Deficient Sleep Lung Function, and Functional Outcomes in Adolescents with Asthma

描述（由申请人提供）：哮喘是工业化国家青少年最常见的慢性疾病。尽管医学治疗取得了进步，但青少年哮喘患病率继续上升，给社会造成了巨大的经济负担，并因缺课而造成生产力损失。因此，有必要确定可改变的健康行为，如睡眠时间，这可能会减少哮喘发作的频率和严重程度。慢性部分睡眠限制（通常睡眠少于最佳功能所需的时间）在青少年中很常见，包括患有哮喘的青少年，通常是由行为引起的。越来越多的证据表明，长期的部分睡眠不足会导致疾病的发展和健康状况的恶化。对于患有哮喘的青少年，慢性部分睡眠限制可能导致肺功能和功能预后较差。因此，增加睡眠时间可能为青少年哮喘的临床管理提供一种新颖、有效、低成本的干预措施。该项目汇集了在儿童睡眠、哮喘和免疫学方面具有丰富专业知识的研究人员，并将招募86名患有哮喘的青少年（12-17岁）参加既定的睡眠控制方案。在一周的基线睡眠稳定之后，患有哮喘的青少年将参加一个随机的、平衡的设计，其中包括两周的实验控制睡眠时间——一周的睡眠不足机会（每晚6.5小时的床上时间）和一周的健康睡眠机会（每晚10小时的床上时间）。受试者将完成客观和主观的日常睡眠测量（活动记录仪，睡眠日记），以及哮喘控制和肺功能（电子呼气峰流量，哮喘日记）。在每个研究周结束时，将收集肺功能（肺活量测定法）、哮喘控制、健康相关生活质量和炎症（呼出一氧化氮、血清细胞因子）的附加测量。本研究的目的是研究慢性部分睡眠限制与健康睡眠机会对哮喘青少年肺功能和功能结局的影响。一项探索性目的是研究慢性部分睡眠限制与健康睡眠机会对哮喘青少年炎症生物标志物的影响。这项提议的研究将是第一个对青少年哮喘患者的睡眠时间进行实验操作的研究，并允许我们的儿科专家团队检查睡眠时间对肺功能和功能结果的因果影响。此外，本研究将利用睡眠时间、肺功能和炎症的客观测量（而不是依赖于自我报告的测量），以及哮喘控制和健康相关生活质量的标准化结果测量。最后，该方案的设计密切模仿了许多青少年在上学的夜晚经历的慢性部分睡眠不足，从而增强了研究结果将具有现实世界相关性和对患有哮喘的青少年临床护理的适用性的信心。

DESCRIPTION (provided by applicant): Asthma is the most common chronic disease for youth in industrialized countries. Despite advances in medical treatments, the prevalence of asthma in youth continues to rise, resulting in a significant burden on society in terms of financial costs and lost productivity due to missed school days. Thus, there is a need to identify modifiable health behaviors, such as sleep duration, that may reduce the frequency and severity of asthma exacerbations. Chronic partial sleep restriction (routinely sleeping less than required for optimal functioning) is common among adolescents, including youth with asthma, and is often behaviorally induced. Growing evidence has shown that chronic partial sleep restriction contributes to disease development and poorer health outcomes. For adolescents with asthma, chronic partial sleep restriction may result in poorer lung function and functional outcomes. Therefore, increased sleep duration may provide a novel, effective, low-cost intervention for the clinical management of asthma in adolescents. This project brings together investigators with substantial expertise in pediatric sleep, asthma, and immunology and will enroll 86 adolescents (ages 12-17 years) with asthma to participate in an established sleep manipulation protocol. Following a week of baseline sleep stabilization, adolescents with asthma will participate in a randomized, counterbalanced design that includes two experimentally manipulated weeks of sleep duration - one week of a deficient sleep opportunity (6.5 hours in bed per night) and one week of a healthy sleep opportunity (10 hours in bed per night). Subjects will complete both objective and subjective daily measures of sleep (actigraphy, sleep diary), as well as asthma control and lung function (electronic peak expiratory flow, asthma diary). Additional measures of lung function (spirometry), asthma control, health related quality of life, and inflammation (exhaled nitric oxide, serum cytokines) will be collected at the end of each study week. The aim of this study is to examine the impact of chronic partial sleep restriction vs. healthy sleep opportunity on lung function and functional outcomes in adolescents with asthma. An exploratory aim will examine the impact of chronic partial sleep restriction vs. healthy sleep opportunity on biomarkers of inflammation in adolescents with asthma. The proposed study would be the first to use an experimental manipulation of sleep duration in adolescents with asthma, and allows our team of pediatric experts to examine the causal impact of sleep duration on lung function and functional outcomes. In addition, this study will utilize objective measures of sleep duration, lung function, and inflammation (rather than relying on self-report measures), as well as standardized outcome measures of asthma control and health related quality of life. Finally, the protocol design closely mimics the chronic partial sleep deficiency experienced by many adolescents on school nights, promoting confidence that the findings will have real-world relevance and applicability in the clinical care for adolescents with asthma.