Inter-relações entre asma e atopia e seu papel na saúde do sono: uma avaliação da adolescência até o início da vida adulta

Abstract

Wheezing (used as a proxy for asthma), allergic rhinitis (AR), and atopic dermatitis (AD) are health conditions that commonly co-occur. Each of these health conditions adversely affects individuals' quality of life by hindering daily activities, work productivity, and sleep health. However, few studies have investigated the cooccurrence of these three health conditions and their effects on sleep health, particularly in low- and middle-income countries, which often face important limitations in terms of resources, access, and coverage compared to high-income countries. Therefore, the objectives of this thesis were: 1) to synthesise existing literature on the prevalence of sleep disorders among individuals with asthma, AR, and/or AD; 2) to estimate the prevalence of these three health conditions and describe their patterns of co-occurrence in adolescence and early adulthood according to different characteristics; 3) to identify and characterise, longitudinally, latent classes of asthma, AR, and AD from ages 11 to 22, and investigate their association with pulmonary function (PF) at ages 15 and 22; 4) to investigate the relationship between sleep health and the identified latent classes. To achieve the first objective, a systematic review was conducted and subsequently published in Sleep Epidemiology (Impact Factor: 6.3; CiteScore: 1.9). Three databases were utilised: Medline, Web of Science, and Google Scholar. From the 20 studies selected, the majority exhibited reasonable quality, underscoring the necessity for methodologically robust population studies. Notably, only one study examined the association between sleep health and the co-occurrence of the three health conditions. The evidence indicated that individuals with asthma, AD, and/or RA have poorer sleep quality compared to individuals without these health conditions. For the remaining objectives, three original articles were developed, all using data from the Pelotas Birth Cohort of 1993. The first study, published in the Jornal Brasileiro de Pneumologia (Impact Factor: 2.9; CiteScore: 3.5), evaluated 4,286 participants at age 15 and 3,789 at age 22. Cluster analysis suggested that the simultaneity of the three health conditions was 2.1 times (95% CI 1.4 - 3.0) higher than expected by chance, suggesting that health assessments should focus on the simultaneity of asthma, AR, and AD. The study also indicated a potential social gradient in the diagnosis and reporting of these co-occurring health conditions. The second original article employed Repeated Measures Latent Class Analysis (RMLCA) with a sample of 4,692 participants. This study identified six latent classes: one asymptomatic (Class 1), AD-dominant (Class 2), wheezing-dominant (Class 3), and three AR-dominant classes, including one (Class 6) with the highest probabilities for all three health conditions. Class 3 and Class 6 showed lower PF compared to Class 1 (reference) at ages 15 and 22. The study also identified significant socioeconomic, behavioural, and health disparities, highlighting the importance of such predictions in identifying critical points for early interventions and personalised treatment strategies. The third original article aimed to fill some of the gaps identified in the systematic review. Using data from 2,738 individuals, the study indicated that Class 3 and Class 6 exhibited higher proportions of daytime dysfunction compared to Class 1, (p < 0.05). Additionally, men in Class 6 showed a higher proportion of sleep medication use than11 those in Class 1 (10.8% vs. 1.6%, p = 0.022). The co-occurrence of asthma, AR, and AD may influence sleep health; however, potential confounding factors should be considered. Keywords: wheezing; pulmonary function; allergic rhinitis; atopic dermatitis; s