Allergies, asthma treatment, and eviction diet have a significant impact on the respiratory effort during sleep and the apnea-hypopnea index in children with obstructive sleep apnea-obesity/asthma association: A STROBE-compliant study

The pathophysiological mechanisms implicated in obstructive sleep apnea (OSA) associated with asthma/allergies remain unclear. Apnea-hypopnea index (AHI) alone is insufficient to accurately guide adequate treatment without identifying the specific patient profile. The same recommendations apply for children suffering from sleep-disordered breathing/asthma either OSA. Asthma is considered favoring OSA; however, it is unclear if allergies preexist predisposing patients to OSA. OSA correlates to obesity; however, links between obesity, allergy, and OSA remain unexplored. Obesity is considered a risk factor for OSA. Nevertheless, children with OSA increase their body mass index (BMI) despite adequate sleep apnea treatment and adapted weight interventions. We aimed to study the respiratory polygraphy (PG)/polysomnography (PSG) profile of children with OSA-asthma association and the influence of allergies and asthma treatment (AT)/eviction diet (ED) on the AHI/respiratory effort/BMI to diagnose, treat, and prevent pediatric OSA-asthma and obesity-associated early and accurately. We effectuated a combined STROBE-compliant study with a cross-sectional/case control/diagnostic part and a cohort. We used Statistical Package for the Social Sciences and path analysis (analysis of a moment structure). We evaluated the effects of AT, allergies, and allergen eviction on PG/PSG parameters such as the AHI, the respiratory effort, the BMI, the respiratory distress index, the sleep fragmentation, oxygen desaturation index, and sleep fragmentation ventilatory origin. We identified that AT, ED, and the coexistence of non-IgE-mediated and respiratory allergies influenced the AHI, respiratory effort during sleep, and the BMI. Increased respiratory effort during sleep innately correlates with sleep-disordered breathing/OSA related to allergies, especially the coexistence of respiratory and non-IgE mediated allergies, and is on the origin of the sleep fragmentation of children suffering OSA-asthma/associated, even if AHI remains in low levels; decreases (as AHI) with AT or ED, and if untreated, contributes to AHI increase, thus favoring the persistence of OSA and its comorbidities (hyperactivity, decrease in school performance, behavior/concentration problems) asthma and obesity. Consideration of AT, allergies, and ED upon interpretation of PG/PSG parameters could ameliorate the diagnosis and treatment of OSA-asthma-associated and possibly avoid, upon their origin, asthma, and obesity.