Table 2.
Impact of Obstructive Sleep Apnea (OSA) on asthma.
| Study | Study Design | Population | Asthma Diagnosis | OSA Diagnosis | Results |
|---|---|---|---|---|---|
| Teodorerscu, M et al. J Asthma 2012 [23] | Cross-sectional |
N = 828 subjects with BA Allergy and pulmonary clinics |
ATS guidelines | SA-SDQ and review of medical notes | High OSA risk associated with persistent daytime (OR = 1.96, 95% CI = 1.31–2.94) and night-time (OR = 1.97, 95% CI = 1.32–1.94) asthma symptoms. |
| Wang et al. Sleep Med 2016 [15] | Prospective cross-sectional cohort study |
N = 146 asthmatics N = 157 controls Asthma follow-up in outpatient clinics |
Physician diagnosis | PSG | Annual number of severe asthma exacerbations was significantly higher in the OSA group compared to the no-OSA group (p < 0.001). AHI significantly correlated with the number of exacerbations (p < 0.001). |
| Tay, T.R Respirology 2016 [60] | Cross-sectional | N = 90 asthmatics | Specialist physician diagnosis (76 had variable airflow obstruction) | Clinical symptoms and BQ or previous positive PSG | OSA or high OSA risk in 35/90 (38.9%). Univariate analysis showed asthmatics with OSA to have worse ACT (p = 0.034) and worse AQLQ (p = 0.029), but not in multivariate analysis. |
| Kim et al. Ann Allergy Asthma Immunol 2013 [25] | Cross-sectional |
N = 217 asthmatics Controls = 0 Randomly recruited from tertiary care clinic |
1. Airway reversibility with FEV1 > 12% and 200 mL post SABA or positive metacholine provocation test 2. Persistent symptoms 3. Physician diagnosis of asthma (need all three) |
BQ | A total of 89/217 (41%) were high risk for OSA. The high OSA risk group had a lower ACT score than the low OSA risk group but it was not statistically significant: 20.9 ± 3.6 vs. 21.5 ± 3.3 (p = 0.091). |
| Teodorescu et al. Chest 2010 [61] | Cross-sectional | N = 472 asthmatics from tertiary care clinic visits | Asthma or allergy specialist using ATS guidelines and ACQ for BA control | SA-SDQ | A total of 109/472 (23%) were high risk for OSA. High OSA risk associated with 2.87-fold higher odds for having poorly controlled asthma (p = 0.0009, 95% CI = 1.54–5.32). |
| Wang et al. BMC Pulm Med 2017 [35] | Retrospective |
N = 77 asthmatics Sleep lab of a tertiary hospital |
ATS criteria. Airway reversibility with FEV1 > 12% and 200 mL post SABA or average daily diurnal peak flow variability was more than 10%. Regular follow up with pulmonary function tests at least every six months for more than 5 years. | PSG | The decline in FEV1 among asthmatics with severe OSA (AHI > 30/h) was 72.4 ± 61.7 mL/year (N = 34), as compared to 41.9 ± 45.3 mL/year (N = 33, p = 0.020) in those with mild to moderate OSA (5 < AHI ≤ 30) and 24.3 ± 27.5 mL/year (N = 10, p = 0.016) in those without OSA (AHI ≤ 5). |
| Teodorescu et al. Sleep Med 2006 [22] |
Cross-sectional |
N = 115 asthmatics Routine asthma follow-up visits |
Physician diagnosis | SA-SDQ | ESS associated with SA-SDQ (p < 0.0001) and asthma severity step (p = 0.04), but was not associated with asthma severity step in multiple regression analysis. |
| Sundbom et al. J Clin Sleep Med 2018 [29] |
Cross-sectional | Women pooled from the Sleep and Health program in Sweden. N = 36 patients with BA N = 15 patientswith BA + OSA N = 109 patients with OSA |
Positive answers to either of the following questions: 1. Have you an attack of asthma in the last 12 months? 2. Are you currently taking any medicine, including inhalers, aerosols, or tablets for asthma? | Full-night home PSG | Women with BA+OSA had a longer sleeping time in N1 and N2 sleep stages than the control group with no BA or OSA. They had also lower mean oxygen saturation (93.4% vs. 94.7%, p = 0.04) than the women with OSA alone. The results were consistent after multivariate analysis. BA was independently associated with lower oxygen saturation while OSA was not. |
| Becerra et al. Respiratory Medicine 2016 [69] |
Retrospective | 2009–2011 U.S Nationwide Inpatient Sample International Classification of Diseases, 9th Revision, Clinical Modification (ICD–9–CM) 493.x to identify primary hospitalizations for asthma. N = 179.789 primary BA hospitalizations |
Secondary diagnosis code for BA hospitalizations with comorbid conditions of obesity (ICD–9–CM 278.0x) and OSA (ICD–9–CM 327.23) | Secondary diagnose code for OSA (ICD–9–CM 327.23) objectively based OSA diagnosis |
Increased hospital length of stay was associated with the presence of obesity (OR for males = 1.07, OR for females = 1.08), OSA (OR for males = 1.07, OR for females = 1.14), and both obesity and OSA (OR for males = 1.19, OR for females = 1.24). Increased total hospital charges was related to obesity (8.64% for males and 9.61% for females), OSA (15.39% for males and 19.13% for females), and both co-morbidities (24.94% for males and 28.50% for females). Presence of OSA alone increased the odds of needing mechanical ventilation for males (OR = 2.56) and females (OR = 3.22), as did presence of both co-morbidities (OR for males = 2.85, OR for females = 3.60). |
| Ferguson et al. Lung 2014 [74] |
Cross-sectional, questionnaire-based |
N = 812 asthmatics at routine follow-up at allergy and pulmonary clinics |
ATS criteria, managed by an academic specialist | SA-SDQ | Hypertension was diagnosed in 191 asthmatics (24%), OSA in 65 (8%), and OSA or high OSA risk (combined OSA variable) in 239 (29%). With adjustment for covariates, associations with hypertension remained significant for some FEV1% categories (70–79% odds ratio = 1.60 [95% CI: 0.90–2.87]; 60–69% OR = 2.73 [95% CI = 1.28–5.79]; < 60% OR = 0.96 [95% CI = 0.43–2.14]), and for OSA (OR = 2.20 [95% CI = 1.16–4.19]). |
| Han et al. BMC Pulmonary Medicine 2016 [75] |
Retrospective | National Health Insurance Service (NHIS) National Sample Cohort 2004–2013 in South Korea. A total of 186.491 patients who were newly diagnosed with BA during the study period at outpatient care were followed for OSA development and mortality. | ICD–10: J.45 | ICD–10:G.47 only when it followed a BA diagnosis | A total of 5179 (2.78%) patients died during the study period. Sleep disorders in patients previously diagnosed with asthma were associated with a higher risk of mortality (hazard ratio (HR): 1.451 (95% CI = 1.253–1.681). The mean duration between BA diagnosis and death was shorter in asthmatics with sleep disorders (mean duration = 103.85 months) compared to asthmatics without sleep disorders (mean duration = 116.05 months, p < 0.0001) |
BA = Bronchial Asthma, OSA = Obstructive Sleep Apnea, ATS = American Thoracic Society, SA-SDQ = Sleep Apnea of Sleep Disorders Questionnaire, PSG = Polysomnography, AHI = Apnea Hypopnea Index, OR = Odds Ratio, CI = Confidence Interval, HR = Hazard Ratio, BQ = Berlin Questionnaire, ACT = Asthma Control Test, AQLQ = Asthma Quality of Life Questionnaire, SABA = Short Acting B Agonist, ACQ = Asthma Control Questionnaire, FEV1 = Forced Expiratory Volume in the first second, ESS = Epworth Sleepiness Scale.