adults. Sleep Disord. 2013;2013:1-23. DOI: 10.1155/2013/251567.
33. Julien JY, Martin JG, Ernst P, Olivenstein R, Hamid Q, Lemiere C, Pepe C, et all. Prevalence of obstructive sleep apnea-hypopnea in severe versus moderate asthma. The J of Allergy and Clin Immunol. 2009;124:371-6. DOI:10.1016/j.jaci.2009.05.016.
34. Sudarmawan DA, Arkhaesy N, Anam MS. Perbedaan hasil fungsi paru pada remaja dengan OSA (obstructive sleep apneu) dan tanpa OSA. J Ked Diponegoro 2019;8:681-92. DOI: 10.14710/dmj.v8i2.23787.
35. Rodriguez CJA, Brockmann PE, Marcus CL. Relation between asthma and sleep disordered breathing in children: is the association causal? Paediatr Respir Rev. 2017;22:72-5. DOI: 10.1016/j.prrv.2016.08.010.
36. Section on Pediatric Pulmonology, Subcommittee on Obstructive Sleep Apnea Syndrome. American Academy of Pediatrics. Clinical practical guideline: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2002;109:704-12. DOI: 10.1542/peds.109.4.704.
How to Cite
Garina L, Yunus F, Timan I, Nalapraya W, Supriyatno B. The impact of obstructive sleep apnea on quality of life in children with asthma. PI [Internet]. 2Jun.2022 [cited 12Aug.2022];62(3):166-3. Available from:
Pediatric Respirology
Received 2022-03-16
Accepted 2022-03-30
Published 2022-06-02