Allergic Disease, Sleep Problems, and Psychological Distress in Children Recruited From the General Community

To evaluate the association between individual allergic disease – defined as eczema, allergic rhinitis, and asthma – and sleep in children recruited from a general community population.

The study population included Australian children aged 5 to 10 years identified from a retrospective dataset. Participants’ parents were contacted via the child’s school and completed a questionnaire reviewing child psychological wellbeing and sleep. The schools were selected from a multistage sampling design that stratified according to socioeconomic status and public versus private education. Children whose allergic disease was unsure, who had missing data for allergic disease, sleep disturbance, and psychological distress, and those with medical problems known to impact sleep (cerebral palsy, facial abnormalities, etc) were excluded.

The study was a retrospective analysis. Parents of children aged 5 to 10 years completed the International Study of Asthma and Allergies in Childhood questionnaire, the Pediatric Sleep Survey Instrument, and the Strengths and Difficulties Questionnaire. Odds ratios were calculated to investigate the odds of experiencing 1 allergic disease condition in the presence of other allergic diseases. Structural Equation Modeling was used to test the association between allergic disease and psychological distress, specifically through sleep.

The analysis included 1449 children, 46% reported 1 or more allergic diseases (29% with a single allergic disease and 17% with 2 allergic diseases). Allergic rhinitis (31%) had the highest frequency. The odds ratio for concurrent allergic disease was highest for asthma, specifically with allergic rhinitis (odds ratio = 3.9). When controlling for coexisting allergic disease, allergic rhinitis was associated with sleep routine difficulty, morning tiredness, nighttime arousals, sleep disordered breathing, and restless sleep; asthma was associated with sleep routine difficulty, sleep disordered breathing, and restless sleep; and eczema was associated with restless sleep. Based on the Structural Equation Modeling, the path weight for number of allergic conditions on total sleep problems represented small to medium effect size. The path weight for total sleep problems on the total psychological distress score represented a large effect size. About 65% of the total effect of the number of allergic diseases on psychological distress was mediated through sleep problems.

In a general community population, the overall sleep and psychological distress scores were within reference range. Despite the overall scores for sleep and psychological distress, allergic rhinitis was associated with a broad range of sleep problems. Asthma and eczema were associated to a lesser degree.

As the incidence of allergic diseases continues to increase, multiple retrospective studies have been conducted to evaluate the association between allergic disease, sleep, and psychological distress. This study focused on the association between allergic disease and sleep in the general population, those who had not been referred to specialty care. Although further research to investigate the mechanisms underlying sleep problems and allergic disease warrants exploration, it is important that healthcare providers are aware of this association. Further, because of the impact that allergic disease has on psychological distress through sleep problems, it is important for healthcare providers to address sleep concerns, especially in those who have been diagnosed with allergic disease.