Long-term CPAP treatment improves asthma control in patients with asthma and obstructive sleep apnoea

Abstract

Purpose Both asthma and obstructive sleep apnoea cause sleep disturbance, daytime sleepiness and diminished quality of life. Continuous positive airway pressure (CPAP) is efficient in reducing symptoms related to sleep apnoea. Here we report the impact of long-term use of CPAP on asthma symptoms. Methods A survey questionnaire was distributed to all of our obstructive sleep apnoea patients with CPAP therapy in 2013. We used the Finnish version of the Asthma Control Test™ (ACT) and a visual analogue scale (0 = no symptoms, 100 = severe asthma symptoms). Asthma was defined as self-reported physician-diagnosed disease and a special reimbursement for asthma medication by the Social Insurance Institution. Results We sent 2577 questionnaires and received 1586 answers (61 %). One hundred ninety-seven patients were asthmatics with a prevalence of asthma among CPAP users of 13 %. We studied 152 patients (58 females) whose CPAP therapy was initiated after starting asthma medication. Their mean (SD) age was 62 (10) years, duration of CPAP 5.7 (4.7) years and their CPAP daily use was 6.3 (2.4) h. Self-reported asthma severity decreased significantly from 48.3 (29.6) to 33.1 (27.4) (p < 0.001), and ACT score increased significantly from 15.35 (5.3) to 19.8 (4.6) (p < 0.001) without a significant change in the body mass index (BMI). The percentage of patients using rescue medication daily reduced from 36 to 8 % with CPAP (P < 0.001). Conclusions We noticed a significant decrease in asthma symptoms with long-term use of CPAP in patients with both asthma and obstructive sleep apnoea.

Clinical presentation of patients with suspected obstructive sleep apnea and self‐reported physician‐diagnosed asthma in the ESADA cohort

“…Our findings are of clinical relevance because they underline that asthmatic patients are under‐referred for sleep studies, despite the existing evidence of a high prevalence of OSA in asthma (Kong et al., ) and the positive effects of OSA treatment on asthma control (Kauppi et al., ; Wang et al., ). The prevalence of physician‐diagnosed asthma in our cohort was of the same order of magnitude as the prevalence rate of asthma recently found in CPAP‐treated patients (Turino et al., ).…”

Continuous positive airway pressure for obstructive sleep apnoea does not improve asthma control

“…Therefore, although ACT is a simple tool in the busy clinic setting, further history taking by the physicians or use of more detailed questionnaires would be necessary to assess the patient's response to treatment. A previous study showed that long‐term CPAP treatment improved asthma control, with improvement of ACT from 15.4 to 19.8 but the reliability of the patients’ responses was questionable as patients needed to recall their CPAP usage from many years earlier. Nevertheless, the current RCT has shown that CPAP treatment for 3 months improved daytime sleepiness, quality of life and the domains of vitality in the SF‐36 questionnaires, as also shown by a previous prospective observational study …”

Screening for obstructive sleep apnea syndrome in asthma patients: a prospective study based on Berlin and STOP-Bang questionnaires

“…The AHI is significantly associated with the occurrence of severe asthma exacerbations (4). Researchers have found that long-term treatment of CPAP in patients with both asthma and obstructive sleep apnoea can decrease the asthma symptoms and improve asthma control and quality of life (9,10). Since evaluating OSA in patients with asthma has been included in the Guidelines for the Diagnosis and Management of Asthma (21), there is a need for clinical investigations of early and periodic detection of OSA among asthma populations.…”

“…Epidemiologic data showed that the prevalence of OSA among asthmatic populations ranges from 38% up to as high as 70% (7). There is growing evidence that continuous positive airway pressure (CPAP) in adults and adenotonsillectomy in children which are recommended as first line treatment of OSA can improve their asthma symptoms (8)(9)(10). Mild OSA in severe asthma patients is associated with increased proportion of neutrophils in sputum and changes in airway remodeling (11,12).…”