About Dr Stephen Oo
Dr. Stephen Oo is a Paediatric Respiratory and Sleep Physician based at Perth Children’s Hospital, Fiona Stanley Hospital, and Respiratory Care WA’s Children’s Respiratory Hub. His focus is on providing comprehensive evaluation and care for children facing respiratory and sleep difficulties.
Asthma and Sleep: A Vital Connection for Children’s Health
Respiratory Care WA: Why should we care about sleep in children?
Dr Stephen Oo: Sleep is one of the fundamental pillars of health, alongside diet and exercise. A wealth of evidence highlights its crucial role in regulating and restoring our body systems.
To fully appreciate the necessity of sleep, consider your own experiences with sleep deprivation—whether it’s the exhaustion of a long-haul flight or the relentless nights of a newborn waking multiple times. Now, imagine that newborn sleep pattern persisting for years with no end in sight.
This is the reality for some of the families I see, not just in the sleep clinic but also in the Respiratory Care WA asthma clinic. Even the slightest improvement in a child’s sleep can bring immense relief, transforming life not just for the child but for the entire family. Parents often describe better sleep as a profoundly life-changing event that restores balance, energy, and well-being to their household.
Respiratory Care WA: How does asthma impact sleep quality in children, and what are the most common sleep disturbances they experience?
Dr Oo: Poor sleep can worsen chronic illnesses, and chronic illness can disrupt sleep—this is particularly true for asthma.
”Sleep disturbance is reported in at least 30-40% of asthmatic children especially those with poorly controlled symptoms.
Cold air is a common trigger for many asthmatics, and this leads to coughing and wheezing at night. For some families, nightly coughing becomes so routine over time that they begin to see it as normal and may not mention it unless specifically asked.
Asthma flare-ups, particularly during winter, can leave families awake for nights on end, administering salbutamol or, in severe cases, spending multiple sleepless nights in the hospital. This chronic sleep deprivation is often described as a seasonal pattern, with families dreading the onset of winter.
Not surprisingly, when we get their child’s asthma under control, families commonly report a vast improvement in quality of life and the first thing they mention is the additional sleep.
Respiratory Care WA: How does poor sleep affect asthma symptoms the next day, including mood, and overall well-being?
Dr Oo: In children, poor sleep typically presents as hyperactivity, attention difficulties, and problems with emotional regulation, rather than just daytime fatigue, which is more common in adults.
In the context of asthma, inadequate sleep affects executive function for the entire family, making it harder to remember to take preventers and absorb important asthma education. It’s a circular problem that makes asthma control worse.
We recognise that these are challenges for the families we see, and we try to account for this in the way that we operate the Children’s Respiratory Hub at Respiratory Care WA. We know that for some families the amount of information we run through can be a lot for a single clinic visit, so we routinely follow up with families a couple of weeks later. This allows time for them to process the information, revisit key points, and ask any questions, ensuring they feel fully supported.
Respiratory Care WA: Are there any other sleep disorders reported in children with poorly managed asthma like sleep apnea? How important is early intervention in preventing long-term issues?
Dr Oo: There is a well-documented association between asthma and obstructive sleep apnoea syndrome (OSAS) in children.
”The incidence of OSAS is around 30% in children with asthma, much higher than the general population, where it’s about 1.5-6%. In severe cases, this rate can be even higher.
Children with asthma often have higher rates of allergies and hay fever, which can contribute to obstructive sleep issues. In many cases, treating nasal congestion with nasal sprays and allergy medications can be enough to alleviate these sleep symptoms, and this is typically the first approach I take. If symptoms persist, we usually proceed with referring the child for sleep studies or an Ear, Nose and Throat (ENT) review.
For most children, an adenotonsillectomy (removal of the tonsils and adenoids) is curative. leaving obstructive sleep apnoea untreated can have serious health consequences, not only due to the ongoing effects of poor sleep but also the long-term risks of hypertension and an increased likelihood of heart disease in the future.
Respiratory Care WA: Can you share any success stories?
Dr Oo: I recently saw a family where the mother was primarily concerned about her 8-year-old son’s breathlessness and fatigue during exercise. When I asked about coughing at night, she reported it as relatively minor. However, lung function testing revealed that his asthma was poorly controlled, which explained the exercise-related issues. We started him on an inhaled corticosteroid that same day.
When I followed up with the family three months later, I was happy to hear that he was now able to play a full game of basketball without stopping for the first time ever. His mother also mentioned that he was finally sleeping through the night for the first time in his life.
Previously, he would wake up two to three times a night, needing resettling, and she had assumed that was just how he was. She didn’t think it was related to asthma and hadn’t mentioned it in the initial consult. Now that his asthma was well controlled, they realised he had actually been coughing a lot more at night than they’d thought, especially since his bedroom was at the opposite end of the house. His mother said, “I never realised the effect this was having on my sleep, and I haven’t felt this good in 8 years.”
