الفهرس 
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Abstract
This study included sixty-one asthmatic children aged between 6 and 16 years old attending Alexandria Sporting Students’ Hospital between August 2015 and September 2016 who were admitted for overnight level III polysomnography. Children with acute asthma attack, bronchiectasis, interstitial lung diseases, tuberculosis and cardiac disease were excluded from the study. The aim of the study was to determine the prevalence of sleep disordered breathing (SDB) especially OSA in school-aged children with asthma and to determine the risk factors associated with SDB in this group of patients.
Regarding asthma control, patients were divided according to ACT into patients with partially controlled asthma (n=26) and patients with uncontrolled asthma (n=35). Males represented 53.8% (n=14) of partially controlled asthmatic children and 45.7% (n=16) of uncontrolled asthmatic children. There was no statistically significant difference between both groups (partially controlled vs. uncontrolled asthma) regarding gender (p= 0.530).
The obstructive apnea-hypopnea index (AHI) in children with partially controlled asthma ranged between 0.80- 11.40 events/hour with mean (± SD) of 4.34 (±2.61) events/hour; while in children with uncontrolled asthma ranged between 0.30-16.80 events/hour with mean (± SD) of 4.15 (±3.83) events/hour without statistically significant difference between both groups (p= 0.347).
In the present study, 46 asthmatic children had OSA (75.4%) whereas they were classified into mild OSA (AHI≥2-5), moderate OSA (AHI>5-10) and severe OSA (AHI>10). In partially controlled asthmatic children group, 54.5% (n=12) had mild OSA, 40.9% (n=9) had moderate OSA and 4.5% (n=1) had severe OSA. In uncontrolled asthmatic children group, 59.3% (n=16) had mild OSA, 33.3% (n=9) had moderate OSA and 7.4% (n=2) had severe OSA. There was no statistically significant difference between the two groups regarding the severity of OSA (MCp= 0.901).
About 23.1% (n=6) of partially controlled asthmatic children suffered daytime sleepiness while 48.6% (n=17) of uncontrolled asthmatic children suffered daytime sleepiness. There was statistically significant difference between both groups regarding daytime sleepiness (p= 0.042).
ADHD score was positive in 65.4% (n=17) of partially controlled asthmatic children and 88.6% (n=31) of uncontrolled asthmatic children had with statistically significant difference between the two groups (p= 0.029).
SCR score was considered as positive in 50% (n=13) of partially controlled asthmatic group and 40% (n=14) of uncontrolled asthmatic group had positive score without statistically significant difference between both groups (p= 0.605).
Regarding presence of OSA, asthmatic patients were divided into two groups; as non-OSA patients with obstructive AHI < 2 events/hour (n=15; 24.6%) and OSA patients with obstructive AHI ≥ 2 events/hour (n= 46; 75.4%). Males represented 46.7% (n=7) of non-OSA patients and 50% (n=23) of OSA patients. There was no statistically significant difference between non-OSA and OSA patients regarding gender (p= 0.823).
ADHD score was positive in 93.3% (n=14) of non-OSA patients and in 73.9% (n=34) of OSA patients without statistically significant difference between both groups (FEp= 0.156).
SCR score was positive in 33.3% (n=5) of non-OSA patients and 47.8% (n=22) of OSA patients without statistically significant difference (p= 0.495).
Regarding asthma control, 33.3% (n=5) of non-OSA patients were partially controlled and 66.7% (n=10) were uncontrolled; while 45.7% (n=21) of OSA patients were partially controlled and 54.3% (n=25) were uncontrolled without statistically significant difference between both groups (p= 0.402). However, patients suffering daytime asthma symptoms > 2 times / week represented 86.7% (n=13) of non-OSA patients and 52.2% (n=24) of OSA patients with statistically significant difference between both groups (p= 0.018).
According to BMI, asthmatic patients were divided into two groups; normal weight (non-obese) patients with BMI < 25 kg/mm2 (n=53; 87%) and obese/overweight patients with BMI ≥ 25 kg/mm2 (n=8; 13%). Males represented 54.7% (n=29) of non-obese patients and 12.5% (n=1) of obese /overweight patients. There was no statistically significant difference between non-obese and obese / overweight patients regarding gender (FEp= 0.053).
The neck circumference in non-obese patients ranged between 26-38 cm with mean (± SD) of 30.43 (±2.36) cm; while in obese/overweight patients ranged between 32-38 cm with mean (± SD) of 34.69 (±2.02) cm with statistically significant difference between both groups (p< 0.001).
Regarding the severity of OSA, 57.1% (n=24) of non-obese patients had mild OSA, 35.7% (n=15) had moderate OSA and 7.1% (n=3) had severe OSA; while 57.1% (n=4) of obese/overweight patients had mild OSA, 42.9% (n=3) had moderate OSA and none of the included cases had severe OSA. There was no statistically significant difference between non-obese and obese/overweight patients regarding the severity of OSA (MCp= 1).
Regarding asthma control, 45.3% (n=24) of non-obese asthmatic patients were partially controlled and 54.7% (n=29) were uncontrolled; while 25% (n=2) of obese/overweight asthmatic patients were partially controlled and 75% (n=6) were uncontrolled without statistically significant difference between both groups (FEp= 0.448).
Nasal obstruction was a statistically significant factor for development of OSA among asthmatic children (p = 0.037) with odd ratio (OR) of 2.18. Obesity appeared to be a risk factor for development of OSA in asthmatic children with OR of 3.82 but did not reach statistical significance (p= 0.324).
The SCR score > 6 had low diagnostic accuracy of 60% for predicting mild OSA in asthmatic children (p= 0.242) with low sensitivity of 48% and only moderate specificity of 67%; however, SCR score had better diagnostic accuracy for predicting moderate OSA with AHI > 5 events/hour in asthmatic children (p=0.024) with a sensitivity of 79% and specificity of 67%. Similarly, Brouillette score had low diagnostic accuracy of 59% for predicting mild OSA in asthmatic children (p= 0.287) but the diagnostic accuracy increased to 70% for predicting moderate OSA with AHI > 5 events/hour (p= 0.012).