Polysomnographic variables in Alternate overlap syndrome: data from sleep heart health study

Abstract

Objective: To evaluate influence of asthma on polysomnographic variables of patients with obstructive sleep apnea (OSA). Methods: A longitudinal retrospective study using data collected from the Sleep Heart Health Study (SHHS). Results: All 2822 patients included had OSA, 2599 were non-asthmatic whereas 223 were asthmatics. Average BMI for non-asthmatics was 28.8 kg/m 2 whereas asthmatics had 29.5 kg/ m 2 . Median pack-years of smoking was 1.42 vs. 1.98 in non-asthmatic and asthmatic groups, respectively. Sex distribution, age (in years), BMI, FEV 1 , FVC, AHI ≥ 4% (all apneas, hypopneas with ≥4% oxygen desaturation or arousal per hour of sleep), RDI ≥ 3% (overall respiratory distribution index at ≥3% oxygen desaturation or arousal), sleep latency, percentage of sleep time in apnea/hypopnea and Epworth sleep scale score were all statistically significant. Nonasthmatics had greater AHI (12.63/hr) compared to asthmatics (11.34/hour), p = 0.0015. RDI in non-asthmatics and asthmatics was (23.07 vs 20.53; p = 0.009). Sleep latency was found to be longer in asthmatics 19.8 minutes vs. 16 minutes (p = 0.008). Epworth sleepiness scale score was high in asthmatics (9 vs. 8, p = 0.002). Conclusion: OSA was found more severe in non-asthmatic subgroup, but asthmatics had statistically significant higher Epworth sleepiness scale score and sleep latency. Clinicians should be vigilant and keep low threshold to rule out OSA particularly on patients with difficult to control asthma, smoker, GERD, obese and nasal disease. ARTICLE HISTORY

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

“…In Part A, 13 studies [ 7 – 19 ] examined the effect of OSA on lung function and ACT in asthma with 1,111 subjects (Table 1 ), and 7 studies [ 20 – 26 ] examined the relationship between asthma and varying severity of OSA with 15,266 subjects (Table 2 ). In Part B, 10 studies [ 9 , 22 , 25 , 27 – 33 ] examined the effect of asthma on PSG and ESS in OSA patients with 9,666 subjects (Table 3 ), and 11 studies [ 10 , 13 – 15 , 34 – 40 ] examined the relationship between OSA and varying severity of asthma with 1869 subjects (Table 4 ). Other characteristics of the included studies are presented in each table.…”

“…2018 [ 32 ] Italy N = 241/5337 54.0 (12.2) 33.9 (8.4) 80.9 N/A Cross-sectional, AHRQ = 8 AHI ≥ 30/h Routine AHI, LSpO 2 , ODI, ESS The overall risk of physician-diagnosed asthma was around 5%, with the expected higher risk in women compared with men. The risk of asthma was highest in OSA-free subjects, with a tendency to progressively decrease with increasing OSA severity Sundbom et al 2018 [ 33 ] Sweden N = 15/109 55.6 (9.7) 28.8 (8.5) 0 N = 4/38 δ Cross-sectional, AHRQ = 5 AHI ≥ 15/h Routine AHI, ODI, T90% Co-exist asthma and OSA are associated with poorer sleep quality and more profound nocturnal hypoxemia than either of the conditions alone Shrestha et al 2019 [ 34 ] Curacao N = 223/2599 66.0 (11.9) 29.0 (4.8) 59.4 Asthma group 1.42 pack year § Non-asthma group 1.88 pack year § Cross-sectional, AHRQ = 7 AHI ≥ 5/h Routine AHI, ArI, T90%, ESS OSA was more severe in a non-asthmatic subgroup, and asthmatics had statistically significant higher ESS scores and sleep latency Antonaglia et al 2022 [ 35 ] Italy N = 35/36 62.0 (11.0) 31.2 (14.7) 73.2 N/A Cross-sectional, AHRQ = 8 AHI ≥ 5/h Routine AHI ESS …”

The Association between Asthma and OSA in Children

“…Both OSA and asthma in children can be described by parents as having labored breathing during sleep, persistent snoring, nocturnal cough, and restless sleep. Asthma and OSA can also present with excessive daytime sleepiness and fatigue from fragmented sleep [ 43 , 44 ]. Some of the symptoms that are treated as asthma may be symptoms of OSA.…”

“…One study in adults showed that the combination of asthma and OSA was associated with lower mean oxygen saturation, especially in REM sleep [ 45 , 46 ]. The combination of asthma and OSA was also associated with shorter sleep time, longer sleep latency, and longer sleep time in stage 1 and stage 2 but decreased percentage of time spent in sleep stage 3 and REM [ 43 , 44 , 47 ].…”