. 2020 Jun 1;201(11):1345–1357. doi: 10.1164/rccm.201810-1838TR

Table 1.

Obstructive Sleep Apnea Burden in Asthma: Epidemiologic and Clinical Studies

Reference	Sample	Assessment and Exclusion of Treated Patients with OSA	Results
Cross-sectional studies

Community cohorts

Larsson et al., 2001 (4)	n = 4,648	OSA^*: questionnaire; OSA treatment not specified	• ↑ Prevalence of snoring (OR, 1.6^†) and apnea (OR, 2.3^†) in asthma
Larsson et al., 2001 (4)	n = 4,648	Asthma: physician diagnosis

Clinical populations

Yigla et al., 2003 (5)	n = 22	OSA^*: PSG; OSA treatment not specified	• 95% (21/22) prevalence of OSA
Yigla et al., 2003 (5)	Pulmonary clinic	Asthma: PFT diagnosis on long-term oral steroids	• ↑ RDI in continuous OCS vs. intermittent OCS group (21.4 ± 3.4 vs. 11.1 ± 1.6)

Karachaliou et al., 2007 (89)	n = 1,501	OSA^*: self-reported symptoms	• Asthma diagnosis not associated with OSA symptoms
Karachaliou et al., 2007 (89)	Primary care	Asthma: physician diagnosis + spirometry	• Asthma diagnosis not associated with OSA symptoms

Auckley et al., 2008 (90)	n = 177, asthma clinic	OSA^*: Berlin questionnaire	• ↑ OSA risk in asthma (39% vs. 27%)
Auckley et al., 2008 (90)	n = 328, internal medicine clinic	Asthma: physician diagnosis + spirometry	• No association between asthma severity and OSA risk

Julien et al., 2009 (3)	n = 52, asthma clinic	OSA^*: PSG; treated OSA excluded	• ↑ OSA prevalence: severe asthma 88%, moderate asthma 58%, control 31% (P < 0.001)
Julien et al., 2009 (3)	n = 26, community control group	Asthma: physician diagnosis. Severity by spirometry, ACQ, and steroid use	• ↑ AHI in asthma

Teodorescu et al., 2009 (27)	n = 244	OSA: OSA risk (SA-SDQ); treated OSA excluded	• Use of ICS ↑ risk of habitual snoring; OR, 1.6^†
Teodorescu et al., 2009 (27)	Pulmonary and asthma clinic	Asthma: NAEPP classification severity	• OSA risk positively associated with asthma severity and ICS use

Teodorescu et al., 2010 (61)	n = 472	OSA: OSA risk (SA-SDQ); treated OSA excluded	• ↑ OSA risk in uncontrolled asthma; OR, 2.9^†
Teodorescu et al., 2010 (61)	Pulmonary and allergy clinic	Asthma: physician diagnosis and ACQ	• ↑ OSA risk in uncontrolled asthma; OR, 2.9^†

Williams et al., 2011 (91)	Asthma, n = 200	OSA^*: habitual snoring	• ↑ Habitual snoring before (OR, 2.1^†) and during (OR, 1.8^†) pregnancy in asthma
	No asthma, n = 1,135	OSA^*: habitual snoring
	Prenatal clinic	Asthma: self-report of physician diagnosis

Teodorescu et al., 2012 (62)	n = 752	OSA: SA-SDQ and medical records (diagnosis with PSG); treated OSA excluded	• ↑ OSA risk in asthma with persistent day and night symptoms; OR, 1.9^†
Teodorescu et al., 2012 (62)	Pulmonary and allergy clinic	Asthma: physician diagnosis	• ↑ Risk of PSG-diagnosed OSA in asthma with day symptoms; OR, 2.1^†

Braido et al., 2014 (92)	Asthma, n = 740	OSA^*: STOP-BANG questionnaire	• ↑ OSA risk in asthma with rhinitis vs. asthma without rhinitis; OR, 1.4^†
	Asthma and allergic rhinitis, n = 1,201	OSA^*: STOP-BANG questionnaire
	Primary care	Asthma: physician diagnosis and allergic rhinitis questionnaire

Teodorescu et al., 2015 (6)	Nonsevere asthma, n = 161	OSA: OSA risk (SA-SDQ); treated OSA excluded	• ↑ SA-SDQ scores in poorly controlled asthma
	Severe asthma, n = 94	OSA: OSA risk (SA-SDQ); treated OSA excluded	• ↑ SA-SDQ scores in poorly controlled asthma
	Control, n = 146	Asthma: physician diagnosis, severity by spirometry and inflammatory markers	• ↑ Sputum neutrophils associated with higher SA-SDQ
	Multicenter study		• ↑ Sputum neutrophils associated with higher SA-SDQ

Longitudinal studies, population-based cohorts

Knuiman et al., 2006 (16)	n = 967	Incident OSA^*: self-reported habitual snoring	• ↑ Risk of habitual snoring in new-onset asthma; OR, 2.8^†
Knuiman et al., 2006 (16)	Prospective	Asthma: questionnaire	• ↑ Risk of habitual snoring in new-onset asthma; OR, 2.8^†

Teodorescu et al., 2015 (17)	No asthma, n = 547	No OSA or PAP use at baseline	• Adjusted RR of incident OSA, 1.4^† in asthma vs. nonasthma
	Asthma, n = 81	Incident OSA: PSG AHI>5 or starting CPAP treatment for OSA	• ↑ Asthma duration (>10 yr) related to increased risk for incident OSA (RR, 1.71^†) and for clinically significant OSA (OSA + excessive sleepiness; RR, 2.94^†)
	Prospective	Asthma: physician diagnosis

Shen et al., 2015 (12)	n = 38,840	Incident OSA^*: ICD-9	• ↑ OSA incidence in asthma vs. nonasthma HR 12.1 vs. 4.8 per 1,000 person-years
Shen et al., 2015 (12)	Retrospective, insurance database	Asthma: ICD-9	• ↑ Incidence of OSA with >1 ER visit/yr (HR, 23.8^†) and with ICS use (HR, 1.3^†)

Definition of abbreviations: ↑ = increased; ACQ = Asthma Control Questionnaire; AHI = apnea–hypopnea index; CPAP = continuous positive airway pressure; ER = emergency room; HR = hazard ratio; ICD = International Classification of Diseases; ICS = inhaled corticosteroid; NAEPP = National Asthma Education and Prevention Program; OCS = oral corticosteroid; OR = odds ratio; OSA = obstructive sleep apnea; PFT = pulmonary function test; PSG = polysomnography; RDI = respiratory disturbance index; RR = relative risk; SA-SDQ = sleep apnea scale of the Sleep Disorders Questionnaire; STOP-BANG = snoring, tiredness, observed apnea, blood pressure, body mass index, age, neck circumference, and gender.

History of OSA or treatment not specified.

^{^†}

Statistically significant OR, HR, or RR.