Table 1.
Excluded studies from the review.
| First Author, Year | Aim of the Study | Subjects and Methods | Asthma | ICS | OSA or SDB | Conclusions | Reasons of Exclusion |
|---|---|---|---|---|---|---|---|
| CHILDREN | |||||||
| Kheirandish-Gozal L, et al., 2011 [34] | Prevalence of OSA in asthmatic PCA children. Effect of A&T on AAE frequency |
92/135 children (age 6.58 ± 1.8 years) with PCA; PSG. A&T was performed in the case of OSA. oAHI ≥5/ora TST (n.58) |
AAE (n. 92), 3.27 ± 1.13/year AAE: OSA+ (n.58) 3.57 ± 1.37/years OSA− (n.34) 3.12 ± 1.40/years (p < 0.05) |
β-rescue agonists (4.1 ± 2.4/week) β-Rescue agonists (/week): OSA+: 4.7 ± 2.9 versus OSA− 3.6 ± 2.1 (p < 0.04) |
β-Rescue agonists (/week): Before A&T OSA+ (No. 35) 4.3 ± 1.8 vs. after A&T 2.1 ± 1.5 (p < 0.001) Before PSG OSA− (n.24) 4.2 ± 1.9 vs. after PSG 3.9 ± 2.2 (p = NS) AAE (/year): Before A&T OSA+ (No. 35) 4.1 ± 1.3 vs. after A&T 1.8 ± 1.4 (p < 0.001) Before PSG OSA− (n.24) 3.5 ± 1.5 vs. after PSG 3.7 ± 1.7 (p = NS) |
The prevalence of OSA is higher in children with PCA Treatment of OSA with A&T is associated with improvements |
Effect of A&T on AAE Frequency in Children With PCA and Associated OSA |
| Bhattacharjee R, et al., 2014 [39] | A&T+ comparison with controls, SDB, and asthma control | ATH A&T n.5942 (44%) vs. controls n.537 (2%) |
AAE decreased from 2243 (30%) pre-A&T to 1566 (2%) post-A&T in children (p < 0.0001) Annual reduction in the incidence of hissing by 40.3% in A&T vs. 0% in controls |
Reduction in ICS prescription 21.5% A&T vs. −2.0% controls (p < 0.001) ICS/LABA −2.2% A&T vs. −20.1% control (p < 0.001) Reduction in continuous inhalation for the first hour by 30% in A&T vs. 0% in controls (p < 0.001) |
Reduction in OSA, snoring, and/or sleep disturbances: A&T n.3603 (27%) vs. control n.1099 (1%) |
Children A&T: 30% reduction in AAE 1 year before A&T versus 1 year after 37.9% reduction in ASAs and 35.8% reduction in asthma-related hospitalizations |
Efficacy of A&T in Improving Asthma Symptoms and Reducing SDB |
| Alfurayh MA, et al., 2022 [40] | Exacerbation of bronchial asthma in the ED in a pediatric population | Cohort study: Children in ED due to asthma exacerbation. Data collection: demographics, comorbidities, and asthma-related variables. |
Visits to the ED: yes (33.9%) vs. no (66.1%) Of the 123 patients who used steroids, 74% (91) had no nocturnal symptoms (p < 0.001) |
Of the 363 asthma patients (age 4.9 ± 2.5 years; 68.8% male), 33.9% (n.123) used steroids for asthma | 1.9% with FBO (n.7). Number of patients hospitalized with OSA 4.5% (p = 0.203). |
Association between steroid use in asthmatic patients, number of ED visits, and nocturnal symptoms | Steroid Use in Asthmatic Patients, Number of ED Visits, and Nocturnal Symptoms |
| Heatley H, et al., 2023 [41] | Intermittent prescribing of OCSs in asthmatic patients and the association with adverse outcomes | Cohort study. Primary Care medical records (ages 4– <12, 12– <18, 18– <65 and ≥65 years) received intermittent OCSs Categories: prescription: single, least frequent (≥90-day range), and frequent (<90-day interval) Controls: patients not treated with OCSs, matched 1:1 |
Dose–response relationship between cumulative annual exposure to OCSs and risk of adverse outcomes | ICS prescriptions (categorized as 0, 1–3, 4–6, 7–9, 10–12, and ≥13 administration) 12 months prior to initial OCS prescriptions: received 1–2 administrations of SABA and ≤3 of ICSs Proportion of patients receiving ≥3 administrations of SABA and ≥4 of ICSs at baseline increased with more frequent OCS prescriptions Higher number of ICS prescriptions in those who had more frequent OCS prescriptions |
Higher risks of adverse outcomes related to OCSs, pneumonia, and OSA | Patients with asthma who received intermittent OCSs have a frequent prescription. Prescribing more frequent OCSs associated with higher risk of adverse outcomes |
Association Between Intermittent OCS Prescribing in Asthmatic Patients and Adverse Outcomes, Such as Pneumonia and OSA |
| ADULTS | |||||||
| Ferguson S, et al., 2014 [42] | Association between lower airway Caliber, OSA, and other asthma-related factors with HTN | Multicenter study; 812 asthmatics (ages 46 ± 14) OSA scale of the SA-SDQ medical records: HTN, OSA, spirometry, and medications |
Subjects with asthma, use of ICSs n.631 (78%): low dose n.189 (23%), medium dose n.235 (29%), and high dose n.207 (25%) | Associations of HTN: Low-dose ICS (OR 0.86, C.I. 0.50–1.45), medium doses (OR 1.1, C.I. 0.75–1.95), and high-dose (OR 2.18, C.I. 1.37–3.48) |
Association of HTN with a history of OSA (OR= 5.18, C.I. 3.66–7.32; p < 0.0001) and high risk of OSA according to SA-SDQ (OR 5.18 C.I. 3.66–7.32, p < 0.001) | Concomitant OSA has been associated with HTN | Association Between OSA and ICSs, with Hypertension in Asthmatic Patients |
| Magnoni MS, et al., 2017 [43] | How Italian allergists deal with asthma patients | 174 questionnaires, 16 questions: Epidemiology, risk factors, therapeutic approaches and adherence to therapy |
Follow-up visits at 56.5%, worsening of symptoms for 41%, percentage of visits due to adverse effects of drugs 3% |
ICSs combined with LABAs were considered the treatment of choice | Sleep apnea and obesity were assessed as the most critical comorbidities/risk factors of PCA | Recognizing and managing OSA could be key to improving asthma control in patients | Survey or a Questionnaire Exploring How talian Allergists Manage Asthma Patients, Including Their Treatment Approaches and Asthma Management |
Legend: AAE, acute asthmatic exacerbations; ACT, asthma control test score; AO, adverse outcomes; ATH, hypertrophy of tonsils and adenoids; A&T, adenotonsillectomy; C.I., confidence interval; ED, emergency department; ESS, Epworth Sleepiness Scale; HTN, systemic hypertension; ICSs, inhaled corticosteroids; LABAs, long-acting beta-agonists; oAHI, obstructive apnea hypopnea index; OCSs, Oral corticosteroids; OSA, obstructive sleep apnea; PCA, poorly controlled asthma; PSA, polysomnography; TST, total sleep time.