Implications
Obesity is a potent predictor of OSA in children with asthma as
indicated by our findings. The BMI z-score with or without reported loud
snoring and morning dry mouth may be used for OSA screening with several
implications for health systems, global public health and our
understanding of the impact of OSA on asthma disease management. First,
the questionnaire-based approach has been the mainstay for initial OSA
screening. In the past two decades, however, electronic medical records
and health informatics systems have reshaped healthcare delivery. Given
that anthropometric measures such as BMI and BMI z-scores are available
on such platforms, OSA risk stratification may be implemented in an
automated fashion on a wide scale. Second, in low to middle income
countries were such databases may not exist, OSA screening may be
deployed via mobile applications that have a BMI z-score calculator or
the MOP algorithm incorporated. Thus, the BMI z-score or MOP algorithm
may serve as low-cost OSA screening methods for children with asthma in
these locations where sleep study facilities may also be non-existent.
Finally, the impact of OSA on asthma and vice-versa may be tracked by
examining retrospective and prospective trends in BMI z-scores, as a
biomarker of OSA, along with metrics of asthma control, which may reveal
disease management practices most likely to decrease the future burden
of OSA and asthma.
In conclusion, we recommend that children with asthma who have BMI
z-scores of 2.07 or greater be referred for in-laboratory
polysomnography and OSA evaluation. Future efforts should refine OSA
screening tools that are specific to children with asthma.
ACKNOWLEDGEMENT: The authors wish to thank the sleep
technologists and staff of the Johns Hopkins Pediatric Sleep Center,
study coordinators, patients as well as caregivers who committed to
participation.