Strengths and Limitations
Our cohort is the largest sample of children with asthma with gold-standard in-laboratory polysomnography in a prospective study design. Objective characterization of sleep and breathing allowed for accurate assessment of obstructive disordered breathing events leading to precise classification of participants with OSA, thus strengthening our findings. A few limitations should be considered. First, our sample was 84% African American; therefore, our findings may not be generalizable to all children with asthma. Nonetheless, it is worth noting that the study by Ehsan et al2 also demonstrated a high prevalence of obesity and OSA in an asthma cohort that comprised 36% African American, therefore, the results described in this study may be applicable to asthma populations of other ethnicities. Second, our sample was not large enough to be split into adequate training and validation sets, which would have allowed for internal performance testing of our OSA screening model. Nevertheless, given the simplicity of obtaining anthropometry and calculating BMI z-scores, our findings may be easily replicated in other asthma cohorts, which would enhance external validity and generalizability.