Not So Easy Sleeping: A Canary in The Coal Mine for Adolescent Asthma?

Purpose: Sleep is an important biologic process and deficits in sleep can lead to poor physical and mental health outcomes. Proper sleep is important for all ages; however, younger individuals need more sleep to maintain a healthy lifestyle. Currently, U.S. adolescents do not sleep enough, which is a concerning warning sign for negative downstream health effects. In adolescents, a lack of sleep has been linked to poor performance in school, drug and alcohol use, sports injuries, car crashes, and even suicide. A recent study has also found that adolescents who have disrupted sleep timing (i.e., going to bed late and waking up late) are more likely to have asthma and allergies - about three times higher - than other adolescents who went to bed earlier. Asthma usually gets worse at night and poor sleep can lead to worse asthma symptoms, but the impact of sleep as a risk factor on the development of asthma is not well known. Given the increasing prevalence of asthma and poor sleep among adolescents, more research is needed in order to isolate appropriate interventions. The purpose of this study was to assess the proportion of high school students who were sleep deficient and if sleep was associated with the health outcome, asthma. Methods: The 2019 Youth Risk Behavior Surveillance System (YRBSS) was used to conduct an independent analysis of all Fort Worth high school student's (n=1,992) sleep and asthma status, stratified by demographic variables. A linear trend analysis from 2015 to 2019 of sleep and asthma, respectively, at the national and high school level was done using logistic regression models controlling for sex, race, and ethnicity. Additionally, a bivariate analysis was conducted using the YRBSS Analysis tool to assess for any associations between poor sleep and asthma. Results: A predominant portion of Fort Worth high school students do not get enough sleep (74.5%, CI [72.1, 76.8]), with 11th (76.9%, CI [72.6, 80.8], p value= 0.01) and 12th graders (82.4%, CI [78.1,86.0], p value=0.00) getting the least sleep in comparison with 9th graders (68.8%, CI [64.7,72.7]). While sleep has been on the decline (p value< 0.05) since 2015, asthma has been increasing (p value< 0.05) since 2015; however, individuals who identified as Hispanic were less likely to have asthma than individuals who identified as White (p value=0.01). The bivariate analysis found that adolescents who get less sleep have a 1.62 times higher likelihood of having asthma (p value< 0.00). Conclusion: Poor sleep is a persistent and significant issue among adolescents that can lead to increased anxiety, depression, and difficulty concentrating in the short-term, and a higher risk for health issues later in life, such as excess weight gain, dyslipidemia, and metabolic and cardiovascular diseases. Sleep must be reprioritized to reduce the propensity for long-term consequences, with a particular focus on 11th and 12th graders. Further research is warranted in regard to the association between sleep status and asthma but better sleep will lead to improved adolescent and lifelong health outcomes.