Study of obstructive sleep apnea (OSA) in asthmatics

Sleep quality and associated factors among people with asthma at public hospitals in east gojjam zone, North West Ethiopia, 2022

INTRODUCTION

The magnitude of poor sleep quality among people with asthma is widespread and has detrimental consequences, including a higher chance of having poor work performance, an increase in the frequency of asthma attacks, an increase in the need for overnight hospitalization, and a worse health related quality of life. However, it has not been well studied, especially in low-income countries like Ethiopia. This study's objective was to assess the degree of sleep quality and related factors among people with asthma who had follow-up visits at public hospitals in the East Gojjam Zone.

METHODS

An institutional-based cross-sectional study design was conducted among 406 people with asthma through consecutive sampling techniques at public hospitals in East Gojjam Zone from June 6 to July 1, 2022. Sleep quality was measured by the Pittsburgh Sleep Quality Index through a face-to-face interview, and the collected data were entered into Epi Data version 4.4.2 and exported to SPSS version 25 for analysis. Logistic regression was fitted to assess the association between dependent and independent variables. Variables with a P-value <0.05 in multivariable logistic regression were considered statistically significant for the dependent variable.

RESULTS

Among participants, 64.5% had poor sleep quality. Having anxiety (AOR = 2.67), comorbidity (AOR = 3.11), poor sleep hygiene practices (AOR = 2.99), severe asthma (AOR = 2.31), very poorly controlled asthma (AOR = 4.00) and current alcohol use (AOR = 3.20) were associated with poor sleep quality.

CONCLUSION

The magnitude of poor sleep quality was high in this study. Severe asthma, having comorbidity, very poorly controlled asthma, poor sleep hygiene practices, having anxiety symptoms and current use of alcohol were variables associated with poor sleep quality. Reduction in alcohol consumption, improving sleep hygiene practices, and treating comorbidities would be effective measures for improving poor sleep quality. Individuals with severe asthma and uncontrolled asthma symptoms need special attention.

Co-existence of OSA and respiratory diseases and the influence of gender

INTRODUCTION

Sleep-disordered breathing (SDB), especially obstructive sleep apnea (OSA), is commonly associated with respiratory diseases, such as COPD, asthma and interstitial lung disease.

AREAS COVERED

This narrative review aims to comprehensively synthesize the existing information on SDB in respiratory diseases, investigate the role of gender in this association, and highlight the importance of OSA management in improving sleep, quality of life, and disease prognosis in these specific patient populations.

EXPERT OPINION

Research indicates a synergistic link between OSA and chronic respiratory diseases, which leads to greater morbidity and mortality compared to each disorder alone. Given the lack of an optimal OSA screening tool for these patients, a comprehensive patient approach and overnight diagnostic sleep study are imperative. Despite the limited evidence available, it seems that gender has an impact on the prevalence, severity, and susceptibility of this coexistence. Recognizing the role of gender in the coexistence of OSA and other respiratory diseases can enhance everyday medical practice and enable clinicians to adopt a more personalized approach toward optimal screening and diagnosis of these patients.

Revisiting Asthma Obstructive Sleep Apnea Overlap: Current Knowledge and Future Needs

Asthma and obstructive sleep apnea are highly prevalent conditions with a high cost burden. In addition to shared risk factors, existing data suggest a bidirectional relationship between asthma and OSA, where each condition can impact the other. Patients with asthma often complain of sleep fragmentation, nocturnal asthma symptoms, daytime sleepiness, and snoring. The prevalence of OSA increases with asthma severity, as evidenced by multiple large studies. Asthma may lower the threshold for arousal in OSA, resulting in the hypopnea with arousal phenotype. Epidemiologic studies in adults have shown that OSA is associated with worse asthma severity, increased frequency of exacerbation, and poor quality of life. The current literature assessing the relationship among OSA, asthma, and CPAP therapy is heavily dependent on observational studies. There is a need for randomized controlled trials to minimize the interference of confounding shared risk factors.

The relationship between obstructive sleep apnea and asthma severity and vice versa: a systematic review and meta-analysis

BACKGROUND

There is a great association between the prevalence of obstructive sleep apnea (OSA) and asthma. Nonetheless, whether OSA impacts lung function, symptoms, and control in asthma and whether asthma increases the respiratory events in OSA are unknown. This meta-analysis aimed to examine the relationship between obstructive sleep apnea and asthma severity and vice versa.

METHODS

We carried out a systematic search of PubMed, EMBASE, and Scopus from inception to September 2022. Primary outcomes were lung function, parameters of polysomnography, the risk of OSA in more severe or difficult-to-control asthmatic patients, and the risk of asthma in patients with more severe OSA. Heterogeneity was examined with the Q test and I² statistics. We also performed subgroup analysis, Meta-regression, and Egger's test for bias analysis.

RESULTS

34 studies with 27,912 subjects were totally included. The results showed that the comorbidity of OSA aggravated lung function in asthmatic patients with a consequent decreased forced expiratory volume in one second %predicted (%FEV1) and the effect was particularly evident in children. %FEV1 tended to decrease in adult asthma patients complicated with OSA, but did not reach statistical significance. Interestingly, the risk of asthma seemed to be slightly lower in patients with more severe OSA (OR = 0.87, 95%CI 0.763-0.998). Asthma had no significant effect on polysomnography, but increased daytime sleepiness assessed by the Epworth Sleepiness Scale in OSA patients (WMD = 0.60, 95%CI 0.16-1.04). More severe asthma or difficult-to-control asthma was independently associated with OSA (odds ratio (OR) = 4.36, 95%CI 2.49-7.64).

CONCLUSION

OSA was associated with more severe or difficult-to-control asthma with decreased %FEV₁ in children. The effect of OSA on lung function in adult patients should be further confirmed. Asthma increased daytime sleepiness in OSA patients. More studies are warranted to investigate the effect of asthma on OSA severity and the impact of different OSA severity on the prevalence of asthma. It is strongly recommended that people with moderate-to-severe or difficult-to-control asthma screen for OSA and get the appropriate treatment.

Obstructive Sleep Apnea and Asthma: More Than Chance?

Purpose of Review

To discuss the current evidence regarding the association and mechanistic interaction between asthma and obstructive sleep apnea (OSA).

Recent Findings

The co-existence of OSA is highly prevalent in asthmatics and significantly associated with increased severity, decreased control, more frequent exacerbations, and hospitalizations despite medical management. Pre-existing asthma may also be a risk factor for new onset OSA. Rhinitis, obesity, and gastro-esophageal reflux are risk factors in both conditions. The obese asthmatic with OSA may present a unique phenotype. Positive airway pressure in severe asthma improves outcomes.

Summary

Pathophysiologic mechanisms and co-morbidities overlap between OSA and asthma, but the exact link has yet to be confirmed. Screening for OSA is recommended in those with severe asthma. Further investigations are needed to delineate the cellular processes with therapeutic targets. Similarly, prospective investigations are needed to evaluate the longitudinal relationship in pre-existing asthma and the development of OSA.

A review of fluid-structure interaction simulation for patients with sleep related breathing disorders with obstructive sleep

Obstructive sleep apnea is one of the most common breathing disorders. Undiagnosed sleep apnea is a hidden health crisis to the patient and it could raise the risk of heart diseases, high blood pressure, depression and diabetes. The throat muscle (i.e., tongue and soft palate) relax narrows the airway and causes the blockage of the airway in breathing. To understand this phenomenon computational fluid dynamics method has emerged as a handy tool to conduct the modeling and analysis of airflow characteristics. The comprehensive fluid-structure interaction method provides the realistic visualization of the airflow and interaction with the throat muscle. Thus, this paper reviews the scientific work related to the fluid-structure interaction (FSI) for the evaluation of obstructive sleep apnea, using computational techniques. In total 102 articles were analyzed, each article was evaluated based on the elements related with fluid-structure interaction of sleep apnea via computational techniques. In this review, the significance of FSI for the evaluation of obstructive sleep apnea has been critically examined. Then the flow properties, boundary conditions and validation of the model are given due consideration to present a broad perspective of CFD being applied to study sleep apnea. Finally, the challenges of FSI simulation methods are also highlighted in this article.

Τhe Co-Existence of Obstructive Sleep Apnea and Bronchial Asthma: Revelation of a New Asthma Phenotype?

Bronchial asthma (BA) and obstructive sleep apnea (OSA) are common respiratory obstructive diseases that may coexist. It would be interesting to study the possible influence of that coexistence on both diseases. Until now, reviews focused mainly on epidemiology. The aim of this study was to review the literature in relation to epidemiology, pathophysiology, consequences, screening of patients, and treatment of the coexistence of OSA and BA. We pooled studies from the PubMed database from 1986 to 2019. OSA prevalence in asthmatics was found to be high, ranging from19% to 60% in non-severe BA, reaching up to 95% in severe asthma. Prevalence was correlated with the duration and severity of BA, and increased dosage of steroids taken orally or by inhalation. This high prevalence of the coexistence of OSA and BA diseases could not be a result of just chance. It seems that this coexistence is based on the pathophysiology of the diseases. In most studies, OSA seems to deteriorate asthma outcomes, and mainly exacerbates them. CPAP (continuous positive airway pressure) treatment is likely to improve symptoms, the control of the disease, and the quality of life in asthmatics with OSA. However, almost all studies are observational, involving a small number of patients with a short period of follow up. Although treatment guidelines cannot be released, we could recommend periodic screening of asthmatics for OSA for the optimal treatment of both the diseases.

Does Continuous Positive Airway Pressure (CPAP) treatment of obstructive sleep apnoea (OSA) improve asthma-related clinical outcomes in patients with co-existing conditions?- A systematic review

INTRODUCTION

A high prevalence of OSA has been observed in asthma populations, with detrimental impact on clinical outcomes.

AIM

To determine if CPAP treatment of co-existing OSA improves asthma-related symptoms and quality of life.

METHODS

Literature review of EMBASE and MEDLINE databases prior to July 2017. Study populations included asthmatics with co-existing OSA treated with CPAP, and ≥1 asthma-related clinical outcome measure.

RESULTS

12 studies; 8 prospective quasi-experimental and 4 observational. Mean CPAP duration; 19.5 (2-100) weeks. Meta-analysis demonstrated significant improvement in mean Asthma Quality of Life Questionnaire scores (AQLQ and mini-AQLQ); 0.59 (95%CI; 0.25, 0.92), p = 0.0006. No significant improvement was demonstrated in forced expiratory volume in 1 s (FEV1)% predicted; 0.32 (95%CI; -2.84, 3.47), p = 0.84. Asthma Control Test/Asthma Control Questionnaire improved in 2 studies, with no improvement in 1 study. 4 studies demonstrated improvement in asthma daytime/night-time symptoms, and 3 studies showed improved asthma severity.

CONCLUSION

Asthmatics with co-existing OSA can experience improved quality of life with CPAP treatment. This effect appears more pronounced in severe OSA or poorly controlled asthma.