Assessment of the prevalence of obstructive sleep apnea in patients with stable uncontrolled asthma, impact of continuous positive airway pressure treatment

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

“…In five of the twelve studies [14][15][16][17][18] there was clear evidence of the application of robust asthma diagnostic criteria following international guidelines. Asthma severity was measured in two of the studies in accordance with current guidelines [17,19] but one of the studies [20] used patient-reported symptoms via a visual analogue scale.…”

“…There was significant heterogeneity in the study designs, populations and outcome measures which precluded meta-analysis of asthma control scores. Shaarawy et al used a prospective quasi-experimental study design with robust asthma diagnostic criteria and included a group of poorly controlled asthmatics [16]. Conversely, although the study population was much larger in the study by Kauppi et al, it was based on retrospective recall of symptoms and ACT pre-CPAP which was then compared to current ACT.…”

“…However it is important to note that a clinically significant improvement in mean ACQ (≥0.5) was not reached. Shaarawy et al [16] looked at fifteen poorly controlled asthmatics (ACT≤17 at baseline) and found no improvement in ACT scores after CPAP. Shaarawy et al studied a population with less severe OSA (mean AHI 23.5) compared to Serrano-Pariente et al (46.3) and this could potentially account for these findings.…”

Prevalence of Obstructive Sleep Apnea-Hypopnea in Severe Asthma

“…[10] On the other hand Some authors have tried to analyze the influence of asthma on the occurrence and severity of OSAS and have concluded that asthma may contribute to the onset and aggravation of OSAS by altering anatomy and physiology Of the upper airways [11] In our study, all patients had moderate to severe persistent asthma that was difficult to control and there was no correlation between the clinical characteristics of the asthmatic disease and the prevalence or severity of OSAS These results are similar to those of Auckley et al who did not find a correlation between the risk of OSAS occurrence and the severity of asthma [4] Guven et al made the same findings On the other hand, Teodorescu, et al demonstrated that a high risk of OSAS did not depend on other known factors of poor asthma control or control level (ACT) [5]. By comparing the polysomnographic results of three groups of patients with moderate asthma, severe asthma, and non-asthmatic patients, Julien et al found no correlation between the occurrence of OSAS and the severity of asthma, atopy, rhinitis, Nasal polyposis, use of prednisolone, use of high dose inhaled corticosteroids, long acting β2 agonist or antileukotrienes [8]. Teodorescu et al found a prevalence of OSAS of 21% in asthmatics in general and this risk multiplies 2.87 times in uncontrolled asthmatics [5].…”

“…The most recent studies have been based on polysomnography as a baseline test to determine the prevalence of OSAS in asthmatics, like the Canadian study by Julien et al comparing the prevalence of OSAS in 3 groups of patients: Severe asthma, 2 nd moderate asthma and 3 rd non-asthmatic subjects. This prevalence was 50%, 23% and 12% (0.007), respectively, and there was no correlation between the severity of asthma and the severity of OSAS [7] A recent study by Shaarawy et al found an OSAS prevalence of 25% in 60 patients followed for uncontrolled asthma [8] Min Kwang Byun et al published a study concluding a prevalence of OSAS of 66.5% in moderate to severe asthmatics [9] The majority of studies have considered OSAS as a factor in the poor control of asthma through various mechanisms, including sleep disorders, upper respiratory tract edema and systemic inflammation associated with OSAS. [10] On the other hand Some authors have tried to analyze the influence of asthma on the occurrence and severity of OSAS and have concluded that asthma may contribute to the onset and aggravation of OSAS by altering anatomy and physiology Of the upper airways [11] In our study, all patients had moderate to severe persistent asthma that was difficult to control and there was no correlation between the clinical characteristics of the asthmatic disease and the prevalence or severity of OSAS These results are similar to those of Auckley et al who did not find a correlation between the risk of OSAS occurrence and the severity of asthma [4] Guven et al made the same findings On the other hand, Teodorescu, et al demonstrated that a high risk of OSAS did not depend on other known factors of poor asthma control or control level (ACT) [5].…”