Asthma and Obstructive Sleep Apnea: Taking It to Heart

To the Editor:

In a recent article, Prasad and colleagues eloquently consolidated the current evidence regarding the bidirectional interaction between asthma and obstructive sleep apnea (OSA) (1). However, to develop a personalized approach toward the treatment of comorbid pulmonary diseases with systemic spillover of inflammation (1), we have to appreciate their cardiovascular interactions (2). Because the cardiovascular impact of OSA and chronic obstructive pulmonary disease is relatively well described (2), a brief discussion with regard to asthma and cardiovascular disease (CVD) is warranted.

A recent large retrospective cohort of patients admitted to National Health Service hospitals in the United Kingdom reported a strong and independent association of asthma, chronic obstructive pulmonary disease, and interstitial lung disease with CVD (3). Asthma was independently associated with ischemic heart disease, and heart failure (hazard ratio, 1.81; 95% confidence interval, 1.75–1.87) and ischemic heart disease (hazard ratio, 1.04; 95% confidence interval, 1.01–1.07) were among the variables that were independently associated with mortality in patients with asthma (3). In another large study, late‐onset asthma, diagnosed at age ≥18 years, was associated with an increased risk of incident CVD events after adjustment for age, sex, and CVD risk factors (4). In a biracial, community-based, long-term investigation of risk factors and natural history of CVD, young adults with a history of asthma were found to have a significantly greater risk of increased left ventricular mass index independently of other major cardiovascular risk factors (5).

Many similarities exist between the biochemical and cellular pathways of cardiac and pulmonary fibrosis (6). As we read the article by Prasad and colleagues and appreciate the multifaceted overlap between asthma and OSA, we have to remind ourselves of the current evidence and knowledge gaps regarding cardiopulmonary interactions in asthma to help improve risk stratification, devise precise management strategies, and identify novel therapeutic targets.