OSA and Chronic Respiratory Disease: Mechanisms and Epidemiology

Abstract

Obstructive sleep apnea (OSA) is a highly prevalent disorder that has profound implications on the outcomes of patients with chronic lung disease. The hallmark of OSA is a collapse of the oropharynx resulting in a transient reduction in airflow, large intrathoracic pressure swings, and intermittent hypoxia and hypercapnia. The subsequent cytokine-mediated inflammatory cascade, coupled with tractional lung injury, damages the lungs and may worsen several conditions, including chronic obstructive pulmonary disease, asthma, interstitial lung disease, and pulmonary hypertension. Further complicating this is the sleep fragmentation and deterioration of sleep quality that occurs because of OSA, which can compound the fatigue and physical exhaustion often experienced by patients due to their chronic lung disease. For patients with many pulmonary disorders, the available evidence suggests that the prompt recognition and treatment of sleep-disordered breathing improves their quality of life and may also alter the course of their illness. However, more robust studies are needed to truly understand this relationship and the impacts of confounding comorbidities such as obesity and gastroesophageal reflux disease. Clinicians taking care of patients with chronic pulmonary disease should screen and treat patients for OSA, given the complex bidirectional relationship OSA has with chronic lung disease.

Sleep-Disordered Breathing and Chronic Respiratory Infections: A Narrative Review in Adult and Pediatric Population

“…GERD can also lead to bronchoconstriction or coughing in patients with lung diseases, by causing microaspiration. Additionally, OSA can also affect airway immunity leading to an increased propensity for respiratory tract infection-mediated exacerbations that can progress underlying chronic airway disease [ 43 , 44 ]. Indeed, the presence of upper airway symptoms was shown to increase disease duration and the exacerbation rate in patients with bronchiectasis [ 45 ].…”

Overlaps between obstructive sleep apnoea and other respiratory diseases, including COPD, asthma and interstitial lung disease

“…The pathophysiological mechanisms in patients with either OSA, COPD or OS for the development of CVD are not clearly defined ( figure 3 ) [ 1 ]. The hallmark of OSA is intermittent nocturnal hypoxia that results in chronic systemic inflammation, endothelial dysfunction, oxidative stress and higher sympathetic activity [ 12 ]. COPD is also associated with nocturnal oxygen desaturation, resulting in systemic inflammation, oxidative stress, sympathetic excitation and vascular dysfunction [ 13 ].…”

Editorial: Clinical aspects of obstructive sleep apnea and cardiovascular consequences

“…Thirdly, craniofacial abnormalities that lead to narrow oropharyngeal space such as torus palatinus, torus mandibularis, macroglossia, tonsillar enlargement, microretrognathia, or edentate status are risk factors ( 13 , 14 ). Finally, certain co-morbid diseases may be related to OSA such as hypothyroidism, chronic kidney disease, HIV infection, epilepsy, asthma, chronic obstructive airway disease, acromegaly, and allergic rhinitis ( 15 – 20 ).…”