Allergists vary in how they perform sleep assessments
August 30, 2022
3 minute read
Key points to remember:
- Most respondents to an American College of Allergy, Asthma and Immunology survey said they often or almost always ask their adult patients with asthma about their sleep.
- More than 60% of respondents said they often or almost always rate the sleep of children who snore.
- Most respondents said they did not plan to use a sleep assessment tool because they did not have enough information or time.
Although patients with asthma and other atopic conditions are at higher risk for sleep disturbances, allergists vary in how they treat their patients’ sleep, according to findings presented in a research letter.
Standardized and easy-to-use assessment tools can help reconcile these differences, Fatima S. Khan, MD, attending physician in the Division of Allergy and Immunology at Ann & Robert H. Lurie Children’s Hospital in Chicago, and Zachary W. Marshall, MD, doctor at the McGovern Allergy and Asthma Clinic in Bellaire, Texas, wrote in Annals of Allergy, Asthma and Immunology.
The ACAAI Respiratory Disorders and Sleep-Related Breathing Disorders Committee developed and distributed an electronic questionnaire to ACAAI members about their awareness and assessment of sleep disorders in their patients.
Responses were given on a 5-point descriptive scale comprising “almost all the time”, “often”, “occasionally”, “rarely” and “never”. The committee received 102 valid questionnaires between September 30 and October 8, 2021.
According to the survey, 90% of respondents have seen adult and pediatric patients. Also, 46% had been practicing for more than 20 years, 32% between 6 and 20 years and 18% for less than 5 years. Locations included suburban (54%), urban (24.5%) and downtown (15.7%) practices, mostly in small groups, self-employed or academic settings.
Treatment of adult patients
With 92 respondents answering questions about adults, most said they ask about sleep in adults with asthma often or almost all the time, while around 10% said they rarely or never do.
More than 60% said they had discussed treatment for obstructive sleep apnea (OSA) with their patients, with 1% rarely discussing treatment. In addition, 41% have never ordered sleep studies, about 15% have rarely ordered them, and about 43% have ordered them occasionally, often, or almost always.
Most often, respondents asked asthma patients about their sleep, with 74% of them asking all the time. Patients with rhinosinusitis and those with atopic dermatitis followed the next two groups most often asked about their sleep. Patients with chronic urticaria and contact dermatitis were asked less often, and about 48% of respondents said they rarely asked patients with food allergies about their sleep.
For patients who snore, 55% of respondents recommend intranasal corticosteroids (INS) almost all the time and 43% recommend them occasionally or often.
Similarly, 9% of respondents recommend first-generation antihistamines almost all the time, 61% recommend them often or occasionally, and 23% rarely recommend them for adults with atopic dermatitis, chronic urticaria and contact dermatitis.
Respondents with more than 10 years of practice experience were significantly more likely to often or almost always ask adults about possible OSAS compared to respondents with less experience (OR = 4.3; 95% CI , 1.6-11.2).
These more experienced allergists were also significantly more likely to often or almost always order overnight sleep studies for adults with suspected OSA (OR = 9.5; 95% CI, 2.4-42, 5).
Treatment of pediatric patients
Of the 86 respondents who answered questions about pediatric patients, more than 60% said they often or almost always assess the sleep of children who snore and 86% recommend INS.
Despite data showing benefits of montelukast for children with sleep-disordered breathing and enlarged adenoids, 32% rarely and 13% never recommended the treatment for children who snore, with only 8% recommending the drug almost all the time.
Additionally, 48% did not order a sleep study when they suspected sleep apnea, 73% using first-generation antihistamines occasionally, often, or all the time, and 94% occasionally, often, or always referring patients to a sleep specialist.
Sleep in patients with food allergies was rated the least and most respondents rarely rated sleep in patients with chronic urticaria, AD, contact dermatitis, or food allergies, regardless of age .
Most respondents had not planned to use a sleep assessment tool, mainly due to a lack of information and time. But variable clinical manifestations can limit physician recognition, the researchers noted, even though there are associations between atopic conditions and sleep disturbances in patients of all ages.
According to the researchers, allergists need information to guide them in the use of valid tools that they could easily integrate into their practices, especially since the lack of sensitive and specific pediatric screening tools further complicates sleep assessments in children.
Allergists and patients, the researchers concluded, would benefit from increased awareness of sleep disorders in patients of all ages with atopic diseases and standardized, easy-to-use assessment tools.