Several studies used symptom-based questions where others employed well-validated questionnaires, such as the Berlin questionnaire. This wide variation in prevalence rates may be due to the difference in methodology used for diagnosing OSA and asthma. In severe and difficult-to-treat asthma populations, co-existence of OSA has been reported at high rates from 50 to 95%. Recently, it has been suggested that the co-existence of asthma with OSA may be a separate phenotype of asthma Ĭross-sectional studies describe an increased prevalence of OSA in asthmatics ranging from 19 to 60%. Common risk factors for OSA include male gender, age, obesity, family history, increase in neck size (> 17 inches in males and 16 inches in females), craniofacial abnormalities (i.e., micrognathia or retrognathia), and hypertension. However, like asthma, OSA also has different phenotypes largely based on craniofacial morphology. OSA is typically thought to occur in obese individuals. We will review the current data regarding the impact of asthma and OSA on clinical outcomes, potential pathophysiologic links between asthma and OSA, along with therapeutic information and address the role of screening (Fig. Furthermore, long-term use of continuous positive airway pressure (CPAP) has been reported to significantly alleviate asthma symptoms in patients with co-existing asthma and OSA. Important to asthma and OSA therapy is identification of risk factors, co-morbidities, and modifiable factors. Īdditionally, asthma and OSA share similar underlying pathophysiology with increased airway resistance involving local and systemic inflammation and co-morbidities, such as gastro-esophageal reflex (GER), obesity, and rhinitis. Although most investigations have focused on the prevalence of OSA in the asthma population, the reverse relationship has also been demonstrated. Studies have consistently demonstrated that asthmatics have an increased risk of OSA with prevalence rates as high as 70%, particularly in those with severe asthma. OSA causes fragmented sleep, fatigue, and excessive daytime sleepiness due to recurrent episodes of complete or partial upper airway obstruction during sleep resulting in impaired gas exchange, sympathetic overactivity, intrathoracic pressure changes, and gasping and choking. Obstructive sleep apnea is underdiagnosed with approximately 13% of men and 6% of women in the USA estimated to have moderate to severe disease. Both uncontrolled asthma and nocturnal asthma have a deleterious effect on sleep quality. A significant number of patients have nocturnal asthma with symptoms occurring only during sleep. Īsthma is a heterogenous disease that affects approximately 6.3% of men and 9% of females in the USA and is characterized by chronic airway inflammation resulting in wheezing, shortness of breath, chest tightness, and/or cough with variable expiratory airflow limitation. In 2013, the co-existence of asthma with OSA was coined as the “alternative overlap syndrome”. OSA not only relates to asthma symptoms but also affects persistent daytime asthma control. Importantly, the co-existence of OSA in asthmatics has been associated with worse asthma control and more severe exacerbations. Evidence supports a bidirectional association where each disorder adversely affects the other and both disorders independently impair sleep quality resulting in poor daytime functioning and decreased quality of life. Both asthma and OSA are highly prevalent airway disorders with significant impact on the healthcare system. Over the last decade, there has been increasing interest in the relationship between asthma and obstructive sleep apnea (OSA). Similarly, prospective investigations are needed to evaluate the longitudinal relationship in pre-existing asthma and the development of OSA. Further investigations are needed to delineate the cellular processes with therapeutic targets. Screening for OSA is recommended in those with severe asthma. Pathophysiologic mechanisms and co-morbidities overlap between OSA and asthma, but the exact link has yet to be confirmed. Positive airway pressure in severe asthma improves outcomes. The obese asthmatic with OSA may present a unique phenotype. Rhinitis, obesity, and gastro-esophageal reflux are risk factors in both conditions. Pre-existing asthma may also be a risk factor for new onset OSA. 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. To discuss the current evidence regarding the association and mechanistic interaction between asthma and obstructive sleep apnea (OSA).
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