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Nocturnal Cough and Sleep Quality to Assess Asthma Control and Predict Attacks

Peter Tinschert, Frank Rassouli, Filipe Barata, Claudia Steurer-Stey, Elgar Fleisch, Milo Alan Puhan, Tobias Kowatsch & Martin Brutsche

abstract

Introduction
Objective markers for asthma, that can be measured without extra patient effort, could mitigate current shortcomings in asthma monitoring. We investigated whether smartphone-recorded nocturnal cough and sleep quality can be utilized for the detection of periods with uncontrolled asthma or meaningful changes in asthma control and for the prediction of asthma attacks.

Methods
We analyzed questionnaire and sensor data of 79 adults with asthma. Data were collected in situ for 29 days by means of a smartphone. Sleep quality and nocturnal cough frequencies were measured every night with the Pittsburgh Sleep Quality Index and by manually annotating coughs from smartphone audio recordings. Primary endpoint was asthma control assessed with a weekly version of the Asthma Control Test. Secondary endpoint was self-reported asthma attacks.

Results
Mixed-effects regression analyses showed that nocturnal cough and sleep quality were statistically significantly associated with asthma control on a between- and within-patient level (p < 0.05). Decision trees indicated that sleep quality was more useful for detecting weeks with uncontrolled asthma (balanced accuracy (BAC) 68% vs 61%; Δ sensitivity -12%; Δ specificity -2%), while nocturnal cough better detected weeks with asthma control deteriorations (BAC 71% vs 56%; Δ sensitivity 3%; Δ specificity -34%). Cut-offs using both markers predicted asthma attacks up to five days ahead with BACs between 70% and 75% (sensitivities 75 - 88% and specificities 57 - 72%).

Conclusion
Nocturnal cough and sleep quality have useful properties as markers for asthma control and seem to have prognostic value for the early detection of asthma attacks. Due to the limited study duration per patient and the pragmatic nature of the study, future research is needed to comprehensively evaluate and externally validate the performance of both biomarkers and their utility for asthma self-management.
   
citation Tinschert P, Rassouli F, Barata F, Steurer-Stey C, Fleisch E, Puhan M A, Kowatsch T, Brutsche M. Nocturnal Cough and Sleep Quality to Assess Asthma Control and Predict Attacks. J Asthma Allergy 2020; 13:669-678.
   
type journal paper/review (English)
date of publishing 14-12-2020
journal title J Asthma Allergy (13)
ISSN print 1178-6965
pages 669-678
PubMed 33363391
DOI 10.2147/JAA.S278155