Obstructive sleep apnea screening in children with asthma.

RATIONALE: Obstructive sleep apnea is highly prevalent in children with asthma, particularly in obese children. The sleep-related breathing disorder screening questionnaire has low screening accuracy for obstructive sleep apnea in children with asthma. Our goal was to identify the questions on the sleep-related breathing disorder survey associated with obstructive sleep apnea in children with asthma. METHODS: Participants completed the survey, underwent polysomnography and their body mass index z-score was measured. Participants with survey scores above 0.33 were considered high risk for obstructive sleep apnea and those with an apnea-hypopnea index ≥ 2 events/h classified as having obstructive sleep apnea. Logistic regression was used to examine the association of each survey question and obstructive sleep apnea. Positive and negative predictive values were calculated to estimate screening accuracy. RESULTS: The prevalence of obstructive sleep apnea was 40% in our sample (n = 136). Loud snoring, morning dry mouth, and being overweight were the survey questions associated with obstructive sleep apnea. The composite survey score obtained from all 22 questions had positive and negative predictive values of 51.0% and 65.5%, while the combined model of loud snoring, morning dry mouth, and being overweight had positive and negative predictive values of 60.3% and 77.6%. On the other hand, the body mass index z-score alone had positive and negative predictive values of 76.3% and 72.2%. CONCLUSIONS: The body mass index z-score is useful for obstructive sleep apnea screening in children with asthma and should be applied routinely given its simplicity and concerns that obstructive sleep apnea may contribute to asthma morbidity.

The Lung Health Ambassador Program: A Community-Engagement Initiative Focusing on Pulmonary-Related Health Issues and Disparities Regarding Tobacco Use.

Introduction: Educational campaigns have the potential to inform at risk populations about key issues relevant to lung health and to facilitate active engagement promoting healthy behaviors and risk prevention. We developed a community-based educational campaign called the Lung Health Ambassador Program (LHAP) with a goal of engaging youth and empowering them to be advocates for pulmonary health in their community. Objective: To evaluate the process outcomes and feasibility of the inaugural LHAP (2018-2019 academic year), with a specific aim to impact tobacco policy in the state of Maryland. Methods: Outcomes regarding feasibility included assessment of number of schools reached, number of students and healthcare professionals participating, and types of projects developed by participating students to impact modifiable risk factors for lung health. The courses for the LHAP were five 1 h sessions implemented at days and times identified by the community. The topics of the LHAP focused on lung anatomy, pulmonary diseases affecting school aged youth, tobacco use and prevalence, and air pollution (both indoor and outdoor). The fifth class discussed ways in which the students could impact lung health (e.g., policy and advocacy) and mitigate pulmonary disparities. Main Results: The LHAP was implemented at two elementary/middle schools, one high school, and two recreation centers within an urban metropolitan region. A total of 268 youths participated in the LHAP (age ranging from 11 to 18), whereby 72 (26.9%) were Hispanic/Latino and 110 (41.0%) were African American. Of the participating students, 240 wrote letters to local politicians to advocate for policies that would raise the legal age of acquiring tobacco products to 21. As for healthcare professionals, 18 academic faculty members participated in implementing the LHAP: 8 physicians and faculty staff and 10 nurses. Conclusions: The LHAP is a community-based program that provides education and training in advocacy with a goal of teaching about and, ultimately, reducing respiratory health disparities. The results from the first year demonstrate that the program is feasible, with success demonstrated in completing educational modules and engaging students. Next steps will include strategies to ensure sustainability and scalability to increase the reach of this program.