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

描述(申请人提供)：哮喘是工业化国家年轻人最常见的慢性病。尽管在医疗方面取得了进展，但青少年哮喘患病率仍在继续上升，给社会造成了巨大的经济成本负担和因缺课而造成的生产力损失。因此，有必要确定可改变的健康行为，如睡眠时间，以降低哮喘恶化的频率和严重程度。慢性部分睡眠限制(通常睡眠少于最佳功能所需的睡眠)在青少年中很常见，包括患有哮喘的青少年，而且通常是由行为引起的。越来越多的证据表明，长期部分睡眠限制会导致疾病的发展和更差的健康结果。对于患有哮喘的青少年，长期部分睡眠限制可能会导致较差的肺功能和功能结果。因此，增加睡眠时间可能为青少年哮喘的临床治疗提供一种新的、有效的、低成本的干预措施。该项目汇集了在儿科睡眠、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(年龄12-17岁)参与既定的睡眠操作方案。在一周的基线睡眠稳定之后，患有哮喘的青少年将参加一项随机的平衡设计，其中包括两周的实验操作睡眠时间-一周睡眠不足(每晚6.5小时)和一周健康睡眠机会(每晚10小时)。受试者将完成睡眠的客观和主观日常测量(活动记录、睡眠日记)，以及哮喘控制和肺功能(电子呼气峰流速、哮喘日记)。肺功能(肺活量测定)、哮喘控制、与健康相关的生活质量和炎症(呼出的一氧化氮、血清细胞因子)的额外测量将在每个研究周末收集。本研究的目的是检测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果的影响。一个探索性的目的将检查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记物的影响。这项拟议的研究将首次对哮喘青少年的睡眠时间进行实验性操作，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，这项研究将利用睡眠时间、肺功能和炎症的客观测量(而不是依赖自我报告的测量)，以及哮喘控制和与健康相关的生活质量的标准化结果测量。最后，该方案设计紧密模拟了许多青少年在上学之夜经历的慢性部分睡眠不足，增强了人们的信心，即这些发现将在青少年哮喘的临床护理中具有现实世界的相关性和适用性。

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.